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Sagastume D, Peñalvo JL, Ramírez-Zea M, Polman K, Beňová L. Dynamics of the double burden of malnutrition in Guatemala: a secondary data analysis of the demographic and health surveys from 1998-2015. Public Health 2024; 229:135-143. [PMID: 38442595 DOI: 10.1016/j.puhe.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/08/2024] [Accepted: 01/31/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE We estimated the prevalence and time trends of the double burden of malnutrition (DBM) in Guatemala and explored its occurrence based on socio-demographic factors. STUDY DESIGN This was a secondary data analysis using information from four Demographic and Health Surveys covering the period 1998-2015. METHODS The unit of analysis was the household within which information was gathered from women 18-49 years and their children, 6-59 months. The main outcome was the prevalence of any DBM in the household (co-existence of undernutrition and overnutrition in a woman, her children or both). We estimated the prevalence of any DBM by survey and analysed time trends. Stepwise logistic regression was used to explore the occurrence of DBM and socio-demographic factors. RESULTS We analysed 39,749 households across all surveys. The prevalence of any DBM was 25.3% (95%CI: 22.1-28.7) in 1998-99, 23.8% (22.0-25.8) in 2002, 25.9% (24.3-27.5) in 2008-09 and 24.2% (22.9-25.5) in 2014-15, with no significant change over time (P = 0.782). Characteristics associated with lower odds of any DBM were rural residence, female-headed household, wealth and women's secondary education. Higher odds were seen for households with electricity, women >25y, indigenous and with >2 children. CONCLUSION Our findings revealed that a quarter of Guatemala's households suffer from DBM, which has remained unchanged for 17 years. Interventions should prioritise urban areas, households of lower socio-economic status and those less educated. To increase awareness of policymakers of this pressing public health concern, further research on DBM could be strengthened by prospective study designs, integrating all household members and expanding the types of malnutrition.
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Affiliation(s)
- D Sagastume
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; Global Health Institute, University of Antwerp, Wilrijk, Belgium.
| | - J L Peñalvo
- Global Health Institute, University of Antwerp, Wilrijk, Belgium; National Center for Epidemiology, Carlos III Institute of Health (ISCIII), Madrid, Spain
| | - M Ramírez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - K Polman
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; Department of Health Sciences, Vrije Universiteit (VU) Amsterdam, the Netherlands
| | - L Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Sagastume D, Barrenechea-Pulache A, Ruiz-Alejos A, Polman K, Beňová L, Ramírez-Zea M, Peñalvo JL. Quantifying Overlapping Forms of Malnutrition Across Latin America: A Systematic Literature Review and Meta-Analysis of Prevalence Estimates. Adv Nutr 2024; 15:100212. [PMID: 38493876 PMCID: PMC11015105 DOI: 10.1016/j.advnut.2024.100212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/07/2024] [Accepted: 03/05/2024] [Indexed: 03/19/2024] Open
Abstract
Estimating the prevalence of double burden of malnutrition (DBM) is challenging in the Latin American and Caribbean (LAC) region where various DBM typologies (e.g., obesity and stunting) are heterogeneous and estimates are scattered across literature This study aimed to assess the prevalence of DBM typologies in the LAC region. We searched PubMed, Embase, Scopus, and Web of Science to identify studies on the prevalence of DBM published between 1 January, 2000, and 23 January, 2023. Outcomes were the prevalence of the identified DBM typologies at the household, individual, or across life course levels. Random-effect meta-analyses of proportions were used to estimate pooled period prevalence for all outcomes. Heterogeneity was explored using meta-regressions. From 754 records identified, 60 (8%) studies were eligible, with a median of 4379 individuals. Studies reported data from 27 LAC countries collected between 1988 and 2017. Most studies used nationally representative surveys (68%) and scored as low risk of bias (70%). We identified 17 DBM typologies for which 360 estimates were analyzed. The prevalence of the identified DBM typologies ranged between 0% and 24%, with the DBM typology of "adult with overweight and child with anemia" having the highest prevalence (24.3%; 95% CI: 18.8%, 30.2%). The most frequently reported DBM typology was "adult with overweight and child with stunting," with a prevalence of 8.5% (95% CI: 7.7, 9.3). All prevalences carried large heterogeneity (I2>90%), modestly explained by subregions and countries. DBM across the life course could not be estimated owing to insufficient estimates. In conclusion, using available data, our study suggests that the burden of DBM in the LAC region ranges between 0% and 24%. In the most frequent DBM typologies, overweight was a common contributor. Substantial progress can be made in curbing the burden of DBM in the LAC region through strategies addressing excess weight within these population groups. This study was registered at PROSPERO as CRD42023406755.
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Affiliation(s)
- Diana Sagastume
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; Global Health Institute, University of Antwerp, Wilrijk, Belgium.
| | | | | | - Katja Polman
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; Department of Health Sciences, Vrije Universiteit (VU) Amsterdam, Netherlands
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Manuel Ramírez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - José L Peñalvo
- Global Health Institute, University of Antwerp, Wilrijk, Belgium; National Center for Epidemiology, Carlos III Institute of Health (ISCIII), Madrid, Spain
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Wellmann IA, Ayala LF, Rodríguez JJ, Guetterman TC, Irazola V, Palacios E, Huffman MD, Rohloff P, Heisler M, Ramírez-Zea M, Flood D. Implementing integrated hypertension and diabetes management using the World Health Organization's HEARTS model: protocol for a pilot study in the Guatemalan national primary care system. Implement Sci Commun 2024; 5:7. [PMID: 38195600 PMCID: PMC10775666 DOI: 10.1186/s43058-023-00539-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/07/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND The HEARTS technical package was developed by the World Health Organization to address the implementation gap in cardiovascular disease prevention in low- and middle-income countries. Guatemala is a middle-income country that is currently implementing HEARTS. National authorities in Guatemala are interested in exploring how hypertension and diabetes management can be integrated in HEARTS implementation. The objective of this study is to conduct a feasibility and acceptability pilot trial of integrated hypertension and diabetes management based on HEARTS in the publicly funded primary care system in Guatemala. METHODS A single-arm pilot trial for 6 months will be carried out in 11 Ministry of Health primary care facilities starting in September 2023. A planned sample of 100 adult patients diagnosed with diabetes (n = 45), hypertension (n = 45), or both (n = 10) will be enrolled. The intervention will consist of HEARTS-aligned components: Training health workers on healthy-lifestyle counseling and evidence-based treatment protocols, strengthening access to medications and diagnostics, training on risk-based cardiovascular disease management, team-based care and task sharing, and systems monitoring and feedback, including implementation of a facility-based electronic monitoring tool at the individual level. Co-primary outcomes of feasibility and acceptability will be assessed using an explanatory sequential mixed-methods design. Secondary outcomes include clinical effectiveness (treatment with medication, glycemic control, and blood pressure control), key implementation outcomes (adoption, fidelity, usability, and sustainability), and patient-reported outcome measures (diabetes distress, disability, and treatment burden). Using an implementation mapping approach, a Technical Advisory Committee will develop implementation strategies for subsequent scale-up planning. DISCUSSION This trial will produce evidence on implementing HEARTS-aligned hypertension and diabetes care in the MOH primary care system in Guatemala. Results also will inform future HEARTS projects in Guatemala and other low- and middle-income countries. TRIAL REGISTRATION ClinicalTrials.gov ID NCT06080451. The trial was prospectively registered on October 12, 2023.
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Affiliation(s)
- Irmgardt Alicia Wellmann
- Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Luis Fernando Ayala
- Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - José Javier Rodríguez
- Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | | | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Eduardo Palacios
- National Program for the Prevention of Chronic Non-Communicable Diseases and Cancer, Ministry of Health, Guatemala City, Guatemala
| | - Mark D Huffman
- Department of Medicine and Global Health Center, Washington University in St. Louis, St. Louis, MO, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Peter Rohloff
- Center for Indigenous Health Research, Wuqu' Kawoq, Tecpán, Guatemala
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Manuel Ramírez-Zea
- Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - David Flood
- Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala.
- Center for Indigenous Health Research, Wuqu' Kawoq, Tecpán, Guatemala.
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA.
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Alemán-Mateo H, López-Teros MT, Pallaro AN, Márquez C, Guzmán EMQ, Ramírez-Zea M, Sánchez MED, Umpiérrez E, Moirano M, Badaloo A, O'Donnell AR, Murphy-Alford AJ, Ferrioli E. Assessment of the performance of the body mass index in diagnosing obesity in community-dwelling older adults in Latin American and Caribbean countries. Arch Gerontol Geriatr 2024; 116:105170. [PMID: 37659347 DOI: 10.1016/j.archger.2023.105170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/19/2023] [Accepted: 08/24/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND The body mass index (BMI) ≥30 kg/m2 is the universally accepted cut-off point for defining obesity; however, its accuracy in classifying obesity in older adults is poorly understood. OBJECTIVES To assess the performance of the BMI cut-off point ≥30 kg/m2 in classifying obesity in older adults, using the fat mass index (FMI) and fat mass percentage (FM%) as reference criteria; and to establish region- and sex-specific BMI-based cut-off points to classify obesity in older adults. METHODS The present study is a secondary analysis derived from a cross-sectional project that included a sample of 1463 older adults from ten Latin American and Caribbean countries. Volunteers underwent total body water measurements using the deuterium dilution technique to determine FMI and FM%. Accuracy of the BMI and derived cutoff points was assessed by the area under the receiver operating characteristic curve (AUC). RESULTS The BMI cut-off point ≥30 kg/m2 had low sensitivity for classifying obesity in these older adults compared to the FMI and FM%. The AUC values for the optimal BMI-derived cut-off points showed an acceptable-to-outstanding discriminatory capacity in diagnosing obesity defined by the FMI. There was also a better balance between sensitivity and specificity than with the values obtained by a BMI ≥30 kg/m2 in older subjects in both regions. CONCLUSION The BMI cut-off point ≥30 kg/m2 had poor sensitivity for accurately diagnosing obesity in older adults from two regions. The region- and sex-specific BMI-derived cut-off points for defining obesity using the FMI are more accurate in classifying obesity in older men and women subjects from both regions.
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Affiliation(s)
- Heliodoro Alemán-Mateo
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo (CIAD), A.C., Carretera Gustavo Enrique Astiazarán Rosas, No. 46, Col. La Victoria, C.P. 83304, Hermosillo, Sonora, México.
| | - Miriam T López-Teros
- Departamento de Salud, Universidad Iberoamericana, Ciudad de México, Prolongación Paseo de Reforma 880, Lomas de Santa Fe, C.P. 01219, Ciudad de México, Distrito Federal, México
| | - Anabel Nora Pallaro
- Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Junin 956, 2 piso 1113 Buenos Aires, Argentina
| | - Carlos Márquez
- Instituto de Nutrición y Tecnología de los Alimentos. El Libano 5724 Casilla 138-11, Santiago, Chile
| | - Eugenia María Quintana Guzmán
- Facultad de Microbiología, Universidad de Costa Rica, Ciudad Universitaria Rodrigo Facio, San Pedro, Montes de Oca San José, Costa Rica
| | - Manuel Ramírez-Zea
- Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - María Elena Díaz Sánchez
- Centro de Nutrición e Higiene de los Alimentos, Instituto Nacional de Higiene, Epidemiología y Microbiología, Ministerio de Salud Pública, Apartado Postal Habana 3, Infanta 1158 e/Clavel y Llinás. La Habana 10300, Cuba
| | - Eleuterio Umpiérrez
- Unidad de Medio Ambiente, Drogas y Doping, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Av. General Aparicio Saravia S/N, By pass Ruta 8 y Ruta 101, Pando, Canelones, Uruguay
| | - Marina Moirano
- Escuela de Nutrición, Universidad de la República, Av. Ricaldoni s/n. Montevideo, Uruguay
| | - Asha Badaloo
- Tropical Metabolism Research Unit, Caribbean Institute for Health Research, University of the West Indies, Kingston 7, Jamaica
| | - Ada Rodriguez O'Donnell
- Servicio de Bioquímica, Instituto Nacional de Salud del Niño. Av. Brasil 600, Breña 15083, Perú
| | - Alexia J Murphy-Alford
- Nutritional and Health Related Environmental Studies Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Eduardo Ferrioli
- Department of Internal Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, São Paulo, Brazil
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Kroker-Lobos MF, Morales-Juárez A, Pérez W, Kanda T, Gomes FS, Ramírez-Zea M, Siu-Bermúdez C. Efficacy of front-of-pack warning label system versus guideline for daily amount on healthfulness perception, purchase intention and objective understanding of nutrient content of food products in Guatemala: a cross-over cluster randomized controlled experiment. Arch Public Health 2023; 81:108. [PMID: 37328782 PMCID: PMC10273755 DOI: 10.1186/s13690-023-01124-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/30/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Front-of-package warning labels (FOPWL) have been adopted in many countries aiming at reducing the consumption of unhealthy food and drink products and have also been considered in Guatemala. The aim of the study is to evaluate the efficacy of FOPWL versus Guidelines for Daily Amount (GDA) on products' healthfulness perception (HP), purchase intention (PI) and the objective understanding of the nutrient content (UNC) in Guatemala. METHODS Participants (children and adults) (n = 356) were randomly assigned to evaluate either FOPWL or GDA during a crossover cluster randomized experiment in rural and urban areas across 3 phases of exposure. During phase 1, participants evaluated mock-up images of single products (single task) and compared pairs of products within the same food category (comparison task) without any label. In phase 2, participants evaluated labels only (without any product), and during phase 3, they evaluated the same products and questions from phase 1, now depicting the assigned front-of-package label. We generated indicators for single-task questions and scores for comparison tasks, one for each HP, PI and UNC questions. We used intention-to-treat, difference-in-difference regression analysis to test whether exposure to FOPWL was associated with HP, PI and UNC, compared to GDA. We also tested models for children and adults and by area (rural/urban) separately adjusting for sociodemographic variables. RESULTS In single tasks, FOPWL significantly decreased the PI (β -18.1, 95%CI -23.3, -12.8; p < 0.001) and the HP (β -13.2, 95%CI -18.4, -7.9; p < 0.001) of unhealthy food products compared to GDA. In the comparison task, FOPWL significantly increased the UNC (β 20.4, 95%CI 17.0, 23.9; p < 0.001), improved PI towards healthier choices (OR 4.5, 95%CI 2.9, 7.0 p < 0.001) and HP (OR 5.6, 95%CI 2.8, 11.1; p < 0.001) compared to GDA. Similar results were found in children and adults and in urban and rural settings. CONCLUSIONS FOPWL reduces products' healthfulness perception and purchase intention, and increases understanding of products' nutrient content compared to GDA.
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Affiliation(s)
- María Fernanda Kroker-Lobos
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Calzada Roosevelt 6-25 zona 11, Guatemala City, Guatemala.
| | - Analí Morales-Juárez
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Calzada Roosevelt 6-25 zona 11, Guatemala City, Guatemala
| | - Wilton Pérez
- INCAP Unit Planning, Institute of Nutrition of Central America and Panama, Calzada Roosevelt 6-25 zona 11, Guatemala City, Guatemala
| | - Tomo Kanda
- Pan American Health Organization/World Health Organization, Diagonal 6 10-50 zona 10, Guatemala City, Guatemala
| | - Fabio S Gomes
- Pan American Health Organization/World Health Organization, 525 23rd St NW, 20037, Washington, DC, USA
| | - Manuel Ramírez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Calzada Roosevelt 6-25 zona 11, Guatemala City, Guatemala
| | - Carolina Siu-Bermúdez
- INCAP Unit Planning, Institute of Nutrition of Central America and Panama, Calzada Roosevelt 6-25 zona 11, Guatemala City, Guatemala.
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Morales-Juárez A, Monterrubio E, Cosenza-Quintana EL, Zamora I, Jensen ML, Vandevijvere S, Ramírez-Zea M, Kroker-Lobos MF. Unhealthy food advertising on Costa Rican and Guatemalan television: a comparative study. Health Promot Int 2023; 38:7162645. [PMID: 37184579 DOI: 10.1093/heapro/daad028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
This study aimed to exhaustively explore the characteristics of food advertising on TV in Guatemala and Costa Rica. The International Network for Food and Obesity Non-Communicable Diseases (NCDs) Research, Monitoring and Action Support (INFORMAS) methodology was applied. In 2016, we recorded 1440 h of video among 10 TV channels. We used the Pan American Health Organization (PAHO) Nutrient Profile (NP) Model to identify 'critical nutrients', whose excessive consumption is associated with NCDs. We created a nutritional quality score (0 if the product did not exceed any critical nutrient, 1 if the product exceeded one and 2 if it exceeded ≥2). We classified food ads as permitted (score = 0) and not-permitted (score 1 or 2) for marketing. Persuasive marketing techniques were classified as promotional characters (e.g. Batman), premium offers (e.g. toys), brand benefit claims (e.g. tasty) and health-related claims (e.g. nutritious). In Guatemala, foods that exceeded one critical nutrient were more likely to use persuasive marketing techniques, and in Costa Rica were those with an excess of ≥2 critical nutrients, compared with foods without any excess in critical nutrients [Guatemala: promotional characters (odds ratio, OR = 16.6, 95% confidence interval, CI: 5.8, 47.3), premium offers (OR = 3.4, 95% CI: 1.4, 8.2) and health-related claims (OR = 3.5, 95% CI: 2.2, 5.7); Costa Rica: health-related claims (OR = 4.2, 95% CI: 2.0, 8.5)]. In conclusion, Guatemalan and Costa Rican children are exposed to an overabundance of not-permitted food ads on TV. This justifies implementing national policies to reduce exposure to not-permitted food for marketing, including on TV and other media.
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Affiliation(s)
- Analí Morales-Juárez
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Eric Monterrubio
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Emma Lucia Cosenza-Quintana
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Irina Zamora
- School of Public Health, University of Costa Rica, San José, Costa Rica
| | - Melissa L Jensen
- School of Nutrition, University of Costa Rica, San José, Costa Rica
| | - Stefanie Vandevijvere
- Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Manuel Ramírez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Maria Fernanda Kroker-Lobos
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
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Smith JW, Ng DK, Alvarez CS, Egner PA, Burke SM, Chen JG, Kensler TW, Koshiol J, Rivera-Andrade A, Kroker-Lobos MF, Ramírez-Zea M, McGlynn KA, Groopman JD. Assessing the Validity of Normalizing Aflatoxin B1-Lysine Albumin Adduct Biomarker Measurements to Total Serum Albumin Concentration across Multiple Human Population Studies. Toxins (Basel) 2022; 14:toxins14030162. [PMID: 35324659 PMCID: PMC8954427 DOI: 10.3390/toxins14030162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 01/12/2023] Open
Abstract
The assessment of aflatoxin B1 (AFB1) exposure using isotope-dilution liquid chromatography-mass spectrometry (LCMS) of AFB1-lysine adducts in human serum albumin (HSA) has proven to be a highly productive strategy for the biomonitoring of AFB1 exposure. To compare samples across different individuals and settings, the conventional practice has involved the normalization of raw AFB1-lysine adduct concentrations (e.g., pg/mL serum or plasma) to the total circulating HSA concentration (e.g., pg/mg HSA). It is hypothesized that this practice corrects for technical error, between-person variance in HSA synthesis or AFB1 metabolism, and other factors. However, the validity of this hypothesis has been largely unexamined by empirical analysis. The objective of this work was to test the concept that HSA normalization of AFB1-lysine adduct concentrations effectively adjusts for biological and technical variance and improves AFB1 internal dose estimates. Using data from AFB1-lysine and HSA measurements in 763 subjects, in combination with regression and Monte Carlo simulation techniques, we found that HSA accounts for essentially none of the between-person variance in HSA-normalized (R2 = 0.04) or raw AFB1-lysine measurements (R2 = 0.0001), and that HSA normalization of AFB1-lysine levels with empirical HSA values does not reduce measurement error any better than does the use of simulated data (n = 20,000). These findings were robust across diverse populations (Guatemala, China, Chile), AFB1 exposures (105 range), HSA assays (dye-binding and immunoassay), and disease states (healthy, gallstones, and gallbladder cancer). HSA normalization results in arithmetic transformation with the addition of technical error from the measurement of HSA. Combined with the added analysis time, cost, and sample consumption, these results suggest that it may be prudent to abandon the practice of normalizing adducts to HSA concentration when measuring any HSA adducts—not only AFB1-lys adducts—when using LCMS in serum/plasma.
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Affiliation(s)
- Joshua W. Smith
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (J.W.S.); (P.A.E.); (S.M.B.); (T.W.K.)
| | - Derek K. Ng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Christian S. Alvarez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA; (C.S.A.); (J.K.); (K.A.M.)
| | - Patricia A. Egner
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (J.W.S.); (P.A.E.); (S.M.B.); (T.W.K.)
| | - Sean M. Burke
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (J.W.S.); (P.A.E.); (S.M.B.); (T.W.K.)
| | - Jian-Guo Chen
- Department of Epidemiology, Qidong Liver Cancer Institute, Qidong 226200, China;
| | - Thomas W. Kensler
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (J.W.S.); (P.A.E.); (S.M.B.); (T.W.K.)
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Jill Koshiol
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA; (C.S.A.); (J.K.); (K.A.M.)
| | - Alvaro Rivera-Andrade
- Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City 1188, Guatemala; (A.R.-A.); (M.F.K.-L.); (M.R.-Z.)
| | - María F. Kroker-Lobos
- Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City 1188, Guatemala; (A.R.-A.); (M.F.K.-L.); (M.R.-Z.)
| | - Manuel Ramírez-Zea
- Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City 1188, Guatemala; (A.R.-A.); (M.F.K.-L.); (M.R.-Z.)
| | - Katherine A. McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA; (C.S.A.); (J.K.); (K.A.M.)
| | - John D. Groopman
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (J.W.S.); (P.A.E.); (S.M.B.); (T.W.K.)
- Correspondence:
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8
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He S, Le NA, Ramírez-Zea M, Martorell R, Narayan KMV, Stein AD. Metabolic flexibility differs by body composition in adults. Clin Nutr ESPEN 2021; 46:372-379. [PMID: 34857223 DOI: 10.1016/j.clnesp.2021.09.730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/02/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND & AIMS With the rise of global cardiometabolic diseases, it is important to investigate risk factors such as obesity. Metabolic flexibility, the ability to maintain metabolic homeostasis following an acute challenge, can reflect cardiometabolic health. We investigated the association between body composition and the metabolic flexibility following meal consumption in an adult population. METHODS In this study of 1027 participants (mean age 44.0 y ± SD 4.2 y), we administered a mixed-macronutrient meal challenge. Fasting and 2-h postprandial plasma were assayed for lipids, glycemic, and inflammation biomarkers. We characterized metabolic flexibility through meal-induced biomarker responses (%Δ, the difference between postprandial and fasting concentrations, divided by fasting concentration). We then compared the responses by sex-specific tertiles of body mass index (BMI) and percent body fat. RESULTS With every unit (kg/m2) increase in BMI, %Δ (95% confidence interval) increased by 0.17% (0.09, 0.26%) for total cholesterol, 0.31% (0.07, 0.54%) for triglycerides, and 0.11% (0.01, 0.20%) for apoA-I, whereas insulin elevation was reduced (-6.30%; -8.41, -4.20%), and the reduction in leptin was attenuated (0.64%; 0.25, 1.05%). With each unit (percent) increase in body fat, we observed similar changes in the %Δ of total cholesterol and leptin but not in triglycerides, apoA-I, or insulin. Glucose response increased by 0.29% (0.06, 0.51%) as body fat increases by one unit. CONCLUSION Metabolic flexibility, as assessed by biomarker responses to an acute physiological meal challenge, differed by body composition. These findings may help elucidate the pathways through which obesity contributes to cardiometabolic diseases.
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Affiliation(s)
- Siran He
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA
| | - Ngoc-Anh Le
- Biomarker Core Laboratory, Foundation for Atlanta Veterans Education and Research (FAVER), Atlanta Veterans Affairs Health Care System (AVAHCS), Atlanta, GA, USA
| | - Manuel Ramírez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | | | | | - Aryeh D Stein
- Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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9
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Ramírez-Luzuriaga MJ, Ochaeta L, Ramírez-Zea M, DiGirolamo A, Waford R, Wray C, Martorell R, Stein AD. Cognitive and socio-emotional correlates of psychological well-being and mental health in Guatemalan adults. BMC Psychol 2021; 9:148. [PMID: 34556179 PMCID: PMC8459534 DOI: 10.1186/s40359-021-00654-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 09/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about associations of psychological and mental well-being with cognitive and socioemotional factors in low and middle-income countries, particularly among vulnerable populations born in adverse environments that may restrict developmental potential. This study aimed to examine the cognitive and socioemotional correlates of psychological well-being and mental health in a cohort of Guatemalan adults born in contexts of poverty and malnutrition. METHODS From Dec 2017 to Apr 2019, data were collected from 704 women and 564 men ages 40-57 years living in four rural villages in eastern Guatemala and Guatemala City. We measured latent domains of psychological well-being, spirituality and religion, emotional support, and executive function using Confirmatory Factor Analysis (CFA). Under a Structural Equation Modeling framework, we examined intercorrelations among latent domains and observed measures of intelligence and mental health. RESULTS CFA supported the construct validity of factor structures in this population. Correlations of psychological well-being with spirituality and religion were moderate in women (r = 0.68, p < 0.001) and men (r = 0.70, p < 0.001). Executive function was weakly correlated with psychological well-being in men (r = 0.23, p < 0.001) and showed no association in women. Correlations of psychological well-being with emotional support and IQ were weak in women (r = 0.34, and r = 0.15, respectively; p < 0.001 for both) and men (r = 0.35, and r = 0.25, respectively; p < 0.001 for both). Mental health and IQ were weakly correlated in men (r = 0.09, p < 0.05) and showed no association in women. Mental health showed weak correlations with emotional support (r = 0.18, p < 0.001 in women; r = 0.09, p < 0.05 in men), psychological well-being (r = 0.32 and r = 0.35, in women and men respectively; p < 0.001 for both) and showed no association with executive function in both sexes. CONCLUSIONS Of all examined factors, spirituality and religion made the greatest contribution to psychological well-being. These findings support the notion that in populations experiencing difficult circumstances, religion can perhaps make a greater contribution to well-being and aid coping. More research is needed to examine mediators of this association.
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Affiliation(s)
- María J Ramírez-Luzuriaga
- Nutrition and Health Science Program, Laney Graduate School, Emory University, 1518 Clifton Rd NE, 30322, Atlanta, GA, USA
| | - Laura Ochaeta
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Manuel Ramírez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Ann DiGirolamo
- Georgia Health Policy Center, Georgia State University, Atlanta, GA, USA
| | - Rachel Waford
- Nutrition and Health Science Program, Laney Graduate School, Emory University, 1518 Clifton Rd NE, 30322, Atlanta, GA, USA.,Hubert Department of Global Health, Rollins School of Public Health Emory University, Atlanta, GA, USA
| | - Charlotte Wray
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Reynaldo Martorell
- Nutrition and Health Science Program, Laney Graduate School, Emory University, 1518 Clifton Rd NE, 30322, Atlanta, GA, USA.,Hubert Department of Global Health, Rollins School of Public Health Emory University, Atlanta, GA, USA
| | - Aryeh D Stein
- Nutrition and Health Science Program, Laney Graduate School, Emory University, 1518 Clifton Rd NE, 30322, Atlanta, GA, USA. .,Hubert Department of Global Health, Rollins School of Public Health Emory University, Atlanta, GA, USA.
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10
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Alvarez CS, Hernández E, Escobar K, Villagrán CI, Kroker-Lobos MF, Rivera-Andrade A, Smith JW, Egner PA, Lazo M, Freedman ND, Guallar E, Dean M, Graubard BI, Groopman JD, Ramírez-Zea M, McGlynn KA. Aflatoxin B 1 exposure and liver cirrhosis in Guatemala: a case-control study. BMJ Open Gastroenterol 2021; 7:bmjgast-2020-000380. [PMID: 32641287 PMCID: PMC7342465 DOI: 10.1136/bmjgast-2020-000380] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 02/07/2023] Open
Abstract
Objective In Guatemala, cirrhosis is among the 10 leading causes of death, and mortality rates have increased lately. The reasons for this heavy burden of disease are not clear as the prevalence of prominent risk factors, such as hepatitis B virus, hepatitis C virus and heavy alcohol consumption, appears to be low. Aflatoxin B1 (AFB1) exposure, however, appears to be high, and thus could be associated with the high burden of cirrhosis. Whether AFB1 increases the risk of cirrhosis in the absence of viral infection, however, is not clear. Design Cirrhosis cases (n=100) from two major referral hospitals in Guatemala City were compared with controls (n=200) from a cross-sectional study. Logistic regression was used to estimate the ORs and 95% CIs of cirrhosis and quintiles of AFB1 in crude and adjusted models. A sex-stratified analysis was also conducted. Results The median AFB1 level was significantly higher among the cases (11.4 pg/mg) than controls (5.11 pg/mg). In logistic regression analyses, higher levels of AFB1 was associated with cirrhosis (quintile 5 vs quintile 1, OR: 11.55; 95% CI 4.05 to 32.89). No attenuation was observed with adjustment by sex, ethnicity, hepatitis B virus status, and heavy alcohol consumption. A significantly increasing trend in association was observed in both models (p trend <0.01). Additionally, the cirrhosis–AFB1 association was more prominent among men. Conclusions The current study found a significant positive association between AFB1 exposure and cirrhosis. Mitigation of AFB1 exposure and a better understanding of additional risk factors may be important to reduce the burden of cirrhosis in Guatemala.
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Affiliation(s)
- Christian S Alvarez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Elisa Hernández
- Centro de Investigaciones Biomédicas, Facultad de Ciencias Médicas, Universidad de San Carlos de Guatemala, Guatemala, Guatemala
| | - Kira Escobar
- Centro de Investigaciones Biomédicas, Facultad de Ciencias Médicas, Universidad de San Carlos de Guatemala, Guatemala, Guatemala
| | - Carmen I Villagrán
- Centro de Investigaciones Biomédicas, Facultad de Ciencias Médicas, Universidad de San Carlos de Guatemala, Guatemala, Guatemala
| | - María F Kroker-Lobos
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala, Guatemala
| | - Alvaro Rivera-Andrade
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala, Guatemala
| | - Joshua W Smith
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Patricia A Egner
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mariana Lazo
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Eliseo Guallar
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael Dean
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Barry I Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - John D Groopman
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Manuel Ramírez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala, Guatemala
| | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
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11
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Mazariegos M, Auchincloss AH, Braverman-Bronstein A, Kroker-Lobos MF, Ramírez-Zea M, Hessel P, Miranda JJ, Pérez-Ferrer C. Educational inequalities in obesity: a multilevel analysis of survey data from cities in Latin America. Public Health Nutr 2021; 25:1-9. [PMID: 34167613 PMCID: PMC7613035 DOI: 10.1017/s1368980021002457] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 04/19/2021] [Accepted: 06/02/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Using newly harmonised individual-level data on health and socio-economic environments in Latin American cities (from the Salud Urbana en América Latina (SALURBAL) study), we assessed the association between obesity and education levels and explored potential effect modification of this association by city-level socio-economic development. DESIGN This cross-sectional study used survey data collected between 2002 and 2017. Absolute and relative educational inequalities in obesity (BMI ≥ 30 kg/m2, derived from measured weight and height) were calculated first. Then, a two-level mixed-effects logistic regression was run to test for effect modification of the education-obesity association by city-level socio-economic development. All analyses were stratified by sex. SETTING One hundred seventy-six Latin American cities within eight countries (Brazil, Chile, Colombia, Costa Rica, El Salvador, Guatemala, Mexico and Peru). PARTICIPANTS 53 186 adults aged >18 years old. RESULTS Among women, 25 % were living with obesity and obesity was negatively associated with educational level (higher education-lower obesity) and this pattern was consistent across city-level socio-economic development. Among men, 18 % were living with obesity and there was a positive association between education and obesity (higher education-higher obesity) for men living in cities with lower levels of development, whereas for those living in cities with higher levels of development, the pattern was inverted and university education was protective of obesity. CONCLUSIONS Among women, education was protective of obesity regardless, whereas among men, it was only protective in cities with higher levels of development. These divergent results suggest the need for sex- and city-specific interventions to reduce obesity prevalence and inequalities.
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Affiliation(s)
- Mónica Mazariegos
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Amy H Auchincloss
- Department of Epidemiology and Biostatics, Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Ariela Braverman-Bronstein
- Department of Epidemiology and Biostatics, Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - María F Kroker-Lobos
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Manuel Ramírez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Philipp Hessel
- Universidad de los Andes, Alberto Lleras Camargo School of Government, Bogotá, Colombia
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carolina Pérez-Ferrer
- CONACYT – National Institute of Public Health (INSP), Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca, 62100, Mexico
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12
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Flood D, Seiglie JA, Dunn M, Tschida S, Theilmann M, Marcus ME, Brian G, Norov B, Mayige MT, Gurung MS, Aryal KK, Labadarios D, Dorobantu M, Silver BK, Bovet P, Jorgensen JMA, Guwatudde D, Houehanou C, Andall-Brereton G, Quesnel-Crooks S, Sturua L, Farzadfar F, Moghaddam SS, Atun R, Vollmer S, Bärnighausen TW, Davies JI, Wexler DJ, Geldsetzer P, Rohloff P, Ramírez-Zea M, Heisler M, Manne-Goehler J. The state of diabetes treatment coverage in 55 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 680 102 adults. The Lancet Healthy Longevity 2021; 2:e340-e351. [DOI: 10.1016/s2666-7568(21)00089-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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13
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Groopman JD, Smith JW, Rivera-Andrade A, Alvarez CS, Kroker-Lobos MF, Egner PA, Gharzouzi E, Dean M, McGlynn KA, Ramírez-Zea M. Aflatoxin and the Etiology of Liver Cancer and Its Implications for Guatemala. WORLD MYCOTOXIN J 2021; 14:305-317. [PMID: 35096197 PMCID: PMC8797158 DOI: 10.3920/wmj2020.2641] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
During the 60 years since the first scientific reports about a relation between aflatoxin exposure and adverse health consequences, both in animals and humans, there has been a remarkable number of basic, clinical and population science studies characterizing the impact of this mycotoxin on diseases such as liver cancer. Many of these human investigations to date have focused on populations residing in Asia and Africa due to the high incidence of liver cancer and high exposures to aflatoxin. These studies formed the basis for the International Agency for Research on Cancer to classify the aflatoxins as Group 1 known human carcinogens. In addition, aflatoxin contamination levels have been used in international commodity trade to set the price of various staples such as maize and groundnuts. While there have been many case-control and prospective cohort studies of liver cancer risk over the years there have been remarkably few investigations focused on liver cancer in Latin America. Our interdisciplinary and multiple institutional collaborative has been developing a long-term strategy to characterize the role of aflatoxin and other mycotoxins as health risk factors in Guatemala and neighboring countries. This paper summarizes a number of the investigations to date and provides a roadmap of our strategies for the near term to discern the emergent etiology of liver cancer in this region. With these data in hand public health-based prevention strategies could be strategically implemented and conducted to lower the impact of these mycotoxins on human health.
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Affiliation(s)
- John D. Groopman
- Departments of Environmental Health and Engineering and Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, U.S.A
| | - Joshua W. Smith
- Departments of Environmental Health and Engineering and Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, U.S.A
| | - Alvaro Rivera-Andrade
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Christian S. Alvarez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, U.S.A
| | - María F. Kroker-Lobos
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, U.S.A
| | - Patricia A. Egner
- Departments of Environmental Health and Engineering and Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, U.S.A
| | | | - Michael Dean
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, U.S.A
| | - Katherine A. McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, U.S.A
| | - Manuel Ramírez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
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14
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Ramírez-Luzuriaga MJ, DiGirolamo AM, Martorell R, Ramírez-Zea M, Waford R, Stein AD. Influence of enhanced nutrition and psychosocial stimulation in early childhood on cognitive functioning and psychological well-being in Guatemalan adults. Soc Sci Med 2021; 275:113810. [PMID: 33713924 PMCID: PMC8024786 DOI: 10.1016/j.socscimed.2021.113810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/06/2021] [Accepted: 02/27/2021] [Indexed: 11/30/2022]
Abstract
Rationale Early-life nutrition interventions in low and middle-income countries have demonstrated long-term benefits on cognitive skills, however, their influence on socioemotional outcomes has not been fully explored. Moreover, the mediating processes through which nutrition intervention effects operate and are maintained over time are understudied. Methods We followed-up a cohort of Guatemalan adults who participated as children in a community randomized food-supplementation trial. We examined associations of exposure to nutritional supplementation from conception to age 2 years with executive function (measured using three sub-tests of the NIH Toolbox Cognition Battery) and psychological well-being (measured using two sub-scales of the NIH Toolbox Emotion Battery) at ages 40–57 years (n = 1268). We used structural equation modeling to investigate the mediating role of psychosocial stimulation (measured in childhood using parent reports and ratings of home environments), cognitive ability (measured at ages 26–42 years using standardized tests), and executive function on the association of early-life exposure to nutritional supplementation with adult psychological well-being (n = 1640). Results We found positive but inconsistent associations of nutritional supplementation in childhood with executive function and psychological well-being in adulthood. Psychosocial stimulation, cognitive ability, and executive function did not mediate the association of early-life nutritional supplementation with adult psychological well-being. We found strong and positive associations of psychosocial stimulation in childhood with cognitive ability, executive function, and psychological well-being in adulthood. Moreover, we observed no interaction of exposure to nutritional supplementation and psychosocial stimulation in childhood with cognitive and psychological well-being outcomes in adulthood. Conclusion Our findings suggest that childhood nutrition interventions have long-lasting effects on cognitive ability and psychological well-being outcomes. We assess the influence of early-life nutrition on neurodevelopmental outcomes. We use a theoretical approach to examine mediators of the association. We found no mediators of the association of early-life nutrition with adult psychological well-being. Psychosocial stimulation is strongly associated with neurodevelopmental outcomes. Improved child nutrition is positively associated with adult psychological well-being.
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Affiliation(s)
- María J Ramírez-Luzuriaga
- Nutrition and Health Science Program, Laney Graduate School, Emory University, 201 Dowman Drive, Atlanta, GA, 30322, USA
| | - Ann M DiGirolamo
- Georgia Health Policy Center, Georgia State University, 55 Park Place NE, Eighth Floor, Park Pl NE, Atlanta, GA, 30303, USA
| | - Reynaldo Martorell
- Nutrition and Health Science Program, Laney Graduate School, Emory University, 201 Dowman Drive, Atlanta, GA, 30322, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, 201 Dowman Drive, Atlanta, GA, 30322, USA
| | - Manuel Ramírez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Calzada Roosevelt 6-25 zona 11, Guatemala City, Guatemala
| | - Rachel Waford
- Nutrition and Health Science Program, Laney Graduate School, Emory University, 201 Dowman Drive, Atlanta, GA, 30322, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, 201 Dowman Drive, Atlanta, GA, 30322, USA
| | - Aryeh D Stein
- Nutrition and Health Science Program, Laney Graduate School, Emory University, 201 Dowman Drive, Atlanta, GA, 30322, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, 201 Dowman Drive, Atlanta, GA, 30322, USA.
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15
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Ramírez-Luzuriaga MJ, Hoddinott JF, Martorell R, Ramírez-Zea M, Stein AD. Early-Life Nutrition and Subsequent International Migration: A Prospective Study in Rural Guatemala. J Nutr 2020; 151:716-721. [PMID: 33382427 PMCID: PMC7948204 DOI: 10.1093/jn/nxaa379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/21/2020] [Accepted: 11/04/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is generally accepted that migrants are favorably self-selected for labor market skills such as higher schooling and greater cognitive capacity, which are highly correlated with early-life nutrition. However, the influence of early-life nutrition on later-life migration is understudied. OBJECTIVE The objective of this study was to examine prospectively the association between height-for-age z scores (HAZ) at 24 mo and subsequent international migration in a cohort of 2392 participants born between 1962 and 1977 in 4 rural villages in eastern Guatemala. METHODS Information on nutritional status and covariates was collected between 1969 and 1977 and migration status was determined as of 2017 (at ages 40-57 y). We used proportional hazards and logistic regression models to assess whether HAZ was associated with international migration, adjusting for early-life and adult characteristics. RESULTS Between 1978 and 2017 there were 297 international migrants (12.4% of the original cohort) during 99,212 person-y of follow-up. In pooled models that were adjusted for early-life characteristics, a 1-SD increase in HAZ was associated with a 19% increase in the risk of international migration (HR: 1.19; 95% CI: 1.02, 1.38). Further adjustment for village characteristics did not alter the estimate substantively (HR: 1.18; 95% CI: 1.02, 1.37), while additional adjustment for schooling attainment attenuated the estimate somewhat (HR: 1.14; 95% CI: 0.98, 1.33). In all models, effect sizes were stronger for men than for women. CONCLUSIONS Our results indicate that early-life nutrition is positively associated with subsequent international migration.
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Affiliation(s)
| | - John F Hoddinott
- Division of Nutritional Sciences and Charles H. Dyson School of Applied Economics and Management, Cornell University, Ithaca, NY, USA
| | - Reynaldo Martorell
- Nutrition and Health Science Program, Laney Graduate School, Emory University, Atlanta, GA, USA,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Manuel Ramírez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
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16
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Alvarez CS, Florio AA, Butt J, Rivera-Andrade A, Kroker-Lobos MF, Waterboer T, Camargo MC, Freedman ND, Graubard BI, Lazo M, Guallar E, Groopman JD, Ramírez-Zea M, McGlynn KA. Associations between Helicobacter pylori with nonalcoholic fatty liver disease and other metabolic conditions in Guatemala. Helicobacter 2020; 25:e12756. [PMID: 33006810 PMCID: PMC7688101 DOI: 10.1111/hel.12756] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Previous studies have suggested an association between Helicobacter pylori (H pylori) and nonalcoholic fatty liver disease (NAFLD). The aim of the current study was to examine the association in Guatemala, a region with elevated prevalences of both H pylori and NAFLD. Associations between H pylori and other metabolic conditions were also examined, as were associations between H hepaticus and H bilis and the metabolic conditions. MATERIALS & METHODS The analysis included 424 participants from a cross-sectional study in Guatemala. H pylori seropositivity was defined as positivity for ≥ 4 antigens. Seropositivities for H bilis and H hepaticus were defined as positivity for ≥ 2 antigens. NAFLD was estimated using the Fatty Liver Index and the Hepatic Steatosis Index. Other conditions examined were obesity, central obesity, hypercholesterolemia, low HDL, diabetes and metabolic syndrome (MetSyn). Prevalence odds ratios (POR) and 95% confidence intervals (CIs) were estimated. RESULTS No overall associations between H pylori,H hepaticus, or H bilis and NAFLD or related metabolic conditions were found. Seropositivity for H pylori antigens CagA and VacA and H hepaticus antigen HH0713 was each significantly associated with NAFLD, however. In addition, associations were observed between the H pylori antigens HyuA, HP1564, and UreA and specified metabolic conditions. CONCLUSIONS While no overall associations between H pylori or Helicobacter species with NAFLD or related conditions were observed, some selected Helicobacter spp. antigens were associated with NAFLD. Further research is warranted to examine whether H. species are associated with any metabolic condition.
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Affiliation(s)
- Christian S. Alvarez
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Rockville, Maryland, U.S.A
| | - Andrea A. Florio
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Rockville, Maryland, U.S.A
| | - Julia Butt
- Infections and Cancer Epidemiology, Infection,
Inflammation and Cancer Research Program, German Cancer Research Center (DKFZ),
Heidelberg, Germany
| | - Alvaro Rivera-Andrade
- Research Center for the Prevention of Chronic
Diseases, Institute of Nutrition of Central America and Panama (INCAP), Guatemala City,
Guatemala
| | - María F. Kroker-Lobos
- Research Center for the Prevention of Chronic
Diseases, Institute of Nutrition of Central America and Panama (INCAP), Guatemala City,
Guatemala
| | - Tim Waterboer
- Infections and Cancer Epidemiology, Infection,
Inflammation and Cancer Research Program, German Cancer Research Center (DKFZ),
Heidelberg, Germany
| | - M. Constanza Camargo
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Rockville, Maryland, U.S.A
| | - Neal D. Freedman
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Rockville, Maryland, U.S.A
| | - Barry I. Graubard
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Rockville, Maryland, U.S.A
| | - Mariana Lazo
- Division of General Internal Medicine, School of Medicine,
Johns Hopkins University, Baltimore, MD, USA,Urban Health Collaborative, Dornsife School of Public
Health, Drexel University, Philadelphia, PA, USA
| | - Eliseo Guallar
- Department of Epidemiology, Bloomberg School of Public
Health, Johns Hopkins University, Baltimore, MD, U.S.A
| | - John D. Groopman
- Department of Epidemiology, Bloomberg School of Public
Health, Johns Hopkins University, Baltimore, MD, U.S.A.,Department of Environmental Health and Engineering,
Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD,
U.S.A
| | - Manuel Ramírez-Zea
- Research Center for the Prevention of Chronic
Diseases, Institute of Nutrition of Central America and Panama (INCAP), Guatemala City,
Guatemala
| | - Katherine A. McGlynn
- Division of Cancer Epidemiology and Genetics, National
Cancer Institute, Rockville, Maryland, U.S.A
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Ramírez-Luzuriaga MJ, Hoddinott J, Martorell R, Patel SA, Ramírez-Zea M, Waford R, Stein AD. Linear Growth Trajectories in Early Childhood and Adult Cognitive and Socioemotional Functioning in a Guatemalan Cohort. J Nutr 2020; 151:206-213. [PMID: 33244598 PMCID: PMC7779237 DOI: 10.1093/jn/nxaa337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/04/2020] [Accepted: 10/05/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Growth faltering in early childhood is associated with poor human capital attainment, but associations of linear growth in childhood with executive and socioemotional functioning in adulthood are understudied. OBJECTIVES In a Guatemalan cohort, we identified distinct trajectories of linear growth in early childhood, assessed their predictors, and examined associations between growth trajectories and neurodevelopmental outcomes in adulthood. We also assessed the mediating role of schooling on the association of growth trajectories with adult cognitive outcomes. METHODS In 2017-2019, we prospectively followed 1499 Guatemalan adults who participated in a food supplementation trial in early childhood (1969-1977). We derived height-for-age sex-specific growth trajectories from birth to 84 mo using latent class growth analysis. RESULTS We identified 3 growth trajectories (low, intermediate, high) with parallel slopes and intercepts already differentiated at birth in both sexes. Children of taller mothers were more likely to belong to the high and intermediate trajectories [relative risk ratio (RRR): 1.21; 95% CI: 1.15, 1.26, and RRR: 1.11; 95% CI: 1.07, 1.15, per 1-cm increase in height, respectively] compared with the low trajectory. Children in the wealthiest compared with the poorest socioeconomic tertile were more likely to belong to the high trajectory compared with the low trajectory (RRR: 2.24; 95% CI: 1.29, 3.88). In males, membership in the high compared with low trajectory was positively associated with nonverbal fluid intelligence, working memory, inhibitory control, and cognitive flexibility at ages 40-57 y. Sex-adjusted results showed that membership in the high compared with low trajectory was positively associated with meaning and purpose scores at ages 40-57 y. Associations of intermediate compared with low growth trajectories with study outcomes were also positive but of lesser magnitude. Schooling partially mediated the associations between high and intermediate growth trajectories and measures of cognitive ability in adulthood. CONCLUSIONS Modifiable and nonmodifiable risk factors predicted growth throughout childhood. Membership in the high and intermediate growth trajectories was positively associated with adult cognitive and socioemotional functioning.
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Affiliation(s)
| | - John Hoddinott
- Division of Nutritional Sciences and Charles H. Dyson School of Applied Economics and Management, Cornell University, Ithaca, NY, USA
| | - Reynaldo Martorell
- Nutrition and Health Science Program, Laney Graduate School, Emory University, Atlanta, GA, USA,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Shivani A Patel
- Nutrition and Health Science Program, Laney Graduate School, Emory University, Atlanta, GA, USA,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Manuel Ramírez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Rachel Waford
- Nutrition and Health Science Program, Laney Graduate School, Emory University, Atlanta, GA, USA,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Peralta A, Paniagua-Ávila A, Fort M, Gulayín P, He J, Irazola V, Mansilla K, Hernández D, Ramírez-Zea M. Translating instruments into multiple Mayan languages for a hypertension T4 study in Guatemala. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Issue
Guatemala is a culturally and linguistically diverse country. Mayan languages are primarily spoken languages; few people know their written form. Health features and outcomes are difficult to assess due to the lack of validated instruments in these languages.
Description of the Problem
A cluster randomized trial to improve hypertension control is being conducted in 36 municipalities where Mayan languages are spoken in addition to Spanish. Instruments for measuring study outcomes were developed in Spanish and cross-culturally adapted into five Mayan languages following WHO's methodology. First, data were gathered on the proportion of people only fluent in a Mayan language in each district. We prioritized those Mayan languages spoken by more than 20% of the non-Spanish speaking population: Achí, K'iche', Kaqchikel, Tz'utujil and Mam. Second, forward translation to the Mayan languages was conducted by a local healthcare professional, who verbally recorded each instrument. The study team identified key words and concepts to guarantee content equivalence. Third, back-translation was conducted by two independent healthcare providers, who were blinded to the original instruments. The research team formally compared the original questionnaires with the back-translated versions to ensure they were conceptually equivalent and culturally adapted. Discrepancies were corrected as needed. Finally, local interviewers were trained on how to accurately use the written Spanish questionnaires and the Mayan language verbal recordings.
Results
By following this methodology, we achieved cross-culturally adapted instruments to improve the information-gathering process in communities where only Mayan languages are spoken.
Lessons
Having culturally adapted tools will allow researchers to reach a broader range of the target population, obtain more accurate information, and take into account participants' culture and cosmovision.
Key messages
Translating questionnaires to people’s native language allows researchers to obtain more accurate information in a standardized way and better understand participants’ culture and cosmovision. The described methodology is beneficial for conducting research in linguistically diverse countries. It promotes effective and inclusive communication among researchers and participants.
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Affiliation(s)
- A Peralta
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - A Paniagua-Ávila
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - M Fort
- Colorado School of Public Health, Colorado School of Public Health, Colorado, USA
| | - P Gulayín
- Institute for Clinical Effectiveness and Health Policy, Center of Excellence for Cardiovascular Health, Buenos Aires, Argentina
| | - J He
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
| | - V Irazola
- Institute for Clinical Effectiveness and Health Policy, Center of Excellence for Cardiovascular Health, Buenos Aires, Argentina
| | - K Mansilla
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - D Hernández
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - M Ramírez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
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Kroker-Lobos MF, Alvarez CS, Rivera-Andrade A, Smith JW, Egner P, Torres O, Lazo M, Freedman ND, Guallar E, Graubard BI, McGlynn KA, Ramírez-Zea M, Groopman JD. Association between aflatoxin-albumin adduct levels and tortilla consumption in Guatemalan adults. Toxicol Rep 2019; 6:465-471. [PMID: 31193789 PMCID: PMC6541741 DOI: 10.1016/j.toxrep.2019.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/08/2019] [Accepted: 05/19/2019] [Indexed: 12/15/2022] Open
Abstract
Aflatoxin B1 (AFB1) is a known human hepatocarcinogen and a recent study reported elevated AFB1 levels, measured by serum albumin biomarkers, among Guatemalan adults. While AFB1 can contaminate a variety of foodstuffs, including maize, Guatemala's main dietary staple, the relationship of maize intake to serum AFB1-albumin adducts levels in Guatemala has not been previously examined. As a result, a cross-sectional study was conducted among 461 Guatemalan adults living in five geographically distinct departments of the country. Participants provided a serum sample and completed a semi-quantitative food frequency questionnaire and a sociodemographic questionnaire. Multiple linear regression analysis was used to estimate the least square means (LSQ) and 95% confidence intervals (95% CI) of log-transformed AFB1-albumin adducts by quintiles of maize consumption in crude and adjusted models. Additionally, analyses of tortilla consumption and levels of maize processing were conducted. The median maize intake was 344.3 g per day [Interquartile Range (IQR): 252.2, 500.8], and the median serum AFB1-albumin adduct level was 8.4 pg/mg albumin (IQR: 3.8, 22.3). In adjusted analyses, there was no association between overall maize consumption and serum AFB1-albumin levels. However, there was a statistically significant association between tortilla consumption and AFB1-albumin levels (ptrend = 0.01). The LSM of AFB1-albumin was higher in the highest quintile of tortilla consumption compared to the lowest quintile [LSM:9.03 95%CI: 7.03,11.70 vs 6.23, 95%CI: 4.95,8.17, respectively]. These findings indicate that tortilla may be an important source of AFB1 exposure in the Guatemalan population. Therefore, efforts to control or mitigate AFB1 levels in contaminated maize used for tortillas may reduce overall exposure in this population.
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Key Words
- AFB1 – lys, covalent adduction of aflatoxins B1 to lysine residues in serum albumin
- AFB1, aflatoxins B1
- Aflatoxins
- BMI, body mass index
- CI, confidence intervals
- Consumption
- FFQ, food frequency questionnaire
- Guatemala
- IARC, International Agency for Research on Cancer
- IQR, interquartile range
- IRB, institutional review board
- Kcal, kilocalories
- Kg, kilograms
- LSM, least square means
- Maize
- Tortilla
- g, grams
- mg, milligram
- mt, meters
- pg, picogram
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Affiliation(s)
- María F. Kroker-Lobos
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Christian S. Alvarez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD, 20892, USA
| | - Alvaro Rivera-Andrade
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Joshua W. Smith
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Patricia Egner
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Olga Torres
- Laboratorio Diagnóstico Molecular, Guatemala City, Guatemala
| | - Mariana Lazo
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Neal D. Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD, 20892, USA
| | - Eliseo Guallar
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Barry I. Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD, 20892, USA
| | - Katherine A. McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD, 20892, USA
| | - Manuel Ramírez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - John D. Groopman
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
- Corresponding author at: Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Room E7547, Baltimore, MD 21205, USA.
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Flannagan KS, Ramírez-Zea M, Roman AV, Das AK, Villamor E. Adipose tissue polyunsaturated fatty acids and metabolic syndrome among adult parents and their children. Nutr Metab Cardiovasc Dis 2018; 28:1237-1244. [PMID: 30360954 DOI: 10.1016/j.numecd.2018.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 08/03/2018] [Accepted: 08/30/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Polyunsaturated fatty acids (PUFA) may play a role in the etiology of the metabolic syndrome (MetS). The aim of the study was to examine the associations of adipose tissue PUFA biomarkers with MetS among parents and children in Mesoamerica. METHOD AND RESULTS We conducted a cross-sectional study among 468 parents and 201 children aged 7-12 y from the capital cities of Guatemala, El Salvador, the Dominican Republic, Honduras, Nicaragua, Panama, Costa Rica, and Belize, and Tuxtla Gutiérrez in Mexico. We measured PUFA biomarkers in gluteal adipose tissue by gas chromatography. In adults, MetS was defined according to the National Cholesterol Education Program's Adult Treatment Panel III definition. In children, we created an age- and sex-standardized metabolic risk score using abdominal circumference, the homeostasis model of insulin resistance, blood pressure, serum HDL cholesterol, and triglycerides. We estimated prevalence ratios of MetS and mean differences in metabolic score across quartiles of PUFA using multivariable-adjusted Poisson and linear regression models, respectively. Among adults, MetS was associated with low alpha-linolenic acid (ALA), high eicosapentaenoic acid (EPA), and low gamma-linolenic acid (GLA). It was linearly, positively associated with dihomo-gamma-linolenic acid (DGLA) and estimated Δ6-desaturase (D6D) activity. Among children, the metabolic score was positively associated with docosapentaenoic acid (DPA), DGLA, and D6D activity. CONCLUSIONS Among Mesoamerican adults, MetS prevalence is inversely associated with adipose tissue ALA and GLA, and positively associated with EPA, DGLA, and the D6D index. Among children, metabolic risk score is positively associated with DPA, DGLA, and the D6D index.
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Affiliation(s)
- K S Flannagan
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - M Ramírez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - A V Roman
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - A K Das
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - E Villamor
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA; Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
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21
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Barquera S, García-Chávez CG, Navarro-Rosenblatt D, Uauy R, Pérez-Escamilla R, Martorell R, Ramírez-Zea M, Sánchez-Bazán K. Postura de la Sociedad Latinoamericana de Nutrición (SLAN) sobre el manejo de conflicto de intereses. ACTA ACUST UNITED AC 2018; 60:592-597. [DOI: 10.21149/9657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/29/2018] [Indexed: 01/26/2023]
Abstract
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.
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22
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Fort MP, Murillo S, López E, Dengo AL, Alvarado-Molina N, de Beausset I, Castro M, Peña L, Ramírez-Zea M, Martínez H. Impact evaluation of a healthy lifestyle intervention to reduce cardiovascular disease risk in health centers in San José, Costa Rica and Chiapas, Mexico. BMC Health Serv Res 2015; 15:577. [PMID: 26711290 PMCID: PMC4693408 DOI: 10.1186/s12913-015-1248-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 12/19/2015] [Indexed: 11/24/2022] Open
Abstract
Background Previous healthy lifestyle interventions based on the Salud para Su Corazón curriculum for Latinos in the United States, and a pilot study in Guatemala, demonstrated improvements in patient knowledge, behavior, and clinical outcomes for adults with hypertension. This article describes the implementation of a healthy lifestyle group education intervention at the primary care health center level in the capital cities of Costa Rica and Chiapas, Mexico for patients with hypertension and/or type 2 diabetes and presents impact evaluation results. Methods Six group education sessions were offered to participants at intervention health centers from November 2011 to December 2012 and participants were followed up for 8 months. The study used a prospective, longitudinal, nonequivalent pretest-posttest comparison group design, and was conducted in parallel in the two countries. Cognitive and behavioral outcome measures were knowledge, self-efficacy, stage-of-change, dietary behavior and physical activity. Clinical outcomes were: body mass index, systolic and diastolic blood pressure, and fasting blood glucose. Group by time differences were assessed using generalized estimating equation models, and a dose–response analysis was conducted for the intervention group. Results The average number of group education sessions attended in Chiapas was 4 (SD: 2.2) and in Costa Rica, 1.8 (SD: 2.0). In both settings, participation in the study declined by 8-month follow-up. In Costa Rica, intervention group participants showed significant improvements in systolic and diastolic blood pressure and borderline significant improvement for fasting glucose, and significant improvement in the stages-of-change measure vs. the comparison group. In Chiapas, the intervention group showed significant improvement in the stages-of-change measure in relation to the comparison group. Significant improvements were not observed for knowledge, self-efficacy, dietary behavior or physical activity. In Chiapas only, a significant dose–response relationship was observed for systolic and diastolic blood pressure. Conclusion Group education interventions at health centers have the potential to improve stage-of-change activation, and may also improve clinical outcomes. In the future, it will be essential to dedicate resources to understand ways to reach a representative group of the patient population, tailor the intervention so that patients are engaged to participate, and consider the broader family and community context that influences patients’ capacity to manage their condition.
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Affiliation(s)
- Meredith P Fort
- Department of Family Medicine, University of Colorado, 13055 East 17th Avenue, Aurora, CO, 80045, USA. .,INCAP Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala.
| | - Sandra Murillo
- INCAP Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala.
| | - Erika López
- INCAP Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala. .,School of Nutrition, University of Sciences and Arts of Chiapas, Tuxtla Gutiérrez, Chiapas, Mexico.
| | - Ana Laura Dengo
- INCAP Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala.
| | - Nadia Alvarado-Molina
- INCAP Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala. .,School of Nutrition, University of Costa Rica, San José, Costa Rica.
| | - Indira de Beausset
- INCAP Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala. .,School of Nutrition, University of Costa Rica, San José, Costa Rica.
| | - Maricruz Castro
- INCAP Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala. .,School of Nutrition, University of Sciences and Arts of Chiapas, Tuxtla Gutiérrez, Chiapas, Mexico.
| | - Liz Peña
- INCAP Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala. .,School of Nutrition, University of Sciences and Arts of Chiapas, Tuxtla Gutiérrez, Chiapas, Mexico.
| | - Manuel Ramírez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala.
| | - Homero Martínez
- INCAP Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala. .,RAND Corporation, 1776 Main Street, Santa Monica, CA, USA. .,Hospital Infantil de México "Dr. Federico Gómez", Mexico City, Mexico.
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Fort MP, Castro M, Peña L, López Hernández SH, Arreola Camacho G, Ramírez-Zea M, Martínez H. Opportunities for involving men and families in chronic disease management: a qualitative study from Chiapas, Mexico. BMC Public Health 2015; 15:1019. [PMID: 26438195 PMCID: PMC4595112 DOI: 10.1186/s12889-015-2361-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 09/28/2015] [Indexed: 12/03/2022] Open
Abstract
Background A healthy lifestyle intervention was implemented in primary care health centers in urban parts of Tuxtla Gutiérrez, Chiapas, Mexico with an aim of reducing cardiovascular disease risk for patients with type 2 diabetes and/or hypertension. During implementation, research questions emerged. Considerably fewer men participated in the intervention than women, and an opportunity was identified to increase the reach of activities aimed at improving disease self-management through strategies involving family members. A qualitative study was conducted to identify strategies to involve men and engage family members in disease management and risk reduction. Methods Nine men with hypertension and/or type 2 diabetes with limited to no participation in disease self-management and health promotion activities, six families in which at least one family member had a diagnosis of one or both conditions, and nine health care providers from four different government health centers were recruited for the study. Participants took part in semi-structured interviews. During interviews with families, genograms and eco-maps were used to diagram family composition and structure, and capture the nature of patients’ relationships to the extended family and community resources. Transcripts were coded and a general inductive analytic approach was used to identify themes related to men’s limited participation in health promotion activities, family support and barriers to disease management, and health care providers’ recommendations. Results Participants reported barriers to men’s participation in chronic disease management and healthy lifestyle education activities that can be grouped into two categories: internal and external factors. Internal factors are those for which they are able to make the decision on their own and external factors are those that are not related solely to their decision to take part or not. Four primary aspects were identified related to families’ relationships with disease: different roles within the family, types of support provided to patients, the opportunity to prevent disease among family members without a diagnosis, and - in some cases - lack of family support or stress-induced by other family members. There was an overlap in recommended strategies for engaging men and family members in chronic disease management activities. Conclusions There is an opportunity to increase the reach of interventions aimed at improving disease self-management by engaging men and family members. The proposed strategies presented by patients, family members, and providers have implications for health education and service provision at primary care health centers and for future research.
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Affiliation(s)
- Meredith P Fort
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Calzada Roosevelt 6-25, Zona 11, Guatemala City, Guatemala. .,Department of Family Medicine, University of Colorado - Denver, Denver, CO, USA.
| | - Maricruz Castro
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Calzada Roosevelt 6-25, Zona 11, Guatemala City, Guatemala. .,School of Nutrition, University of Sciences and Arts of Chiapas, Tuxtla Gutiérrez, Chiapas, Mexico.
| | - Liz Peña
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Calzada Roosevelt 6-25, Zona 11, Guatemala City, Guatemala. .,School of Nutrition, University of Sciences and Arts of Chiapas, Tuxtla Gutiérrez, Chiapas, Mexico.
| | | | - Gabriel Arreola Camacho
- School of Nutrition, University of Sciences and Arts of Chiapas, Tuxtla Gutiérrez, Chiapas, Mexico.
| | - Manuel Ramírez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Calzada Roosevelt 6-25, Zona 11, Guatemala City, Guatemala.
| | - Homero Martínez
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Calzada Roosevelt 6-25, Zona 11, Guatemala City, Guatemala. .,RAND Corporation, 1776 Main Street, Santa Monica, CA, USA. .,Hospital Infantil de México, "Dr. Federico Gómez", Mexico City, Mexico.
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Behrman JR, Hoddinott J, Maluccio JA, Soler-Hampejsek E, Behrman EL, Martorell R, Ramírez-Zea M, Stein AD. What determines adult cognitive skills? Influences of pre-school, school, and post-school experiences in Guatemala. Lat Am Econ Rev 2014; 23:4. [PMID: 26550556 PMCID: PMC4631444 DOI: 10.1007/s40503-014-0004-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Most empirical investigations of the effects of cognitive skills assume that they are produced by schooling. Drawing on longitudinal data to estimate production functions for adult verbal and nonverbal cognitive skills, we find that: (1) School attainment has a significant and substantial effect on adult verbal cognitive skills but not on adult nonverbal cognitive skills; and (2) Pre-school and post-school experiences also have substantial positive significant effects on adult cognitive skills. Pre-school experiences captured by height for age at 6 years substantially and significantly increase adult nonverbal cognitive skills, even after controlling for school attainment. Post-school tenure in skilled jobs has significant positive effects on both types of cognitive skills. The findings (1) reinforce the importance of early life investments; (2) support the importance of childhood nutrition ("Flynn effect") and work complexity in explaining increases in nonverbal cognitive skills; (3) call into question interpretations of studies reporting productivity impacts of cognitive skills that do not control for endogeneity; and (4) point to limitations in using adult school attainment alone to represent human capital.
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Affiliation(s)
- Jere R. Behrman
- Department of Economics, Sociology and Demography, University of Pennsylvania, Philadelphia, PA, USA
| | - John Hoddinott
- Department of Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - John A. Maluccio
- Department of Economics, Middlebury College, Middlebury, VT, USA
| | | | | | | | - Manuel Ramírez-Zea
- Institute of Nutrition for Central America and Panama (INCAP), Guatemala City, Guatemala
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Gatica GLM, Ramírez-Zea M, Letona P, Caballero B. Differences and similarities in feeding behaviors between Guatemalan mothers and their children. FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.1028.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Montano CM, Estrada K, Chávez A, Ramírez-Zea M. Perceptions, knowledge and beliefs about prevention of cardiovascular diseases in Villa Nueva, Guatemala. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.precon.2007.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Stein AD, Gregory CO, Hoddinott J, Martorell R, Ramakrishnan U, Ramírez-Zea M. Physical activity level, dietary habits, and alcohol and tobacco use among young Guatemalan adults. Food Nutr Bull 2005; 26:S78-87. [PMID: 16060214 DOI: 10.1177/15648265050262s108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Physical activity, diet, and alcohol and tobacco use are all related to the development of obesity, diabetes, coronary heart disease, osteoporosis, and cancer. We examined the distribution of measures of these behaviors in a cohort of individuals born in four villages in Guatemala between 1962 and 1977 and who were 26-41 years old in 2003. Response rates to the instruments averaged 80% of cohort members known to be living in Guatemala. Physical activity levels were moderate, and were lowest among migrants to Guatemala City. Dietary habits reflect early phases of the nutrition transition, with high carbohydrate and moderate fat intakes. Migrants to Guatemala City reported higher intakes of meat and of dairy products, while those remaining in or near the original study villages reported higher consumption of tortillas and of vegetables and fruits. One-third of men reported consuming alcohol and 42% were current smokers. Very few women reported alcohol or tobacco use.
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Affiliation(s)
- Aryeh D Stein
- Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA.
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Ramírez-Zea M, Melgar P, Flores R, Hoddinott J, Ramakrishnan U, Stein AD. Physical fitness, body composition, blood pressure, and blood metabolic profile among young Guatemalan adults. Food Nutr Bull 2005; 26:S88-97. [PMID: 16060215 DOI: 10.1177/15648265050262s109] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We assessed the distribution of several risk factors related to health: muscular strength (handgrip strength), cardiovascular endurance (step test), flexibility (sit and reach test), anthropometry and body composition, blood pressure, fasting plasma glucose, lipid profile, and hemoglobin in a cohort of Guatemalan adults who were born in four rural villages between 1962 and 1977. By 2002 approximately 32% had migrated to Guatemala City or elsewhere in the country. Men are more physically fit and leaner than women. Fatness, poor physical fitness, and metabolic syndrome are highly prevalent in women living in both rural and urban areas. Risk profiles worsen with increasing age. Men who migrated to Guatemala City have lower physical fitness, greater fatness and systolic blood pressure, and worse lipid profile than men who still live in their original villages. Such a pattern was not evident in women, except that blood pressure was higher in urban women than in women who lived in their original villages.
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Affiliation(s)
- Manuel Ramírez-Zea
- Institute of Nutrition of Central America and Panama (INCAP), P.O. Box 1188, Calzada Roosevelt, Zona 11, Guatemala City, Guatemala.
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