Energy contribution from non-breastmilk items in low-income Guatemalan infants in their sixth month of life / Contribución de energía de fuentes diferentes a la leche materna en infantes de seis meses de edad de bajos recursos en Guatemala

Objective. To examine the nature and energy contribution of complementary feeding in breastfed infants in their sixth month of life, and the prevalence of the use of bottles as a delivery method. Materials and methods. We recruited 156 breastfeeding infants at a health clinic in metropolitan Quetzaltenango, Guatemala. A previous-day recall was performed. Results. Sixty nine mothers (44%) reported offering items other than breastmilk. The median contribution of energy from complementary foods among infants with mixed feeding (n=66) was 197 kcal/day (interquartile range [IQR] 49-353). The median energy contribution of formula or cow's milk among consumers (n=39) was 212 kcal/day (IQR 84-394). Bottles were used on the previous day by 55 (80%) of the 69 mothers not offering exclusive breastfeeding. Conclusions. Premature introduction of non-breastmilk items is commonly practiced in feeding Guatemalan infants. Adherence to the internationally recognized guidelines for early infant feeding should be an intervention priority for this population.

Objetivos. Examinar la naturaleza y contribución energética de la alimentación complementaria en infantes lactantes en el sexto mes de vida y la prevalencia del uso de biberones como método de alimentación. Material y métodos. Se seleccionaron 156 infantes lactantes en un centro de salud en la ciudad de Quetzaltenango, Guatemala. Se solicitó una rememoración de la alimentación del día anterior. Resultados. Sesenta y nueve madres (44%) reportaron dar alimentos adicionales a la leche materna. La mediana de contribución energética de alimentos complementarios en infantes con alimentación mixta (n=66) fue 197 kcal/día (rango intercuartil [RIC] 43-353). La mediana de contribución energética de leche de vaca entre consumidores (n=39) fue 212 kcal/día (RIC 84-394). De 69 madres que ofrecían alimentación mixta, 55 (80%) proporcionaron biberones. Conclusiones. Las madres guatemaltecas practican comúnmente la introducción prematura de la alimentación complementaria. La adhesión a las guías internacionalmente reconocidas para alimentación de infantes debe ser una prioridad de intervención en esta población.

Sex Differences Independent of Other Psycho-sociodemographic Factors as a Predictor of Body Mass Index in Black South African Adults.

To better understand the sex differences in body mass index (BMI) observed in black South African adults in the Transition and Health during Urbanization of South Africans Study, the present study investigated whether these differences can be explained by the psycho-sociodemographic factors and/or health-related behaviours. A cross-sectional survey was undertaken among 1,842 black South African individuals from 37 study sites that represented five levels of urbanization. The behavioural factors that possibly could have an influence on the outcome of body-weight and that were explored included: diet, smoking, level of education, HIV infection, employment status, level of urbanization, intake of alcohol, physical activity, and neuroticism. The biological factors explored were age and sex. The prevalence of underweight, normal weight, and overweight among men and women was separately determined. The means of the variables were compared by performing Student’s t-test for normally-distributed variables and Mann-Whitney Utest for non-normally-distributed variables. The means for the underweight and overweight groups were tested for significant differences upon comparison with normal-weight individuals stratified separately for sex. The differences in prevalence were tested using chi-square tests (p<0.05). All the variables with a large number of missing values were tested for potential bias. The association between sex and underweight or overweight was tested using the Mantel-Haenszel method of odds ratio (OR) and calculation of 95% confidence interval (CI), with statistical significance set at p<0.05 level. Logistic regression was used for controlling for confounders and for testing for effect modification. Females were more likely to be overweight/ obese (crude OR=5.1; CI 3.8-6.8). The association was attenuated but remained strong and significant even after controlling for the psycho-sociodemographic confounders. In this survey, the risk for overweight/ obesity was strongly related to sex and not to the psycho-sociodemographic external factors investigated. It is, thus, important to understand the molecular roots of sex- and gender-specific variability in distribution of BMI as this is central to the future development of treatment and prevention programmes against overweight/obesity.

Fruit and vegetable intake of schoolchildren in Quetzaltenango, Guatemala / Consumo de frutas y vegetales en escolares de Quetzaltenango, Guatemala

Objective. To determine if fruit and vegetable consumption among high– and low–socioeconomic status (HSES–LSES) urban schoolchildren in Quetzaltenango, Guatemala, was adequate according to World Health Organization (WHO) recommendations.Methods. Cross-sectional data from 449 third- and fourth-grade girls and boys from 12 elementary schools were collected, analyzed, and presented by socioeconomic status and gender. Public schoolchildren were classified as LSES (n = 219) and private schoolchildren were classified as HSES (n = 230). Dietary fruit/vegetable intake of each student was determined based on a 24-hour recall pictorial record and personal interview. All food items containing fruits or vegetables (including beverages) were classified and tabulated. Frequency of fruit/vegetableintake was calculated based on “mentions” (number of times a fruit or vegetable item was reportedly consumed), and nutritional adequacy was assessed for each group by mean and median values and compared to WHO daily recommended fruit/vegetable intake (400 g). Based on World Cancer Research Fund (WCRF) exclusion guidelines, the fruit/vegetable contribution to total energy was estimated. Results. Of the 247 different food items identified, 93 (37.7%) contained a fruit or vegetable. Total food mentions (n = 6 512) included 637 fruit items and 701 vegetable items. Althoughmean fruit/vegetable intake in grams was 461.3 (standard deviation, ± 332.5), more than half (56.3%) of the subjects fell below the 400-g recommended daily level. Estimatedfruit/vegetable contribution to total energy was 21.2% for HSES and 19.1% for LSES. Conclusion. This study revealed inadequate fruit/vegetable intake among the study sample. For compliance with global recommendations, interventions promoting fruit/ vegetable intake are needed.

Objetivo. Determinar si el consumo de frutas y vegetales en escolares de ingresos altos y bajos de zonas urbanas de Quetzaltenango es el adecuado según las recomendaciones de la Organización Mundial de la Salud (OMS). Métodos. Estudio transversal en 449 niñas y niños de tercer y cuarto grados de 12 escuelas de educación elemental. Los datos se presentaron según el sexo y el nivel socioeconómico. Los niños de escuelas públicas (n = 219) se consideraron de nivel socioeconómicobajo (NSEB) y los de escuelas privadas (n = 230) como de nivel socioeconómicoalto (NSEA). El consumo de frutas y vegetales en la dieta de cada estudiantese determinó a partir de un recordatorio de 24 horas mediante registros pictóricos y entrevistas personales. Se tabularon todos los alimentos que contenían frutas o vegetales (incluidas las bebidas). La frecuencia del consumo de frutas y vegetales se calculó a partir de las veces que se mencionó el consumo de una fruta o un vegetal y se evaluó el grado de adecuación nutricional mediante la comparación de los valores medios y medianos de cada grupo con el consumo diario recomendado por la OMS (400 g). Se utilizaron las directivas de exclusión del Fondo Mundial para las Investigacionescontra el Cáncer (WCRF) para estimar la contribución de las frutas y vegetalesal aporte energético total. Resultados. De los 247 diferentes alimentos identificados, 93 (37,7%) contenían unafruta o un vegetal. Del los 6 512 registros, 637 contenían alguna fruta y 701 algún vegetal. Aunque el consumo medio de frutas y vegetales fue de 461,3 g (desviación estándar = ± 332,5 g), más de la mitad (56,3%) de los estudiantes tenían un consumo pordebajo de los 400 g diarios recomendados. Se estimó que las frutas y vegetales contribuían en 21,2% al aporte energético total en los niños de NSEA y en 19,1% en los de NSEB.Conclusiones. Estos resultados demuestran el inadecuado consumo de frutas y vegetales en la muestra estudiada...

Nutritional status of urban schoolchildren of high and low socioeconomic status in Quetzaltenango, Guatemala

OBJECTIVE: The prevalence of overweight and obesity is growing in children in many developing countries, increasing chronic disease risk. Our objective was to assess the prevalence of stunting, underweight, overweight, and obesity in schoolchildren 8 to 10 years old who were of high or low socioeconomic status (SES) in Quetzaltenango, which is the second largest city in Guatemala METHODS: Between April and June 2005 we conducted a cross-sectional survey among 583 children in private and public elementary schools, in which we measured height and weight. The Centers for Disease Control and Prevention (CDC) 2000 height-for-age z-scores, weight-for-age z-scores, and body mass index-for-age centiles were used to define stunting, underweight, overweight, and obesity. RESULTS: Mean height, weight, and body mass index were significantly higher in the 327 children of high SES than in the 256 children of low SES, across sexes and age groups. The prevalence of stunting was significantly higher in low-SES children than in high-SES ones (27.0 percent vs. 7.3 percent, P < 0.01) , and this was also true for underweight (14.1 percent versus 4.6 percent, P < 0.01). In contrast, the prevalence of overweight (17.7 percent versus 10.5 percent, P < 0.01) was higher in high-SES children than in low-SES ones; the same was true for obesity (14.4 percent versus 2.3 percent, P < 0.01). The prevalence of stunting among children of low SES, and the prevalence of overweight and obesity among children of high SES far exceeded the CDC 2000 reference ranges. CONCLUSIONS: A high prevalence of both stunting and excess body weight was found in this urban Guatemalan population, with notable contrasts between social classes. The obesity among high-income children indicates that the city is undergoing the nutrition transition, with further implications for future risks related to chronic disease. Nutrition and health interventions are needed to reduce these risks.

OBJETIVO: En muchos países en desarrollo se elevan las prevalencias de sobrepeso y de obesidad en niños, con el incremento del riesgo de enfermedades crónicas. El objetivo de este trabajo fue evaluar las prevalencias de retraso en el crecimiento, peso bajo, sobrepeso y obesidad en escolares de 8 a 10 años de edad de niveles socioeconómicos (NSE) alto o bajo en Quetzaltenango, la segunda mayor ciudad de Guatemala. MÉTODOS: Se realizó un estudio transversal entre abril y junio de 2005 en el que se midió el peso y la talla de 583 niños de escuelas primarias privadas y públicas. Para evaluar el retraso en el crecimiento, el peso bajo, el sobrepeso y la obesidad se utilizaron como referencias las puntuaciones z de la talla para la edad y del peso para la edad y los centiles de los índices de masa corporal para la edad, propuestos por los Centros para el Control y la Prevención de las Enfermedades (CDC) de los Estados Unidos de América en 2000. RESULTADOS: La talla, el peso y el índice de masa corporal medios fueron significativamente mayores en los 327 niños de NSE alto que en los 256 niños de NSE bajo en todos los grupos de edad y sexo. La prevalencia de retraso en el crecimiento fue significativamente mayor en los niños con NSE bajo que en los de NSE alto (27,0 por ciento frente a 7,3 por ciento; P < 0,01), al igual que la prevalencia de peso bajo (14,1 por ciento frente a 4,6 por ciento, P < 0,01). En contraste, la prevalencia de sobrepeso fue mayor en los niños con NSE alto que en los de NSE bajo (17,7 por ciento frente a 10,5 por ciento, P < 0,01), al igual que la prevalencia de obesidad (14,4 por ciento frente a 2,3 por ciento, P < 0,01). Las prevalencias de retraso en el crecimiento en los niños de NSE bajo y de sobrepeso y obesidad en los de NSE alto fueron mucho mayores que las referencias establecidas por los CDC en el año 2000. CONCLUSIONES: Se encontraron elevadas prevalencias de retraso en el crecimiento y de peso corporal excesivo...