Protein-Energy Supplementation in Early-Life Decreases the Odds of Mental Distress in Later Adulthood in Guatemala

The prevalence of mental health concerns is growing worldwide, along with lack of access to and receipt of needed treatment. Current gaps in treatment provision have led to exploring alternative methods of prevention, with research linking nutrition and mental health, of particular relevance in low- and middle-income countries, with a high prevalence of undernutrition. To examine whether exposure to a protein-energy nutritional supplement during the first 1000 d of life decreased odds of mental distress in adulthood among men and women in Guatemala compared with receiving a low energy-no protein supplement or supplementation outside the 1000-d window. Data from participants (n = 1249) in a longitudinal cohort protein-energy supplementation trial (early-life, supplementation data from 1969 to 1977, ages 0­7 y; life course, outcome data from 2017­2018 follow-up, ages 40­57 y) were analyzed for associations between nutrition in the first 1000 d and mental distress in adulthood (WHO Self- Reporting Questionnaire 20 [SRQ-20]), controlling for early-life variables and current life stress; life course variables (e.g. education) were examined as potential mediators of this relation. Generalized linear mixed models and zero-inflated Poisson generalized linear mixed models were utilized. Both partial and full supplementation with Atole during the first 1000 d were associated with 63% (95% CI: 0.16, 0.87) and 56% (95% CI: 0.19, 1.03) lower odds, respectively, of experiencing mental distress in adulthood. Did not differ by sex. These inverse relations remained relatively unchanged (partial OR = 0.34 [95% CI: 0.14, 0.83]; full OR = 0.38 [95% CI: 0.16, 0.92]) after controlling for early-life and life course variables, including life stress. Protein-energy supplementation during the first 1000 d of life in Guatemala, where undernutrition is prevalent, may reduce the prevalence of later mental distress in adulthood. This effect appears to occur directly, rather than indirectly, through pathways of life course variables such as education, wealth, and marital status. Keywords: early childhood nutrition, protein-energy

Ultraprocessed Products as Food Fortification Alternatives: A Critical Appraisal from Latin America

Ultraprocessed products (UPPs), associated with obesity and non-communicable diseases (NCDs), are becoming predominant on the global market and a target for market-driven fortification initiatives. The aim of this article is to describe the implications of adding micronutrients to UPPs with excessive amounts of critical nutrients associated with NCDs and provide recommendations for legislation and policies. UPPs with added micronutrients such as breakfast cereals, sugarsweetened beverages, powder beverages, fruit juices, sauces, and bouillon cubes, among others, are commonly available and heavily promoted in Latin American countries. Misleading advertising of UPPs with added micronutrients and with excessive content of sugar, fat, and salt might increase the consumption of such products, giving them a "health halo effect" that leads consumers to overestimate their nutritional quality and healthfulness. Although international collections of standards such as the Codex Alimentarius provide some guidelines on this matter, countries need to implement national legislations, through a food systems approach, to regulate the marketing and labeling of UPPs. Lastly, there is still the need to foster research to close knowledge gaps and help countries to guide the process of food fortification strategies from a regulatory standpoint.

Age at childbirth and change in BMI across the life-course: evidence from the INCAP Longitudinal Study

Background: Parity has been associated with both short- and long-term weight gain in women. However, it is not clear if timing of parity across the reproductive age has different associations with BMI. Methods: To prospectively assess the association between age at childbirth and maternal change in BMI, we analyzed data from the ongoing INCAP Longitudinal Study, which started in 1969 in four villages in Guatemala. Cohort women (n=778) provided information on reproductive history and anthropometric measures were measured in 1988-89 (adolescence, 15 to 25y), 2002-04 (early adulthood, 26 to 36y) and 2015-17 (mid adulthood, 37 to 55y). We evaluated the associations of number of live births in the period preceding each study wave (1969-77 to 1988-89, 1988-89 to 2002-04 and 2002-04 to 2015-17) with BMI change in the same period using multivariable linear regression models. Results: Number of live births between 1988 and 89 and 2002-04 was positively associated with increased BMI, while there was not an association between number of live births and BMI in the other intervals. Women who had one, two, or three or more children between 1988 and 89 and 2002-04 had 0.90 (kg/m2, 95% CI: -0.55, 2.35), 2.39 (kg/m2, 95% CI: 1.09, 3.70) and 2.54 (kg/m2, 95% CI: 1.26, 3.82) higher BMI, respectively, than women who did not give birth in the same period. Conclusions: Our findings suggest that women who had three or more children during early adulthood gained more weight compared to women who had no children in the same period. In contrast, women who had children earlier or later in their reproductive lives did not gain additional weight compared to those who did not have children during that period. Childbirth may have different

Total adult cardiovascular risk in Central America / Riesgo cardiovascular total en adultos en América Central

OBJECTIVE:To evaluate prevalence of cardiovascular risk among adults 40 years and older using population-based samples from six Central American countries. METHODS: Risk factors were derived from a multi-national cross-sectional survey implemented in 2003-2006, which included a sample of 4 202 participants aged 40 years and older. Charts produced by the World Health Organization and the International Society of Hypertension for the Region of the Americas sub-region B were used to predict risk on the basis of factors including age, sex, blood pressure, total serum cholesterol, smoking status, and diabetes status. RESULTS: Overall, 85.9% of the population was classified as having < 10% risk for cardiovascular events during the following ten years. The likelihood of being in this risk group decreased with age in both males and females. Four percent of respondents were identified as having > 20% risk. More than 75% of those with a 30-40% risk had previously been identified by health services, and an additional 23% were identified during the study, suggesting they could be diagnosed by opportunistic screening for diabetes, hypertension and hypercholesterolemia. Results of bivariate analysis showed that respondents who were male, older, obese and/or less educated had higher risk for cardiovascular events, but a multivariate analysis including education indicated highest risks for older, obese, and less educated females. CONCLUSIONS: Measuring cardiovascular disease risk identifies most cases of (or at risk for) diabetes, hypertension and hypercholesterolemia among adults 40 years and older. This strategy can facilitate implementation of control programs and decrease disabilities and premature mortality.

RESUMEN OBJETIVO:Evaluar la prevalencia del riesgo de padecer enfermedades cardiovasculares en adultos de 40 años de edad o mayores mediante el uso de muestras poblacionales obtenidas de seis países de América Central. MÉTODOS: Se tomaron los factores de riesgo de una encuesta transversal multinacional realizada entre 2003 y 2006, que incluyó una muestra de 4 202 participantes de 40 años de edad o mayores. Se usaron gráficos producidos por la Organización Mundial de la Salud y la Sociedad Internacional para la Hipertensión de la Región de las Américas, subregión B, para predecir el riesgo sobre la base de factores como la edad, el sexo, la presión arterial, las concentraciones totales de colesterol sérico, y la situación con respecto al tabaquismo y la diabetes. RESULTADOS: En términos generales, 85,9% de la población quedó clasificada en el grupo con un riesgo menor de 10% de sufrir episodios cardiovasculares en el transcurso de los 10 años siguientes. La probabilidad de pertenecer a este grupo de riesgo disminuyó con la edad, tanto en los hombres como en las mujeres. Se determinó que 4% de los encues-tados tenían un riesgo mayor de 20%. Más de 75% de los que tenían un riesgo de 30% a 40% ya habían sido identificados por los servicios de salud y otro 23% fue identificado durante el estudio, lo cual indica que los diagnósticos pueden hacerse mediante un tami-zaje oportunista para la detección de diabetes, hipertensión e hipercolesterolemia. Según los resultados del análisis bivariado, los entrevistados de sexo masculino, de edad más avanzada, obesos o con poca escolaridad tenían un mayor riesgo de sufrir episodios cardiovasculares, pero un análisis multivariado que abarcó el nivel educativo reveló que los riesgos más altos los tienen las mujeres mayores, obesas y con poca instrucción. CONCLUSIONES: El cálculo del riesgo cardiovascular permite identificar la mayoría de los casos (o personas con riesgo de presentar) diabetes, hipertensión e hipercolesterolemia en adultos de 40 años de edad o mayores. Esta estrategia puede facilitar la puesta en práctica de los programas de control, así como reducir la discapacidad y la mortalidad prematura.