Comparative performance of NEMS-S Surveys in latino food stores in the greater boston area

The dietary practices of diverse population groups, associated with the nutritional transition and the rapid demographic changes occurring globally require more attention to the food preferences of migrant groups such as Latinos living in the United States United States of America (US). This work aimed at the performance of an instrument utilized to measure availability of healthy food options in Latino stores located in the town of Somerville, state of Massachusetts. The methodology included the application of two versions: Guatemalan and US of the Nutrition Environment Measures Survey for Stores (NEMS-S), for the assessment of the availability of healthy food options in three Latino stores. Data were analyzed using descriptive statistics. The results indicated that foods sold in Latino stores were identified more successfully with the Guatemalan-NEMS-S than with the US NEMS-S. There was a general lack of healthy food options found when using the US survey, as well as a relatively narrow selection of fruits and vegetables. As conclusion, it was found that the US NEMS-S tended to identify a lower number of healthy food options, as compared to a larger number of similar options when a culturally-appropriate survey was used. These findings illustrate a manner in which a culture-specific instrument perform more appropriately than similar instruments adapted for other population groups, especially when the results are to be applied to support development of healthy food policies(AU)

Las prácticas alimentarias de diversos grupos de población, asociadas a la transición nutricional, y a los rápidos cambios demográficos que se producen a nivel mundial, exigen más atención a las preferencias alimentarias de grupos migrantes, como por ejemplo Latinos en los Estados Unidos de Norteamérica (EU). Este trabajo documenta los resultados de aplicar un instrumento para medir disponibilidad de alimentos saludables en tres tiendas latinas ubicadas en la ciudad de Somerville, estado de Massachusetts. La metodología utilizada incluyó la aplicación de dos versiones: guatemalteca y EU de la Encuesta para Medir Ambiente Nutricional en Tiendas (NEMS-S, siglas en inglés), para evaluar la disponibilidad de alimentos saludables. Los datos se analizaron con estadísticas descriptivas. Los resultados indicaron que los alimentos vendidos en las tiendas latinas fueron identificados con más acierto con el NEMS-S guatemalteco que con el NEMS-S de EU. Con este último instrumento, se obtuvo un número menor de opciones saludables y una selección limitada de frutas y de vegetales. Como conclusión, se encontró que el NEMS-S de EU identificaba un menor número de opciones de alimentos saludables, en comparación con el instrumento culturalmente apropiado. Estos hallazgos ilustran la importancia de utilizar instrumentos específicos para determinar disponibilidad de alimentos saludables, especialmente cuando los resultados se utilicen para apoyar el desarrollo de políticas alimentarias(AU)

Symposium Report: Effective and Safe Micronutrient Interventions, Weighing the Risks against the Benefits.

Micronutrient fortification of staple foods can be an effective strategy to combat micronutrient malnutrition. When planning on fortification, challenges faced include the collection of essential information on population food and nutrient intake patterns, as well as the use of this information in a method to select appropriate fortification levels. A symposium was organized aimed at discussing the existing approaches to set effective and safe micronutrient fortification levels and to outline the challenges and needs in this area. Two different approaches to establish effective and safe fortification levels for food fortification were presented. In the first approach, the Estimated Average Requirement (EAR) and Tolerable Upper Intake Level (UL) are used as cut-points in the micronutrient intake distribution to evaluate and simulate effective and safe micronutrient intakes. This was exemplified by challenges encountered in Guatemala and Cameroon towards unequal vitamin A intake distribution and the impact of the food vehicle choice. Secondly, the risk-benefit approach was presented as an approach in which risks and benefits of micronutrient intakes can be quantified and balanced in order to optimize fortification benefits with the least risks and to allow decision making. This was illustrated by a case on folic acid fortification in The Netherlands. Irrespective of the approach, food and nutrient intake data are required to identify potential vehicles for fortification, quantify the nutrient gap to be addressed, and set the appropriate level of fortification based on consumption pattern. Such information is rarely available to the quality and extent ideal to set fortification levels and requires regular updating, as exemplified in the case of sugar fortification in Guatemala. While the EAR cut-point method can be used to determine the proportion of the population meeting their required and safe nutrient intakes and set goals, riskbenefit assessment may offer an answer to commonly-asked questions as to whether, and at which levels, the benefits of increasing micronutrient intakes outweigh the risks.

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.

Maternal health and health-seeking behaviors among indigenous Mam mothers from Quetzaltenango, Guatemala / Salud materna y comportamientos relacionados con la búsqueda de asistencia sanitaria en madres indígenas mames del departamento de Quetzaltenango, Guatemala

OBJECTIVE: To obtain background information about maternal health and health-seeking behaviors among indigenous mothers living in rural Mam-Mayan communities of Quetzaltenango, Guatemala. METHODS: A cross-sectional analysis of 100 pregnant and breastfeeding women in four communities was performed to determine prevalence and determinants of service utilization. RESULTS: Extreme poverty, poor education, and poor access to basic resources were prevalent. Out of 100 women 14-41 years old, 33% did not use the formal health care sector for antenatal care; the majority consulted a traditional birth attendant. Only 13% delivered in a hospital. Lower socioeconomic status, lack of fluency in Spanish, and no ownership of a motorized vehicle were associated with the highest likelihood of poor utilization of services. CONCLUSIONS: A variety of factors affect utilization of maternal health services by indigenous women in rural Quetzaltenango. These include socioeconomic disparities, ethnic and linguistic differences, and poor access to basic resources. The current reproductive needs of women should be addressed to improve their health and increase their chance of having healthy children.

OBJETIVO: Obtener información básica acerca de la salud materna y los comportamientos relacionados con la búsqueda de asistencia sanitaria en madres indígenas residentes en comunidades rurales de la etnia maya mam en Quetzaltenango, Guatemala. MÉTODOS: Se llevó a cabo un análisis transversal de 100 mujeres pertenecientes a cuatro comunidades, embarazadas o en período de lactancia, con objeto de determinar la prevalencia y los determinantes de la utilización de servicios. RESULTADOS: La pobreza extrema, la escasa formación y el acceso limitado a los recursos básicos fueron prevalentes. De las 100 mujeres, de 14 a 41 años de edad, 33% no acudieron al sector formal de atención de salud en busca de asistencia prenatal; la mayor parte de ellas consultaron a una partera tradicional. Solo 12% dieron a luz en un hospital. El nivel socioeconómico inferior, la falta de fluidez en español y la carencia de un vehículo motorizado se asociaron con la mayor probabilidad de escasa utilización de los servicios. CONCLUSIONES: Diversos factores afectan a la utilización de los servicios de salud materna por parte de las mujeres indígenas del Quetzaltenango rural. Entre estos factores figuran las desigualdades socioeconómicas, las diferencias lingüísticas y étnicas, y el acceso limitado a los recursos básicos. Es preciso atender a las necesidades reproductivas actuales de las mujeres para mejorar su salud y aumentar sus probabilidades de tener hijos sanos.

Prevalence of Giardiasis in Children Attending Semi-urban Daycare Centres in Guatemala and Comparison of 3 Giardia Detection Tests.

Giardia intestinalis is an intestinal parasite widely prevalent in children attending daycare centres worldwide and has been associated with undernutrition. Stool samples from 48 Guatemalan children (aged 1.5-7 years) attending participating daycare centres were analyzed over five weeks for presence of Giardia intestinalis using light microscopy, ELISA, and rapid dipstick test. Giardia prevalence rates were 43.7% at Week 0 and 44.7% at Week 4, based on ELISA. Intensity, but not prevalence, of infection showed a trend toward decreased weight-for-age (1-tailed p=0.08). We believe that ELISA analysis of stool samples may be further adapted for measuring the intensity of infection in humans.

Food variety, dietary diversity, and food characteristics among convenience samples of Guatemalan women / La variedad, diversidad y características de la dieta en muestras de conveniencia de mujeres guatemaltecas

OBJECTIVE: To compare variety and diversity patterns and dietary characteristics in Guatemalan women. MATERIAL AND METHODS: Two non-consecutive 24-h recalls were conducted in convenience samples of 20 rural Mayan women and 20 urban students. Diversity scores were computed using three food-group systems.Variety and diversity scores and dietary origin and characteristics were compared between settings using independent t-test or Mann-Whitney-U-test. RESULTS: Dietary variety and diversity were generally greater in the urban sample when compared to the rural sample, depending on the number of days and food-group system used for evaluation.The diet was predominantly plant-based and composed of non-fortified food items in both areas.The rural diet was predominantly composed of traditional,non-processed foods. The urban diet was mostly based on non-traditional and processed items. CONCLUSION: Considerations of intervention strategies for dietary improvement and health protection for the Guatemalan countryside should still rely on promotion and preservation of traditional food selection.

OBJETIVO: Comparar patrones y características de diversidad y variedad de la dieta de mujeres guatemaltecas. MATERIEL Y MÉTODOS: Se realizaron dos recordatorios de 24-horas en una muestra de conveniencia de 20 mujeres rurales y 20 estudiantes urbanas. Se calcularon puntajes de diversidad usando tres sistemas de grupos alimentarios. La variedad y diversidad, así como el origen y características de la dieta, se compararon entre ambos sitios. RESULTADOS: La variedad y diversidad en general fueron mayores en la muestra urbana en comparación con la muestra rural, dependiendo del número de días y del sistema de grupos de alimentos utilizados para la evaluación. La dieta rural fue predominantemente vegetal y compuesta de alimentos tradicionales no procesados. La dieta urbana estaba basada primordialmente en alimentos procesados. CONCLUSIÓN: Las consideraciones para crear estrategias de intervención para el mejoramiento de la dieta en el área rural dependen de la conservación de la selección de alimentos tradicionales.

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...

The street food culture of Guatemala City: a case study from a downtown, urban park

This study investigated the structure and environment of 31 street food vendors in an urban park in the downtown area of Guatemala City. Vendors were interviewed and observed in order to assess the quality, safety, and accessibility of street food. The street food vending in the park consisted of five types: whole meal, snack, beverage, fruits, and carts. A great variety of typical Guatemalan meals, as well as ready-to-eat fruits and hot dog chapin (hot dog with cabbage and avocado cream), were found in the park. The food preparation and handling revealed inadequacies concerning the hygiene. Circumstances, such as the lack of portable water near the vending site and unhygienic sanitary facilities, supported the transmission of pathogens. The clientele was of all ages, and included female as well as the male purchasers. Typical clients came from the surrounding area, i.e. the employees of civil and private offices, commercial businesses, and the non-food vendors of the park. Comparing the economy of street food with the definition of very poor in Guatemala, the prices on the street were often above the daily money needed for a basic food basket. However, a special clientele were the very poor, such as the street children and handicapped people, who carned their meals by helping out at the vending sites. Mainly female street food vendors were found at the whole meal, snackm and refreshment sites whereas men sold predominantly at the carts. For all of the vendors, it was the main source of income and for many families the only one.

Perfil de riesgo cardiovascular en el área rural de Guatemala: Situación actual en relación a países desarrollados y subdesarrollados / Current risk of cadiovascular disease in rural area of Guatemala: actual situation compared with developed and undeveloped countries

Con el objeto de estimar la prevalencia de factores de riesgo cardiovascular se estudiaron 375 sujetos, 142 hombres y 233 mujeres entre 20 y 78 años de edad, del interior de la república de Guatemala. Las variables de estudio incluyeron: hábito de fumar; presión arterial; antropometría; rendimiento físico y determinación de lípidos plasmáticos. Se excluyeron sujetos con antecedentes de enfermedad cardiovascular, mujeres que estuvieron tomando anticonceptivos y sujetos con valores de triglicéridos mayores de 400 mg/dl. El hábito de fumar 1 ó más cigarrillos por día fue reportado en el 41de los hombres y 4 de las mujeres. La prevalencia de hipertensión en hombres fue de 3.5 y 10.7 en mujeres. Se clasificó como sobrepeso al 21.8 y 30.9 de los hombres y mujeres respectivamente. El porcentaje de obesos para hombres y mujeres fue 4.2 y 15. La razón cintura: cadera como índice de distribución de grasa fue igual o menor de 1.0 en hombres y 0.8 en mujeres.El 32 de las mujeres y 27 de los hombres tuvieron valores de colesterol = 200 mg/dL de los cuales 11 de las mujres y 7 de los hombres tuvieron valores superiores a 240 mg/dL. Alrededor del 20 de los sujetos estudiados tuvieron valores de colesterol -LDL mayores de 130 mg/dL y 44 valores de colesterol -HDL menores de 35 mg/dL. Las prevalencias encontradas en esta población son similares a las reportadas en otros países en vías de desarrollo, pero menores que las de países desarrollados

The distribution of intestinal helminth infections in a rural village in Guatemala

Fecal egg count scores were used to investigate the distribution and abundance of intestinal helminths in the population of a rural village. Prevalences of the major helminths were 41% with Ascaris lumbricoides 60% with Trichuris trichiura and 50% with Necator americanus. All three parasites showed a highly aggregated distribution among hosts. Age/prevalence and age/intensity profiles were typical for both A. lumbricoides and T. trichiura with the highest worm burdens in the 50-10 year old children. For hookworm both prevalence and intensity curves were convex in shape with maximum infection levels in the 30-40 year old age class. Infected females had higher burdens of T. trichiura than infected males in all age classes of the population; there were no other effects of host gender. Analysis of associations between parasites within hosts revealed strong correlations between A. lumbricoides and T. lumbricoides and T. trichiura. Individuals with heavy infections of A. lumbricoides and T. trichiura showed highly significant aggregation within households. Associations between a variety of household features and heavy infections with A. lumbricoides and T. trichiura are described