The epidemic of childhood obesity in the Americas must be stopped: Governmental and PAHO leadership are crucial.

The Pan American Health Organization's approach to preventing child obesity is built on (1) documenting and monitoring the problem and its social and economic impacts; (2) advocating for prevention and control policies through the life-course, within and outside of the health sector; (3) leading initiatives on healthy diet and active living and educating policy makers and the public about obesogenic environments, including policies to reduce the marketing of food and beverages to children; (4) enabling healthy environments for daily life activities, especially for children in schools and community settings; (5) strengthening capacity for integrated management of obesity and noncommunicable diseases with emphasis on primary health care; and (6) mobilizing partners and resources to combat the problem.

Ultrasound measurement of fetal size in rural Guatemala.

OBJECTIVES: To describe the fetal growth pattern of a population from rural Guatemala and determine when during gestation growth faltering becomes evident. METHODS: Ultrasound examinations were conducted for 319 women. Femur length (FL), biparietal diameter (BPD), abdominal (AC) and head circumference (HC) were compared with reference values. RESULTS: FL and AC were similar to reference values throughout gestation. BPD and HC were below the 50th percentile by 30 weeks' gestation and below the 10th percentile later in gestation. We expected all four dimensions to show marked growth restriction during gestation. Measurement differences may explain the results but would call into question the value of cross-study comparisons. Infants born small for gestational age were small in all measures as early as 15 weeks. CONCLUSIONS: Fetal growth faltering begins in early gestation among infants who were born small. The lack of deviation from reference data for FL and AC requires further clarification.

Determinants of fasting glucose in young Guatemalan adults.

OBJECTIVE: To examine correlates of fasting glucose, a precursor for type 2 diabetes mellitus, in young adults in Guatemala, a country undergoing an epidemiologic transition. DESIGN: Cross-sectional. METHODS: Anthropometric, lifestyle, dietary, serum lipid, and socioeconomic characteristic data were collected on 189 men and 201 women (mean age 24.4 years) born in four villages in Eastern Guatemala. We used linear regression to identify parsimonious predictive models, including 2-way interactions. RESULTS: In men, mean fasting glucose was 87.3 mg/dL (SD 10.2); our model explained 30% of variance. Body mass index (BMI), abdomen-to-hip ratio (AHR), and total cholesterol showed graded positive effects. BMI and AHR interacted (P<.001); men with high BMI and high AHR had the highest fasting glucose levels. No dietary factors independently predicted fasting glucose. In women, mean fasting glucose was 83.9 mg/dL (SD 8.5); 22% of variance was explained by BMI, energy-adjusted fat intake, physical activity, birth village, and current residence (rural/urban). BMI and fasting glucose were positively related. Urban residence interacted with birth village (P=.06) and physical activity (P=.13). CONCLUSIONS: The major conclusion drawn from this study is that increased adiposity, even among lean individuals, is the largest environmental predictor of fasting glucose. Prevention and control of obesity in young adults in transitioning countries are key strategies for the prevention of diabetes.

Indoor and outdoor PM2.5 and CO in high- and low-density Guatemalan villages.

Continuous particles less than 2.5 microm in diameter (PM2.5) and carbon monoxide (CO) were monitored during breakfast, lunch, and dinner in three high-density and four low-density villages near Quetzaltenango, Guatemala to help assess the viability of this region for a proposed respiratory health and stove intervention study. Approximately 15 homes were visited during each mealtime in each of the seven villages; in all, 98 homes were visited, with a sampling duration of 2-3 min per home per meal. For each village, a line (transect) was drawn on a village map along existing roads from one end of the village to the other; homes and between-home outside locations along the transect were monitored. Although the predominant stove type was the open fire, several other stoves, in various levels of disrepair, were observed frequently. The highest indoor concentrations of PM2.5 were observed in homes using the open fire (avg. = 5.31 mg/m3; SD=4.75 mg/m3) or equivalent, although homes using the plancha--indigenous wood-burning stove with chimney--also had measurements > 13.8 mg/m3, PM2.5 limit of detection. The highest indoor concentrations of CO were also observed in homes using the open fire (avg. = 22.9 ppm; SD = 28.1 ppm), with a maximum measurement of > 250 ppm. For both PM2.5 and CO, levels measured in homes with plancha, lorena, or open fire were significantly higher than levels taken in the street or in homes using a gas stove. The Spearman correlation coefficient between PM2.5 and CO for all data combined was 0.81, and ranged from 0.30 for the lorena to 0.68 for the plancha in homes using wood-fueled stoves. Although indoor PM2.5 and CO levels were not significantly different between high- and low-density villages, street-level PM2.5 (p = 0.002) and CO (p= 0.002), were significantly higher in the high - density villages. These data provide a useful picture of the pollution levels coming from a range of cooking stoves in various levels ofdisrepair, as well as a representation of how outdoor particle mass and CO levels vary from high- versus low-density villages.

Delayed clamping of the umbilical cord improves hematologic status of Guatemalan infants at 2 mo of age.

Iron deficiency anemia is a serious health problem that affects the physical and cognitive development of children. Therefore, it is important to develop cost-effective interventions to improve the hematologic status of the millions of children affected by this condition worldwide. We studied 69 Guatemalan infants who had been randomly assigned to one of three groups at the time of delivery: 1) cord clamping immediately after delivery (n = 21); 2) clamping when the cord stopped pulsating, with the infant placed at the level of the placenta (n = 26); or 3) clamping when the cord stopped pulsating, with the newborn placed below the level of the placenta (n = 22). Maternal and infant hematologic assessments were performed at the time of delivery and 2 mo postpartum. At baseline the groups had similar socioeconomic, demographic, and biomedical characteristics and the newborns had similar hematocrit status. Two months after delivery, infants in the two groups with delayed cord clamping had significantly higher hematocrit values and hemoglobin concentrations than did those in the early-clamping group. The percentage with hematocrit values < 0.33 was 88% in the control group compared with 42% in group 2 and 55% in group 3 (P = 0.01). These results suggest that waiting until the umbilical cord stops pulsating (approximately 1 min after delivery) is a feasible low-cost intervention that can reduce anemia in infants in developing countries.