Dietary Patterns and Anti-Flavivirus IgG Seroconversion in Colombian Children.

The burden of flaviviral infections, especially dengue and Zika, is high in the Americas. Malnutrition affects the risk and response to infections, but the role of diet on flaviviral infection risk is uncertain. The objective of this study was to investigate the relations between dietary patterns adherence and anti-flavivirus IgG seroconversion in children during a Zika epidemic in a dengue-endemic area of Colombia. In 2015-2016, we followed 424 anti-flavivirus IgG seronegative children aged 2 to 12 years for 1 year. Baseline data included children's sociodemographic, anthropometric, and dietary information collected through a 38-item food frequency questionnaire (FFQ). IgG testing was repeated at the end of follow-up. The primary exposure was adherence to each of four dietary patterns (animal foods, traditional, ultraprocessed foods, and prudent) that were identified from the FFQ through principal component analysis. Secondary exposures were intake frequencies of foods contributing to relevant patterns. We estimated risk of seroconversion by quartiles of adherence scores and compared them using relative risks (RR) and 95% CI from Poisson regression adjusted for sex, age, and socioeconomic status indicators. Seroconversion risk was 32.1%. Adherence to the traditional pattern was positively related to seroconversion. RR comparing fourth versus first quartiles of adherence was 1.52 (95% CI: 1.04-2.21; P trend = 0.02). Of the most representative foods in this pattern, potato and sugarcane water intake frequencies were related to increased seroconversion risk. In conclusion, adherence to a traditional foods pattern, including potatoes and sugarcane water, was positively associated with anti-flavivirus IgG seroconversion.

Meal Pattern in the Colombian Population: Results of the National Nutrition Survey. ENSIN, 2015.

Background: Information on meal patterns (type, number, relative contribution to energy/day (%), time, and location of meals) is limited or nonexistent. Design: Cross-sectional, nationally representative surveys. Setting. Colombia. Participants. n = 26,115 from 3 to 64 years old. The sample analyzed included 3,127 children between 3 and 4 years old, 13,384 children between 5 and 17 years old, and 9,604 adults between 18 and 64 years old. Data Analysis. Meal patterns were described by age group. Through multiple linear regression, crude and adjusted differences in the categories of the covariates studied were estimated. The number/day of meals was the dependent variable. Results: The number of meals/day (mean ± SD) was 4.4 ± 0.0, without differences by sex (P = 0.068), current weight (P = 0.336) , or wealth index (P = 0.480), but there were differences in the level of education of the head of the household (P < 0.0001) and the level of food security of the household (P < 0.0001). A total of 96.8% of the population eats 3 or more meals/day (95% CI: 96.2, 97.2). The consumption frequency (mean ± SD) of the three main meals was 0.95 ± 0.0 "times/day," 1.0 ± 0.0 and 0.95 ± 0.0, for breakfast, lunch, and dinner, respectively. Lunch is the meal that makes the greatest relative contribution to the total energy consumed (energy/day), 33.9% (95% CI: 32.7, 35.1). Breakfast is eaten outside the home by 13.0% of the subjects, lunch by 26.0%, and dinner by 3.8%. The minimum fasting interval is 9 hours and the maximum is 10 hours and 30 minutes. The meal pattern is equivalent to type "A," with three main meals and two or three intermediate meals (midmorning and midafternoon) taken during 15 hours of the day. Conclusions: All age groups had more than four meals/day. The number is directly related to socioeconomic level. Lunch is the main meal.

Intake of Animal Protein and Dietary Sources in the Colombian Population: Results of the National Nutrition Survey (ENSIN-2015).

BACKGROUND: There is a lack of knowledge in Colombia about dietary intake and sources of animal protein. DESIGN: Cross-sectional, nationally representative surveys. Setting. Colombia. Participants. n = 32,457 participants aged from 1 to 64 years. The sample analyzed included 21,036 boys and nonpregnant girls, 10,099 adults, and 1,322 pregnant women, 118 of whom were below 18 years of age. RESULTS: Protein intake was 32.9 g/d (95% CI: 32.4, 33.4) per 1,000 kilocalories. The relative contribution (%) of total protein to the total energy intake/day (acceptable macronutrient distribution) was 13.2% (95% CI: 13.0, 13.3). The acceptable macronutrient distribution (AMDR) for animal protein for those aged 1 to 64 years was 7.8% (95% CI: 7.6, 8.0), with a minimum of 7.1% (95% CI: 6.7, 7.5), which was for children aged from 13 to 17 years, and a maximum of 8.3% (95% CI: 8.1, 8.5), for children aged from 1 to 4 years (P=0.018). For all groups, animal protein made up the majority of total proteins, with 62.6% (95% CI: 61.7, 63.6) for preschoolers, 55.8% (95% CI: 53.2, 58.4) for school-aged children, 54.6% (95% CI: 53.0, 56.1) for adolescents, 58.1% (95% CI: 57.5, 58.7) for adults, and 57.5% (95% CI: 55.2, 59.7) for pregnant women (P=0.027). The three main dietary sources of animal protein were red meat (17.8%), chicken (16.3%), and eggs (10.5%). The sources of vegetal protein were bread-arepa-pasta (20.0%), cereals (19.8%), and legumes (8.2%). CONCLUSIONS: Protein intake is excessive according to the Recommended Dietary Allowance (RDA), while it is not excessive from the perspective of the AMDR.

Inequality, abuse of women and duration of breastfeeding, Colombia, 2010: Ecological study / Desigualdad, maltrato de la mujer y duración de la lactancia materna, Colombia, 2010: Estudio ecológico

Abstract Introduction: Breastfeeding decreases morbidity, mortality and promotes health in the mother and child. The lower morbidity in relative terms in breastfed versus non-breastfed infants reduces healthcare costs. In Colombia, the duration of breastfeeding is far from desirable times and continues to decline. Objectives: The objectives were (a) to determine economic inequality based on poverty at the ecological level during exclusive breastfeeding (EBF) and total breastfeeding (BF) and (b) to establish the social determinants of EBF and BF using the territory as a unit of analysis. Method: An ecological study was conducted based on data collected in the National Survey of the Nutritional Situation of 2010 in Colombia regarding the median duration of exclusive breastfeeding and total breastfeeding. The data was summarized in 24 departments or geodemographic units that represent the Colombian territory (n=24). Fourteen variables representing the economic, social, human and structural development levels in the territory were related by linear regression to explain the duration of EBF and BF. Results: EBF lasted 1.18 months (95% CI: 1.00 to 1.36), and BF lasted 14.79 months (95% CI: 13.50 to 16.08). Economic inequality was low, and the Gini coefficient was 0.35 for EBF and 0.10 for BF. The EBF duration is affected by the gender empowerment measure (GEM) (β =-1.94, p=0.006) and medical coverage (%) (β =-0.02, p=0.060). The BF duration is explained by the monetary poverty (β =0.12, p=0.007) GEM (β =-9.94, p=0.033) and female abuse rate x 100,000 (β =0.01, p=0.005). Conclusions: The impact of social and human development is greater than the economic aspect as a determinant of EBF and BF duration in Colombia. Exclusive and total breastfeeding are phenomena explained differently.

Resumen Introducción: La lactancia materna disminuye la morbilidad, la mortalidad y promueve la salud de la madre y del niño. La menor morbilidad en términos relativos en los niños amamantados frente a los no amamantados reduce los costes sanitarios. En Colombia, la duración de la lactancia materna está lejos de los tiempos deseables y sigue disminuyendo. Objetivos: Los objetivos fueron (a) determinar la desigualdad económica basada en la pobreza a nivel ecológico durante la lactancia materna exclusiva (LME) y la lactancia materna total (LMT) y (b) establecer los determinantes sociales de la LME y la LMT utilizando el territorio como unidad de análisis. Método: Se realizó un estudio ecológico a partir de los datos recogidos en la Encuesta Nacional de Situación Nutricional de 2010 en Colombia sobre la mediana de duración de la lactancia materna exclusiva y la lactancia materna total. Los datos se resumieron en 24 departamentos o unidades geo demográficas que representan el territorio colombiano (n=24). Catorce variables que representan los niveles de desarrollo económico, social, humano y estructural del territorio se relacionaron mediante regresión lineal para explicar la duración de la LME y la LMT. Resultados: La LME tuvo una duración de 1,18 meses (IC 95 %: 1,00 a 1,36), y la LMT tuvo una duración de 14,79 meses (IC 95 %: 13,50 a 16,08). La desigualdad económica fue baja, y el coeficiente de Gini fue de 0,35 para la LME y de 0,10 para la LMT. La duración de la LME se ve afectada por la medida de empoderamiento de género (GEM) (β =-1,94, p=0,006) y la cobertura médica (%) (β=-0,02, p=0,060). La duración de la LMT se explica por la pobreza monetaria (β =0,12, p=0,007) GEM (β =-9,94, p=0,033) y la tasa de maltrato femenino x 100 000 (β =0,01, p=0,005). Conclusiones: En Colombia el impacto del desarrollo social y humano es mayor que el aspecto económico como determinante de la LME y de la duración de la LMT. La lactancia materna exclusiva y total son fenómenos que se explican de manera diferente.

Energy and protein intake in the Colombian population: results of the 2015 ENSIN population survey.

The present study was aimed at (1) the differences between current weight v. ideal weight, (2) total energy intake and comparing it with required energy (Rkeer), (3) absolute protein intake in g/kg per d and g/1000 calories, (4) how energy and protein intake relate to the nutritional status of the subjects in terms of overall overweight (OEW) [overweight + obesity] and conservative overweight (CEW) [obesity] and (5) the contribution (%) of protein to total energy intake based on the acceptable macronutrient distribution range (AMDR). A dietary study was carried out in Colombia with 29 259 subjects between 1 and 64 years of age, based on cross-sectional data collected in 2015 by a 24-h dietary recall (24HR) administered as part of the National Nutrition Survey. Energy and protein intake did not differ by nutritional status. In the general population, energy intake was 2117 kcal/d (95 % CI 1969, 2264). The total protein intake was 64⋅3 g/d (95 % CI 61⋅4, 67⋅3). Adequate energy intake ranged from 90 to 100 %, except for the 1-4-year-old group, which ranged from 144 to 155 %. Protein intake was 1⋅64 g/kg per d (95 % CI 1⋅53, 1⋅75). The mean AMDR for protein to total energy intake was 13⋅3 % (95 % CI 12⋅9, 13⋅7). Excess weight began during the first 4 years of age. In conclusion, it is worth reviewing and updating energy and protein intake recommendations and dietary guidelines for the Colombian population and designing and modifying public policy.

Median Urinary Iodine Concentration in Colombian Children and Women is High and Related to Sociodemographic and Geographic Characteristics: Results from a Nationally Representative Survey.

BACKGROUND: Salt iodization has been mandatory in Colombia for over half a century. The iodine status of the population has not been recently evaluated using nationally representative data. OBJECTIVE: We estimated the median urinary iodine concentration (mUIC) of Colombian women and children overall and by individual and environmental characteristics. METHODS: Using data from spot urine samples collected in the 2015 Colombian National Nutrition Survey, we estimated mUIC in 24,248 boys and girls aged 1 to <13 y and 9122 women of reproductive age (WRA). Within each group, we compared mUIC by levels of sociodemographic, anthropometric, and geographic factors by using adjusted median differences with 95% CIs from quantile regression models. RESULTS: mUICs were 395 ± 3 µg/L among children and 381 ± 3 µg/L among WRA. Schoolchildren 5 to <13 y old had higher mUIC (407 ± 3 µg/L) than did preschoolers or toddlers. Girls had 21 µg/L (95% CI: -29, -14) lower mUIC than boys after adjustment. In addition, among children, mUIC was positively associated with household wealth and inversely associated with indigenous compared with mestizo ethnicity, living in the southern or Pacific compared with the central regions of Colombia, and altitude. Among WRA, mUIC was positively associated with obesity and inversely with age, indigenous compared with mestizo ethnicity, education, household wealth, living in southern compared with central Colombia, altitude, and alcohol intake frequency. CONCLUSION: Colombian children and WRA had mUIC well above conventional cutpoints of iodine excess. Whether excessive iodine affects other subpopulations and its functional consequences warrant urgent investigation.

Nutrition gap in children, urban-rural: the key education and food. Colombia, 2015.

OBJECTIVE: To analyze the nutritional situation of children under five years old from both urban and rural areas of Colombia. METHOD: Analytical study, based on cross-sectional data, collected from ENSIN-2015. The sample consisted of 12,256 children aged between 0 and 4 years old. We calculated the prevalence ratios (PR) with their respective 95% confidence interval (95%CI). PR were assessed by binomial regression models with malnutrition or overweight as the dependent variable and geographic area as the explanatory variable. We used context variables to adjust the estimated PR and control the confounder within. RESULTS: Acute malnutrition (weight-for-height) had a prevalence of 1.6%, while overweight had a 5.6% rate. No differences per geographic zone in the weight-for-height indicator were found. Stunted growth - chronic malnutrition - was higher in the rural area (PR = 1.2; 95%CI 1-1.53; p = 0.050). Prevalences adjusted by variables related to structural, social and economic developement showed that both the household chief's educational level and the food insecurity of the area account for malnutrition. CONCLUSION: The height-for-age indicator works better to establish development level. Measures against coverage, relevance and quality of education and access to food can harm the nutritional status of the children.

Trends of Adherence to Dietary Patterns in Colombian Population, 2010-2015.

Objectives: In this study we sought to determine: (1) adherence to each one of the dietary patterns (DPs) identified in Colombia by the National Nutrition Surveys (ENSIN) in 2010 and 2015; (2) trends in adherence to these patterns between 2010 and 2015; and (3) differences in adherence between the 2 surveys according to some of the biological and socioeconomic variables. Methods: We conducted a cross-sectional study with secondary analysis of data from the ENSIN-2010 and ENSIN-2015 surveys that enrolled 37,667 persons. Diet was assessed by a Food Frequency Questionnaire. Based on a factor analysis, 3 dietary patterns were identified: traditional/starch pattern (TSP), fruit-vegetable/dairy pattern (FVDP), and snack pattern (SP). We used multiple linear regression to estimate adjusted differences in adherence to patterns between ENSIN-2010 and ENSIN-2015. Results: For both years, adults had the lowest adherence to the 3 DPs. Between 2010 and 2015, the TSP pattern decreased for children, the FVDP remained the same for all age groups, and SP decreased for all age groups. Conclusion: These findings can aid in designing, monitoring, and evaluating food education intervention strategies with a differential approach and an emphasis on the traditional Colombian dietary pattern, according to the life cycle stage.

Prevalence and correlates of vitamin D deficiency in a tropical setting: results from a nationally representative survey.

BACKGROUND: The prevalence of vitamin D deficiency (VDD) may be high in countries with abundant sun exposure year-round, but nationally representative data are lacking. OBJECTIVE: We examined the prevalence and distribution of VDD by individual and environmental characteristics in a nationally representative sample of Colombian children, pregnant women, and adult nonpregnant women. METHODS: Using the 2015 Colombian National Nutrition Survey, we defined VDD and low vitamin D (LVD) as serum 25-hydroxyvitamin D [25(OH)D] <30 nmol/L and <50 nmol/L, respectively, in 31,841 children aged 1 to <18 y, 1262 pregnant women, and 7170 nonpregnant women aged 18-49 y. Within each group, we compared VDD and LVD prevalence by levels of sociodemographic, anthropometric, and geographic factors using adjusted prevalence ratios with 95% CIs from multivariable Poisson regression. RESULTS: The mean ± SE 25(OH)D was 65.1 ± 0.4 nmol/L. The prevalence ± SE of VDD and LVD was 3.1% ± 0.3% and 23.9% ± 0.8%, respectively. Pregnant women had the highest VDD prevalence at 6.7% ± 1.5%, whereas toddlers had the highest prevalence of LVD at 42.5% ± 1.8%. Altitude was one of the strongest correlates of VDD and LVD, with every 100 m above sea level related to a 4% increase in LVD prevalence (P <0.0001). Among children, VDD was positively associated with BMI-for-age Z >1 and maternal education. Among pregnant women, VDD was positively related to education. Among adult nonpregnant women, VDD was associated with BMI and household wealth. CONCLUSION: The prevalence of VDD and LVD in Colombian women and children is nonnegligible; some age groups are disproportionately affected. Altitude was a strong predictor of vitamin D status in this tropical setting. VDD was positively related to indicators of higher socioeconomic status.

Inseguridad alimentaria y desarrollo humano predicen la incidencia de cáncer colorectal en Colombia: Estudio ecológico / Food insecurity and human development predict colorectal cancer incidence in Colombia: an ecological study

Resumen Introducción: la inseguridad alimentaria (INSA) ha sido asociada a la generación de enfermedad crónica y como barrera en el tratamiento del cáncer. Ante la ausencia de estudios, establecimos a nivel ecológico la relación entre INSA y la tasa de incidencia de cáncer de colon, recto y ano x 100.000 habitantes (ICCRA). Objetivo: el objetivo fue establecer el grado de asociación entre la inseguridad alimentaria y la tasa de incidencia de cáncer colorrectal x 100.000 habitantes. Materiales y métodos: estudio ecológico realizado con información secundaria que producen regularmente las agencias del estado y que miden el nivel de desarrollo humano, social y económico en el territorio en las 33 unidades geodemográficas que conforman a Colombia. Utilizando regresión lineal múltiple con la ICCRA como la variable dependiente, la INSA como principal explicatoria y otras variables del contexto, establecimos la relación entre INSA y la ICCRA y ecuaciones predictivas de la ICCRA por sexo. La bondad de ajuste en los modelos se garantizó mediante el coeficiente de determinación (R2) y el método de Bland y Almant. Resultados: la INSA se relaciona de manera inversa y el IDH de manera directa con la ICCRA. Dos ecuaciones predicen la ICCRA; En hombres, [ICCRA=-6,38+-0,25*INSA+35,5*IDH]. En Mujeres, [ICCRA=6,47+-0,23*INSA+19,1*IDH]. El coeficiente de determinación R2 (%) en hombres es de 88 y en mujeres de 72. La diferencia media entre ICCRA observada versus la estimada fue de -0,00 en hombres (IC95 %: -3,13 a 3,13), y en mujeres de -0,00 (IC95 %: -4,08 a 4,08) Conclusión: la INSA puede estar en la vía causal de la ICCRA. La INSA y el IDH predicen con precisión la ICCRA.

Abstract Introduction: food insecurity (FI) has been associated with the generation of chronic disease and as a barrier in the treatment of cancer. Food insecurity leads to nutrient-poor diets, including dietary fiber. Colon cancer in Colombia is the third cause of death and its incidence is increasing. Objective: the objective was to establish the degree of association between food insecurity and the incidence rate of colorectal cancer x 100.000 inhabitants. Methods: ecological study carried out with information that measure the level of human, social and economic development in the territory of the 24 geodemographic units that make up Colombia. Using multiple linear regressions with colorectal cancer as the dependent variable, food insecurity as the main explanatory and other variables of the context, we established the relationship between food insecurity and colorectal cancer and predictive equations of colorectal cancer. The goodness of fit in the models was the coefficient of determination (R2) and the Bland and Alman method. Results: food insecurity is related in an inverse manner, and the human development Index is directly related to colorectal cancer. Two equations predict colorectal cancer with precision; Men, [colorectal-cancer = -6.38 + -0.25 * food-insecurity + 35.5 * human development Index]. Women, [colorectal-cancer = 6.47 + -0.23 * food-insecurity + 19.1* human development index]. The average difference between colorectal cancer observed versus the estimated, was -0.00 in men (95% CI: -3.13 to 3.13), and in women of -0.00 (95% CI: -4.08 to 4.08). Conclusion: food insecurity may be in the causal pathway of colorectal cancer. Food insecurity and the human development Index predict colorectal cancer.

Red meat and egg intake and serum ferritin concentrations in Colombian children: results of a population survey, ENSIN-2015.

The present study aimed to (a) establish the frequency of consumption of red meat and eggs; (b) determine serum ferritin levels (µg/l); and (c) establish the relationship between serum ferritin and the consumption of red meat and eggs. In Colombia during 2014-2018, an analytical study was conducted in 13 243 Colombian children between the ages of 5 and 17 years, based on cross-sectional data compiled by ENSIN-2015 (Encuesta Nacional de la Situación Nutricional en Colombia-2015) on serum ferritin levels and dietary consumption based on a questionnaire of the frequency of consumption. Using simple and multiple linear regression, with the serum ferritin level as the dependent variable and the frequency of consumption as the main explanatory variable, the crude and adjusted partial regression coefficients (ß) between serum ferritin levels and consumption were calculated. The frequency of habitual consumption of red meat was 0⋅49 (95 % CI 0⋅47, 0⋅51) times/d. The frequency of habitual egg consumption was 0⋅76 (95 % CI 0⋅74, 0⋅78) times per d. The mean serum ferritin level in men was 41⋅9 (95 % CI 40⋅6, 43⋅1) µg/l and in women, 35⋅7 (95 % CI 34⋅3, 37⋅7) µg/l (P < 0⋅0001). The adjusted ß between the consumption of red meat and eggs and serum ferritin levels were ß = 3⋅0 (95 % CI 1⋅2, 4⋅7) and ß = 2⋅5 (95 % CI 1⋅0, 3⋅9) for red meat and eggs, respectively. In conclusion, red meat and eggs are determinants of serum ferritin levels in Colombia and, therefore, could be considered public policy options to reduce anaemia and Fe deficiency.

Dietary patterns and breast cancer in Colombia: an ecological study.

BACKGROUND: The role that diet plays in the development of breast cancer is unclear and breast cancer continues to increase in Colombia and worldwide. The objective of this study was to assess the association between patterns of dietary consumption and the incidence of breast cancer. METHODS: An ecological study was conducted in 24 geodemographic units in which 95% of the women of Colombia live. The association between breast cancer rate (dependent variable) and three dietary patterns established with factor analysis (traditional/starch, fiber/dairy and snack) was investigated using simple and multiple linear regression. The use of variables related to socioeconomic context and the duration of breastfeeding allowed for the control of possible confounding. All information was derived from concurrent national surveys or was obtained directly over a period of time close to the period during which the study was conducted. RESULTS: There is an inverse relationship between breast cancer rate and illiteracy rate (ß=-2808.3), duration of breastfeeding (ß=-3354.1), adherence to traditional/fiber dietary patterns (ß=-30467) and adherence to the snack dietary pattern (ß=-43612). The goodness of fit for the model was R2=84%. CONCLUSIONS: Increasing the duration of breastfeeding, ensuring education to promote health and following traditional food consumption patterns, regardless of what foods are consumed, can protect against the development of breast cancer.

Nutrition gap in children, urban-rural: the key education and food. Colombia, 2015 / Brecha nutricional en niños, urbano-rural: educación y alimentos, la clave. Colombia, 2015

ABSTRACT OBJECTIVE: To analyze the nutritional situation of children under five years old from both urban and rural areas of Colombia. METHOD: Analytical study, based on cross-sectional data, collected from ENSIN-2015. The sample consisted of 12,256 children aged between 0 and 4 years old. We calculated the prevalence ratios (PR) with their respective 95% confidence interval (95%CI). PR were assessed by binomial regression models with malnutrition or overweight as the dependent variable and geographic area as the explanatory variable. We used context variables to adjust the estimated PR and control the confounder within. RESULTS: Acute malnutrition (weight-for-height) had a prevalence of 1.6%, while overweight had a 5.6% rate. No differences per geographic zone in the weight-for-height indicator were found. Stunted growth - chronic malnutrition - was higher in the rural area (PR = 1.2; 95%CI 1-1.53; p = 0.050). Prevalences adjusted by variables related to structural, social and economic developement showed that both the household chief's educational level and the food insecurity of the area account for malnutrition. CONCLUSION: The height-for-age indicator works better to establish development level. Measures against coverage, relevance and quality of education and access to food can harm the nutritional status of the children.

RESUMEN OBJETIVO: Analizar el estado de nutrición en menores de cinco años de áreas urbanas y rurales en Colombia. MÉTODOS: Estudio analítico, con base en datos de corte transversal, recolectados por la ENSIN-2015. La muestra fue de 12.256 niños colombianos entre cero y cuatro años. Se calcularon razones de prevalencia (RP) y sus respectivos intervalos al 95% de confianza (IC95%). Las RP se obtuvieron de modelos de regresión binomial con el déficit o el exceso, como la variable dependiente y la zona geográfica como la principal explicación. Variables del contexto se utilizaron para ajustar las RP estimadas y limpiar el efecto confusor de éstas. RESULTADOS: La prevalencia de desnutrición aguda (peso/talla) fue de 1,6%, la de exceso de 5,6%. No existieron diferencias por zona geográfica, en el indicador (peso/talla). El retraso talla/edad - desnutrición crónica - fue mayor en la zona rural (RP = 1,2; IC95% 1,00-1,53; p = 0,050). Las prevalencias ajustadas por variables que dan cuenta del desarrollo estructural, social y económico, mostraron que la escolaridad del jefe y la inseguridad alimentaria del hogar explican la desnutrición. CONCLUSIONES: El indicador talla/edad es el mejor para establecer el nivel de desarrollo. Medidas contra la cobertura, pertinencia, calidad en la educación y el acceso a los alimentos impactarán negativamente el estado de nutrición en los niños.

Adherence to a snacking dietary pattern is decreasing in Colombia among the youngest and the wealthiest: results of two representative national surveys.

BACKGROUND: A common recommendation is to reduce the consumption of snack food and replace this consumption with nutrient-dense foods. The objective was to assess whether in Colombian children and adults there were changes in the consumption of the snack dietary pattern (SP) in the 5 years 2010-2015. In addition, this study aimed to establish the relationship between the SP and some biological, socioeconomic, and geographic variables in Colombia, South America. METHODS: Based on a Food Frequency Questionnaire (FFQ) applied both in 2010 and 2015 in the national nutritional situation surveys, the adherence to the snack consumption pattern was established through factor analysis. The change in the adherence of consumption to the SP was established for the five-year period [2015 minus 2010], using multiple linear regression models. Crude and adjusted differences were estimated by the following covariables: sex, age, marital status, food security, wealth index, ethnicity, education of the head of the household, area and region. In total, 37,981 subjects were analyzed. In 2010, 10,150 children (5 to 17 years old) and 5145 adults (18 to 64 years old) were included, and in 2015, 13,243 children and 9443 adults. RESULTS: In children, the adjusted difference in the adherence to SP was - 0.37 (95% CI: - 0.42, - 0.32). In adults, the adjusted difference in the adherence to SP was - 0.27 (95% CI: - 0.31, - 0.24). In all categories of covariables, consumption decreased, for all p < 0.0001. In children, the decrease in consumption was inversely associated with height-age. The decrease was smaller at the extremes of the BMI distribution, Z < -2 and Z > 2. The decrease in consumption was directly associated with the level of food security in the home and the wealth index. In adults, the decrease in consumption was inversely related to age and was directly related to the level of food security of the household, wealth index, and education level. The BMI decrease was greater in subjects with 18.5-24.9. In subjects with 30+, it was lower than in subjects with 25.0-29.9. CONCLUSIONS: In the 5 years 2010-2015, snack consumption is decreasing. The region, the richest subjects, those with adequate BMI, and in households with more educated heads of household, achieved a greater decrease in SP.

Cambios alimentarios en Colombia; resultados de dos encuestas nacionales de nutrición, 2010-2015 / Food changes in Colombia; results of two national nutrition surveys, 2010-2015

Resumen Introducción: Colombia experimenta una transición alimentaria sumada a la nutricional. Objetivo: Establecer en Colombia para el período 2010-2015 la prevalencia y la frecuencia/día del consumo usual de 28 alimentos y dos prácticas de interés para la nutrición pública. Además, establecer las diferencias en la prevalencia y frecuencia/día entre años. Metodología: Estudio analítico en población entre 5 y 64 años, con datos de corte transversal recolectados en las dos últimas Encuestas Nacionales de Situación Nutricional en Colombia, ENSIN-2010 y 2015. Los datos de consumo fueron los obtenidos a través de un Cuestionario de Frecuencia de Consumo. A través de modelos de regresión lineal se estimaron las diferencias crudas y ajustadas para la prevalencia y la frecuencia/día del consumo usual de 28 alimentos y dos prácticas asociadas. Resultados: En el período 2010-2015, en los niños, la prevalencia de consumo de leche, carne, atún, vísceras, leguminosas, pan, tubérculos, azúcar, gaseosas y alimentos fritos disminuyó, al igual que la de verduras y frutas. En los adultos, la prevalencia de leche, carne, atún, vísceras, pan, tubérculos, azúcar, alimentos fritos y alimentos light disminuyó, al igual que la de verduras y frutas. En niños y adultos la prevalencia de consumo de alimentos de paquete aumentó, pero su frecuencia/día disminuyó. La prevalencia de uso del salero disminuyó en niños y adultos, pero su frecuencia/día aumentó. Discusión: El cambio alimentario establecido es similar en niños y adultos confirmando que la cultura alimentaria se hereda socialmente y se transmite de manera vertical entre padres e hijos. Conclusiones: Colombia experimenta una transición alimentaria. Se requiere política pública para orientar el consumo.

Abstract Introduction: Colombia experiences a food transition coupled with nutritional transition. Objective: Establish in Colombia for the period 2010-2015 the prevalence and frequency/day of the usual consumption of 28 foods and two practices of interest for public nutrition. Also, establish differences in prevalence and frequency/day between years. Methodology: Analytical study in population between 5 and 64 years, with cross-sectional data collected in the last two National Surveys of Nutritional Situation in Colombia, ENSIN-2010 and 2015. The consumption data were obtained through a Food Frequency Questionnaire. Through linear regression models, raw and adjusted differences were estimated for the prevalence and frequency/day of usual consumption of 28 foods and two associated practices. Results: In the 2010-2015 period, in children, the prevalence of consumption of milk, meat, tuna, viscera, legumes, bread, tubers, sugar, soft drinks, and fried foods decreased, as did those of vegetables and fruits. In adults, the prevalence of milk, meat, tuna, offal, bread, tubers, sugar, fried foods, and light foods decreased, as did those of vegetables and fruits. In children and adults, the prevalence of packaged food consumption increased, but its frequency/day decreased. The prevalence of saltshaker use decreased in children and adults, but its frequency/day increased. Conclusions: The established dietary change is similar in children and adults confirming that the food culture is inherited socially and transmitted vertically between parents and children. Colombia experiences a food transition. Public policy is required to guide food consumption.

Food Changes and Geography: Dietary Transition in Colombia.

BACKGROUND: The food transition can no longer be studied in developed countries because the so-called Western diet now predominates in these areas. However, in developing countries, it is still possible to study the food transition. It is a novel concept that complements other transitions such as the demographic, economic, nutritional and epidemiological transitions. OBJECTIVES: The objectives of this study were to a) estimate the average departmental adherence to the three pre-established food patterns, b) assess adherence patterns based on the Global Spatial Analysis, c) evaluate whether the Local Spatial Variations in the adherence to food patterns are random or follow defined patterns (cluster) and d) generate 2D maps to graphically locate the food patterns that compose the phenomenon of the food transition occurring in Colombia. METHODS: The National Survey of the Nutritional Situation in Colombia, 2010 was analyzed. Based on factor analysis, three consumption patterns were established; Protein/Fiber, Snack and Snack and Traditional/Starch and the average departmental adhesion was estimated. The global and local spatial variation was calculated with the Moran indexes. FINDINGS: the average adherence to the traditional consumption/starch pattern was -0.00 (95% CI: -0.12 to 0.12). The mean adherence to the protein/fiber intake pattern was -0.07 (95% CI: -0.16 to 0.03). The average adherence to the pattern of snack consumption was -0.03 (95% CI: -0.11 to 0.05). The three patterns of food consumption values for the Global Total Moran Index, for men and women were positive and statistically significant. CONCLUSIONS: The food transition experienced by Colombia is not homogeneous and there are well defined clusters for adherence in the three predefined food patterns. Within the clusters there are differences by sex. In regions where the traditional pattern/starch predominates, the presence of the snack pattern is very weak.

Patrones de consumo alimentario y pobreza monetaria en Colombia / Food consumption patterns and monetary poverty in Colombia

RESUMEN Se estimaron las desigualdades en tres patrones de consumo alimentario en adultos colombianos (18 y 64 años) relacionadas con la pobreza monetaria. Se realizó un estudio ecológico, que relacionó la pobreza monetaria de 33 unidades geo-demográficas con tres patrones de consumo obtenidos mediante análisis de factores de la Encuesta Nacional de Situación Nutricional en Colombia- 2010. Utilizando Epidat v. 4.2®, se calcularon índices de desigualdad basados en rangos, disparidad o dispersión, en desproporcionalidad, basados en modelos de regresión y los basados en el concepto de entropía. El coeficiente de determinación (r2) para el patrón frutaverdura/lácteos fue de 0,30; para el patrón tradicional/almidón de 0,08 y para el patrón snack de 0,00. La razón de tasas más alta fue para el patrón fruta-verdura/lácteos (2,61), seguida por la razón para el patrón tradicional/almidón (0,93) y la más baja para el patrón snack (0,85). La desigualdad, alcanzó el mayor coeficiente de Gini en el patrón de consumo snack (0,26), le sigue el alcanzado en el patrón tradicional/almidón (0,17) y el fruta-verdura/lácteos (0,12). Concluimos que la mayor desigualdad ocurrió en el patrón de consumo fruta-verdura/lácteos, es deseable aumentar la adherencia la patrón tradicional y disminuir la ingesta de proteínas en los más ricos.

ABSTRACT We estimated the inequalities in three patterns of food consumption in Colombian adults (18 and 64 years) related to monetary poverty. An ecological study was conducted, which linked the monetary poverty of 33 geo-demographic units with three consumption patterns obtained through factor analysis using the National Nutrition Situation Survey in Colombia-2010. Using Epidat v. 4.2®, inequality indexes based on ranges, disparity or dispersion were calculated, in disproportionality, based on regression models and those based on the concept of entropy. The determination coefficient (r2) for the fruit-vegetable/dairy pattern was 0.30, 0.08 for the traditional pattern/starch, 0.00 and for the snack pattern. The highest rate ratio was for the fruit-vegetable/dairy pattern (2.61), followed by the ratio for the traditional pattern/starch (0.93), and the lowest for the snack pattern (0.85). Inequality reached the highest Gini coefficient in the pattern of snack consumption (0.26), followed by that reached in the traditional pattern/starch (0.17) and the fruit-vegetable/dairy pattern (0.12). We showed that the greatest inequality occurred in the fruit-vegetable / dairy consumption pattern, it is desirable to increase the adherence to the traditional pattern and decrease the protein intake in the richest population.

Consumption of sweetened-beverages and poverty in Colombia: when access is not an advantage.

BACKGROUND: This study characterizes the intake of sweetened beverages and establishes whether economic inequalities in their consumption exists. METHODS: Ecological study. Mixed methods using food frequency questionnaire and inequality indices. Based on the National Nutrition Survey, Colombia, 2010. The sweetened beverage intake of 17,514 subjects in 33 geodemographic units was estimated with a food frequency questionnaire and summarized. The calculation of inequality was based on the monetary poverty. The prevalence (yes/no) and frequency (times/day) of sweetened beverage consumption were estimated. Indices of economic inequality were calculated for both prevalence and frequency. RESULTS: The prevalence of sweetened beverage consumption was between 79.2% (95% CI, 75.7 to 82.8) in adults and 88.5% (95% CI, 85.8 to 91.3) in minors. The frequency of consumption in terms of times/day, was between 0.20 (95% CI, 0.16 to 0.24) in adults and 0.40 (95% CI, 0.33 to 0.46) in minors. The Gini coefficient for the prevalence was close to zero, between 0.04 and 0.08; for the frequency, it was slightly higher, between 0.12 and 0.25. CONCLUSIONS: It was established that there is no economic inequality in the consumption of sweetened beverages. Consumption taxes could be regressive.

Trends in Iron, Zinc, and Vitamin A Status Biomarkers Among Colombian Children: Results From 2 Nationally Representative Surveys.

BACKGROUND: Micronutrient deficiencies are still highly prevalent in countries undergoing the nutrition transition, but nationally representative data documenting their burden in children are exceedingly rare. OBJECTIVE: To examine the distribution and recent trends in micronutrient status biomarkers of Colombian children. METHODS: We compared the distributions of plasma ferritin, serum zinc, and vitamin A in Colombian children between 2005 and 2010 using 2 cross-sectional, nationally representative surveys overall and by categories of sociodemographic variables. Analysis for ferritin included boys and nonpregnant girls aged 1 to 17 years. Analyses for zinc and vitamin A included children aged 1 to 4 years. RESULTS: The mean 2010 to 2005 differences in ferritin, zinc, and vitamin A were 2.5 µg/L (95% confidence interval [CI]: 1.3 to 3.7), -34.9 µg/dL (95% CI: -39.6 to -30.2), and -11.5 µg/dL (95% CI: -12.3 to -10.7), respectively, after adjusting for sociodemographic characteristics. These differences varied significantly by region of residence. In 2010, region of residence was a significant correlate for all 3 micronutrients. Other important correlates included age and maternal education for ferritin and body mass index-for-age Z score, maternal education, wealth index, food insecurity, and urbanicity for vitamin A. CONCLUSIONS: Plasma ferritin was slightly higher in 2010 than in 2005, whereas serum zinc and vitamin A were substantially lower in 2010. In the absence of obvious causal explanations, it is uncertain whether this decline represents a worsening of micronutrient status in Colombian children or an artifact due to systematic laboratory or data management errors incurred in the surveys.

Dietary transition and excess weight in adults according to the Encuesta de la Situación Nutricional en Colombia, 2010.

INTRODUCTION: Dietary transition is codetermined by demographic and nutritional transitions.  OBJECTIVES: To establish the prevalence of overweight individuals among Colombians aged 18 to 64, identify their dietary patterns and establish the relationship between this and their excess weight.  MATERIALS AND METHODS: We analyzed the Encuesta de la Situación Nutricional en Colombia, 2010 (National Survey of the Nutritional Situation in Colombia, 2010). Dietary patterns were established with factor analysis in 5,217 subjects, who answered a questionnaire on food consumption frequency. The relationship between excess weight and adherence to quartiles in the patterns was established with binomial regression.  RESULTS: The prevalence of excess weight was 47.4% in men (95% CI: 44.7; 50.0) and 57.1% in women (95% CI: 54.9; 59.3, p<0.0001). Three patterns were established: protein/fiber, sandwich/snack and traditional/starch. When the models were adjusted for age, sex and level of food security in the home, the protein/fiber and traditional/starch patterns were found to be associated with excess weight (test of linear trend for quartiles of adherence, p=0.007 and p=0.001, respectively). Neither the frequency of consumption of carbonated and sugary drinks, with an adjusted relative risk of 100 (95% CI: 93 - 109; p=0.913), nor that of fast food with 102 (95% CI: 89; 117; p=0.759) were associated with excess weight.  CONCLUSIONS: Excess weight increases constantly with age, particularly in women, and is associated positively with indicators of socioeconomic status and subjects changing from the traditional/starch pattern to the protein/fiber one.