Normative Fecal Calprotectin Concentrations in Guatemalan Preschoolers Are High Relative to Children Reported Elsewhere.

BACKGROUND: Calprotectin is a fecal marker of intraintestinal inflammation derived from activated enteric neutrophils and macrophages. It is useful as a clinical marker in inflammatory bowel diseases; furthermore, it may have a role in public health epidemiology. OBJECTIVES: The aim of the study was to describe the distribution of fecal calprotectin in Guatemalan preschool children sharing a common institutional diet; to relate it collectively to pediatric distributions in other geographic settings, and individually to concomitant indicators of intestinal infection or colonization and other descriptive features of the child. METHODS: Fecal samples were collected in 87 subjects, ages 2 to 7 years across 3 daycare centers sharing a common institutional menu, but from different ecological settings. Stools were examined, variously by routine light microscopy, quantitative egg counts, and a Giardia antigen test, for microbiological diagnosis, and an ELISA assay for fecal calprotectin (CalproLab). RESULTS: The median fecal calprotectin value was 58 mg/kg, with a mean of 98 ±â€Š136 mg/kg and a range from 10 to 950 mg/kg; 61% of values were above the manufacturer's cut-off for elevated concentration and 51% exceeded an age-adjusted criterion. There were no associations between sex, age, growth indicators, or fecal microbiological findings by microscopy or ELISA assays, alone or in combination. The central tendency (mean or median) and distribution were generally shifted to the right in relation to comparable reports from children across the world literature. CONCLUSIONS: Although specific, low-grade intestinal infections do not define calprotectin subgroups, right-shifted fecal calprotectin status in this population may reflect a general and diffuse stress of adverse environmental sanitation.

Vitamin D status among indigenous Mayan (Kekchi) and Afro-Caribe (Garifuna) adolescents from Guatemala: a comparative description between two ethnic groups residing on the Rio Dulce at the Caribbean coast in Izabal Province, Guatemala.

OBJECTIVE: To assess vitamin D status and the influence of risk factors such as skin pigmentation and time spent outdoors on hypovitaminosis D among Guatemalan Kekchi and Garifuna adolescents. DESIGN: Cross-sectional study, with convenient sampling design. Blood samples, anthropometric and behavioural data were all collected during the dry season. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were measured by RIA. SETTING: Communities of Rio Dulce and Livingston, Izabal Province, Caribbean coast of Guatemala, with latitude and longitude of 15°49'N and 88°45'W for Livingston and 15°46'N and 88°49'W for Rio Dulce, respectively. SUBJECTS: Eighty-six adolescents, divided evenly by sex and ethnicity, with mean age of 14 years. RESULTS: Mean (sd) 25(OH)D value was 27·8 (7·2) ng/ml for the total group, with 25·8 (5·9) and 29·8 (7·9) ng/ml, respectively, in Kekchis and Garifunas (P=0·01). Use of vitamin D supplementation, clothing practices and sun protection were not statistically different between groups. Skin area exposed on the day of data collection ranged from 20·0 % minimum to 49·4 % maximum, with mean (sd) exposure of 32·0 (8.5) %. With univariate regression analysis, age (P=0·034), sex (P=0·044), ethnicity (P=0·010), time spent outdoors (P=0·006) and percentage skin area exposed (P=0·001) were predictive. However, multivariate analysis indicated that only sex (P=0·034) and percentage skin area exposed (P=0·044) remained as predictors of 25(OH)D. CONCLUSIONS: Despite residing in an optimal geographic location for sunlight exposure, nearly 65 % of study adolescents were either insufficient or deficient in vitamin D. Correction and long-term prevention of this nutritional problem may be instrumental in avoiding adverse effects in adulthood attributed to low 25(OH)D during adolescence.

The Nutritional Contribution of Foods and Beverages Provided by Government-Sponsored Day Care Centers in Guatemala.

BACKGROUND: Meals served at government-run day care centers must be nutritionally adequate to ensure good health and proper development of preschool-aged children. They can provide a controlled opportunity to complement the daily diet of children in vulnerable populations. OBJECTIVE: To determine the nutrient adequacy and leading food sources of nutrients provided by the diet served in government-sponsored day care centers. METHODS: Estimated daily energy and nutrient intakes of a theoretical 40-day day care center menu were calculated, and the nutrient adequacy was assessed. Nutrient densities and critical nutrient densities of the menu were computed to identify nutrient inadequacies. Furthermore, main sources of nutrients were identified, and energy and nutrient distributions were examined by meal time. RESULTS: The menu provides approximately 90% of daily energy requirement and more than 100% of Recommended Nutrient Intakes (RNIs), with the exception of vitamin D and calcium. Sugar was the first leading source of energy, whereas milk was the first leading contributor of vitamin D. CONCLUSION: Within an environment of budgetary constraints, the Guatemalan government developed and advocated an exemplary menu offering for children in the vulnerable preschool period. We have demonstrated that, if prepared and served as planned, the items from the official, standard menu would supply most of the nutrients needed. High vitamin A intake related to the mandated national fortification program is a potential problem. From the analysis, it was found that vitamin D emerges as the most prominent candidate for a problem nutrient of deficient intake.

Associations among Inflammatory Biomarkers in the Circulating, Plasmatic, Salivary and Intraluminal Anatomical Compartments in Apparently Healthy Preschool Children from the Western Highlands of Guatemala.

BACKGROUND: Undernutrition and inflammation are related in many ways; for instance, non-hygienic environments are associated with both poor growth and immunostimulation in children. OBJECTIVE: To describe any existing interaction among different inflammation biomarkers measured in the distinct anatomical compartments of whole blood, feces, plasma and saliva. METHODS: In this descriptive, cross-sectional study, samples of whole blood, feces, plasma and saliva were collected on the 8th and last week of observation among 87 attendees (42 girls and 45 boys) of 3 daycare centers offering a common 40-day rotating menu in Guatemala's Western Highlands. Analyses included white blood cell count (WBC), fecal calprotectin, and plasmatic and salivary cytokines including IL-1B, IL-6, IL-8, IL-10 and TNF-α. Associations were assessed using Spearman rank-order and goodness-of-fit correlations, as indicated, followed by backwards-elimination multiple regression analyses to determine predictor variables for IL-10 in both anatomical compartments. RESULTS: Of a total of 66 cross-tabulations in the Spearman hemi-matrix, 22 (33%) were significantly associated. All 10 paired associations among the salivary cytokines had a significant r value, whereas 7 of 10 possible associations among plasma cytokines were significant. Associations across anatomical compartments, however, were rarely significant. IL-10 in both biological fluids were higher than corresponding reference values. When a multiple regression model was run in order to determine independent predictors for IL-10 in each anatomical compartment separately, IL-6, IL-8 and TNF-α emerged as predictors in plasma (r2 = 0.514) and IL-1B, IL-8 and TNF-α remained as independent predictors in saliva (r2 = 0.762). Significant cross-interactions were seen with WBC, but not with fecal calprotectin. CONCLUSION: Interactions ranged from robust within the same anatomical compartment to limited to nil across distinct anatomical compartments. The prominence of the anti-inflammatory cytokine, IL-10, in both plasma and saliva is consistent with its counter-regulatory role facing a broad front of elevated pro-inflammatory cytokines in the same compartment.

Erythrocyte fatty acid status in a convenience sample of residents of the Guatemalan Pacific coastal plain.

We report the fatty acid composition, and in particular, the n-3 and n-6 long-chain polyunsaturated fatty acids (LCPUFA), in erythrocytes from a convenience sample of 158 women and 135 schoolchildren residing in the southern Pacific Coast of Guatemala. Erythrocyte fatty acids were analyzed by gas-liquid chromatography with flame ionization detection and the profiles were expressed as a weight percent; the Omega-3 Index values were also determined. Schoolchildren had significantly higher mean ARA and total n-6 fatty acid levels than the women. Women had significantly higher EPA fatty acid levels than schoolchildren, but the reverse was true for DHA. For mean total n-3 fatty acid concentration, women and schoolchildren had similar values. The red cell weight percentages of selected fatty acids were also similar in women and schoolchildren. As compared with erythrocyte fatty acid data from developed countries, Guatemalan women and schoolchildren had consistently lower LCPUFA values. The traditional diet of Guatemalans living in the Pacific coastal region provided a worse erythrocyte fatty acid profile than that typically obtained from a Western diet. Additional fatty acid composition studies with associated dietary intake data in other inland locations may be useful for the interpretation of the nutritional status of Guatemalan children and adults.

Evaluating food menus from daycare centers in Guatemala City: descriptive and analytical approaches.

OBJECTIVE: This objective of this study was a methodological analysis of the variety and diversity of dietary items and their different origins offered in institutional menus across four daycare centers serving low-income families in Guatemala City. METHODS: Foods, as served in daycare centers, were used to explore and illustrate the different approaches to evaluating food quality. Foods served at daycare centers were analyzed for variety (number of different items) and diversity (using three food-classification systems). The weight and energy contributions for each meal were reported for animal, plant, mixed, or water; modern versus traditional foods; fortified versus non-fortified foods; and processed versus unprocessed foods. RESULTS: During 5 d of observation, three of the four daycare centers served 100% of the food groups of the current Guatemalan and international classification systems. In addition, the results showed the four daycare centers provided mainly traditional and non-fortified plant-based foods. However, although the traditional foods contributed more by weight, the modern foods contributed more energy. These findings showed that the "modern" foods served at daycare centers are energy dense compared with traditional foods. CONCLUSIONS: These daycare centers contributed to variety and diversity while serving mainly traditional, plant-based foods. Our analysis went beyond the simple existence (mention) of a food as consumed to weight in grams or calories to provide potentially new and useful perspectives for understanding how guidelines for healthful eating patterns can be promoted and assessed, not only in children or in institutions but across all age groups, and settings.

Contribution of complementary food nutrients to estimated total nutrient intakes for urban Guatemalan infants in the second semester of life.

Complementary foods (CF) are introduced earlier or later than appropriate in developing societies. They often contribute poorly to overall adequate micronutrient intake during the critical period for growth and development, which constitutes the period from 6 to 12 months of life. The objective of this study was to determine the contribution of the CF nutrients to the total estimated nutrient intake in infants in the second semester of life. Three non-consecutive 24-hour recalls interviews were conducted with mothers of 64 infants, aged 6-12 months on enrolment, from a convenience sample in a marginal urban settlement in Guatemala City. Retrospective recording of early introduction of pre- and post-lacteal feeding and introduction of first foods and beverages was included. Human milk intakes were estimated by a model based on assumptions that human milk plus CF exactly satisfied the infant's daily energy needs. The WHO/FAO Recommended Nutrient Intakes (RNI) were the standards for adequate nutrient consumption. Instances of exclusive breast feeding to 6 months were rare, with the introduction of CF earlier than recommended. Baby food in jars was mentioned most frequently as the first food offered. The contribution of CF increased with age through the second semester of life. CF contributed more of a nutrient than human milk in all instances. However,CF nutrient density for Ca, Fe, and Zn fell below international standard. Fortified sugar contributed excessive amounts of Vitamin A to the diets. We conclude that for most nutrients, intakes reached or exceeded recommendation levels, unusual within the CF experience in scientific literature.

Food variety, dietary diversity, and food characteristics among convenience samples of Guatemalan women.

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.

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.

Nutrient offerings from the meals and snacks served in four daycare centers in Guatemala City.

OBJECTIVE: To assess the nutritional content and contribution to recommended nutrient intakes of the menu offerings in diverse daycare centers serving low-income urban families in Guatemala City. METHODS: An observational study design was used to record all food and drink items offered to children attending four daycare centers on 5 different days of the week to represent a typical week (20 d). Direct recording of menus, weighing of ingredients used, and the preparation of dishes and drinks were undertaken. Estimated energy, macronutrients, and eight selected micronutrients were assessed and related to the Food and Agriculture Organization/World Health Organization recommended nutrient intakes. Nutrient densities and critical densities were computed. The diet was also assessed separately by meal time. Top sources of energy and nutrients were identified. RESULTS: The quantity and quality of food items provided at the four daycare centers examined varied greatly. For some nutrients, the recommended nutrient intakes were already accounted for by the food consumed from the institutional fare. As expected, those centers with more meal times covered on their menus had a greater degree of coverage of requirements. Adequacy ratios were above 100% for eight, seven, three, and one of nine nutrients examined for centers A, B, C, and D, respectively. When intakes were compared using nutrient density, all significances were abolished across all nutrients of interest. CONCLUSION: The present descriptive analysis provides the basis for suggesting reforms at the specific centers and for understanding the generic challenges and opportunities across the system for low-income attendees in Guatemala City.

Contribution of complementary food nutrients to estimated total nutrient intakes for rural Guatemalan infants in the second semester of life.

BACKGROUND: In developing countries, complementary foods are often introduced earlier or later than appropriate and the quality is frequently insufficient, particularly in rural areas where complementary foods have traditionally been based on starchy gruels. Adequate intakes of a number of nutrients are recognized to be problematic in traditional complementary feeding regimens in developing societies. AIM: To determine the contribution of the complementary feeding nutrients to the estimated total nutrient intake in Guatemalan infants. METHODS: Three non-consecutive 24-hr recalls were collected from a convenience sample of mothers of 64 infants, aged 6-12 month on enrolment, in the rural Guatemalan highland village of Santo Domingo Xenacoj. Additional information on early introduction of pre- and post-lacteal feeds and on first foods and beverages was included. Human milk intakes were estimated by a model based on assumptions regarding satisfaction of weight-based daily energy needs by the combined diet. The 2004 WHO/FAO recommended nutrient intakes were used as the standard for adequate nutrient consumption. RESULTS: We observed that exclusive breastfeeding up to 6 month is rare. Mean nutrient intakes and densities were above recommended intakes for all nutrients examined, except calcium, iron and zinc. Intakes of most nutrients were greater from the complementary feeding component of the diet. Vitamin A intake was excessive due to consumption of fortified sugar. CONCLUSIONS: We conclude that intakes of most micronutrients were near recommendation levels, unusual within the complementary feeding experience in scientific literature. Calcium, iron and zinc were identified as "problem nutrients" as persistently reported in developing countries.

The positive deviance approach can be used to create culturally appropriate eating guides compatible with reduced cancer risk.

The 1997 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Report provides 14 individual guidelines to reduce global cancer risk. The positive deviance approach could be appropriate for creating class-appropriate, healthy eating menu guides for consuming a diet to minimize cancer risk in Guatemala. Guatemalan adult participants (n = 873) were enrolled in the Concordance Project from 3 socioeconomic strata: rural area (n = 301), lower urban (n = 298), and higher urban (n = 274). Participants with intakes below recommended nutrient intakes and current smokers were excluded from the analysis. Concordance with 14 selected WCRF/AICR individual guideline components was evaluated. We selected participants for making a set of 14 rotating menus for a cancer prevention healthy eating guide. A priority sorting through the 873 participants of the survey identified a total of 23 and 21 model participants, respectively, from the rural and urban poor groups (concordant with 12 of 14 recommendation components) and 15 from the urban middle class (concordant with 11 of 14 recommendation components), with the highest degree of concordance with the WCRF/AICR guidelines. The most commonly violated recommendation was sugar consumption, followed by maintaining weight stability. The FFQ for 14 individuals from each class were transformed into a day menu to create a rotating diet guide derived from members of each social group. A potentially useful personal guide for eating compatibly with adequate nutrient intake and reduced cancer risk, appropriate to the culture and economic means of distinct social classes in Guatemala, is approaching the stage for application.