1 McGill University, Montreal, QC, Canada
2 CeSSIAM, Guatemala City, Guatemala
Background: It is well known that certain maternal infections impair infant growth. Less clear is whether subclinical asymptomatic breast inflammation during the first six months of lactation will also retard infant growth. During subclinical mastitis, a common inflammatory condition of the lactating breast, tight epithelial junctions become “leaky” allowing for movement of sodium and potassium, pro-inflammatory cytokines, and growth factors into milk via the paracellular pathway.
Objective: The objectives of this longitudinal study were to: (1) to explore the consequences of maternal infection on infant weight-for-age (WAZ), length-for-age (LAZ) and headcircumference-for-age (HCZ) at two stages of lactation; (2) and to investigate the relative contribution of milk pro-inflammatory cytokines and growth factors to infant
anthropometry.
Methods: Breast milk samples were collected from a cohort of lactating Mam-Mayan mothers during early (0-6 wks, n=134) and established lactation (4-6 mo, n=120). Inductively Coupled Plasma Mass Spectrometry measured milk Na and K. Luminex measured milk pro-inflammatory cytokines (IL-1, IL-6, IL-8, TNF-α) and growth factors (EGF, VEGF). Analysis for presence of maternal urine leukocytes and direct smear of maternal stool samples for non-pathogenic protozoa (Blastocystis hominis, Entamoeba coli, Iodamoeba butschli and Endolimax nana) were measured. Independent variables for breast leakiness (Na/K ratio), breast inflammation, maternal infection and growth factors in milk were explored in separate multiple linear regression models for LAZ, WAZ and HCZ in early and in established lactation.
Results: Breast leakiness, as measured by a higher Na/K ratio, was positively correlated with all pro-inflammatory cytokines in early lactation but in established lactation, only milk IL-6 was positively correlated with Na/K ratio. In early lactation, LAZ was positively associated with maternal height and urine leukocytes. WAZ was positively associated with maternal weight and negatively with milk Na/K ratio and maternal stool Blastocystis hominis. HCZ was also negatively associated with milk Na/K ratio and maternal stool Blastocystis hominis but positively with the pro-inflammatory cytokine IL-6 in milk. In established lactation, LAZ was positively associated with maternal height but negatively with maternal stool Entamoeba coli and EGF in milk. WAZ was also negatively associated with maternal stool Entamoeba coli and positively with maternal weight and milk pro-inflammatory cytokine TFN-α. HCZ was positively associated with maternal height and the milk pro-inflammatory cytokine IL-6 but negatively with EGF in milk.
Conclusion: Our integrative approach shows that non-pathogenic protozoa in maternal stool and breast leakiness contribute to poor infant growth. However, in contrast to our expectation that pro-inflammatory cytokines in milk would retard infant growth and that growth factors would promote infant growth, we observed the opposite to be true which suggests a more complex interrelationship among maternal infection, breast inflammation and infant growth than previously understood.
1 School of medicine, Tufts University, Boston, MA
2 Center for the Study of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala
Background: Stunted adults have higher risk for chronic diseases, but scarce information on its prevalence exist in Guatemala.
Objective: Our aim was to access prevalence of stunting estimations using total vs. height adjusted with knee height (KH) in older (≥60 y) Guatemalan adults. We also aimed at estimating body mass index (BMI, kg/m2) with both sets of height estimators.
Methods: We recruited 52 men and 72 women from Quetzaltenango City, Guatemala. We measured their total (TH) and KH in cm and weight in kg. T-tests and correlation models were tested to assess differences in stunting prevalence using TH or KH, plus BMI (kg/m2) estimates using either TH or KH. Adult stunting was defined as height below 150 cm and 145 cm in men and women respectively.
Results: KH (cm) for men and women (M/W) were 48.7±2.3/44.4±2.1, p<0.001, and TH adjusted by KH were 157.4±4.3 / 144.4±4.2, p<0.001, as compared to measured TH of 156.3±6.6 / 144.0±6.4, p<0.001. Weights (kg) were 58.7±10.7 / 55.2±13.2, p>0.05. BMI (kg/m2) with TH as compared to the KH adjusted, were 23.8 vs. 23.5 for men and 26.4 vs. 26.3, with p>0.05 in both cases. Correlation coefficients for TH and KH were 0.90, p<0.01, and for BMI-TH vs. BMI-KH resulted in 0.96, p<0.001. Stunting prevalence was 52.8% for women and 13.7% for men. Stunted vs. non-stunted women had a significantly higher torso:leg ratio, an indication of short legs. This was not replicated with men.
Conclusions: Estimates of stature and BMI with TH or KH were not significantly different. Women, as compared to men, had higher rates of stunting, and probably relatively shorter legs to their trunks. Average BMI in women was above normal. These findings are relevant and require corrections at earlier life stages, as adult stunting and obesity are linked to adversities in survival, adult-health, learbning-capacity and physical prductivity.
1 Department of Health Sciences, Vu University, Amsterdam, Netherlands
2 Vu University, Amsterdam, Netherlands
3 CeSSIAM, Guatemala City, Guatemala
4 CeSSIAM Quetzaltenango, Quetzaltenango, Guatemala
Background: In an exercise aimed at assessing trunk-to-leg ratio from photographic imaging, a derivative study examined its accuracy to estimate standing height.
Objective: To compare photographic imaging procedures to measured standing height in preschool children.
Methods: The photographic images of 200 preschool children, 100 each from Sololá and Quetzaltenango were evaluated for estimation of standing height. Original standing height was measured with a wall-stadiometer. A photograph was taken from a 3-m distance with the child standing sideways and looking forward in the Frankfort Plane Gaze while standing in front of a color-coded metric ruler. An ocular estimation of height, at the intersection with the ruler was made from print outs, enlarged on a computer screen and from the zoomed camera screen.
Results: The mean measured standing height was 108.8 cm (median: 109 cm) compared to 109.0 cm (median: 109 cm)(p<0.05) determined by a photo-image. The Pearson correlation coefficient was r=0.988 and the Lin concordance correlation was r=0.987. According to the Bland-Altman agreement analysis, height derived from a photo-image overestimates measured height by 0.20 cm. For 34.5% of the photo-image data, the estimates were identical, and for an additional 50.0% they were ±1 cm of the measured value.
Conclusion: This study shows a high correlation to measured height from photographic imaging, using the same sagittal photograph applied to body-segment analysis. Equivalent validity was obtained with direct reading from the camera or computer screen as with measurement from a photographic print.
1 CeSSIAM, Guatemala City, Guatemala
2 School of Nutrition Science and Policy, Tufts University, Boston, MA
Background: In the past we explored the use of standardized photographic images as a potential method to measure length in newborns, which showed corrigible limitations in accuracy.
Objective: To refine a photographic technique used to assess newborn anthropometry by studying the effect of several technical photographic variables on intrinsic error, using inanimate baby models.
Methods: Vertical (25, 50, 75, 100 and 125 cm) and horizontal (left, center and right) camera displacements, reference object size (5, 10, 20 and 25 cm), camera type (digital vs smartphone), and zoom magnification (pre vs post) were varied to optimize length accuracy from the photographic image. Total length from the images was calculated by adding up the head+trunk plus upperand lowerleg segments of the models, measured in mm on a paper printout, computer or smartphone screen, and then converted to actual length in cm in reference to the object. These were compared to the gold standard infantometer measurements for accuracy.
Results: Increasing focal length reduces error, with an optimal height at 1 m (0.07% error, p<0.001). Camera must be centered over a focal point equidistant to the baby and reference bar to minimize error (0.01%, p<0.001). Camera optics impact error significantly (p=0.018). Variance in procedures for zoom and in reference bar length do not appear to significantly minimize error.
Conclusion: Thus, technical photographic variables can be optimized to minimize estimated length error in inanimate model figures, promising a new, valid and comfortable camerabased technique for assessing birthlength in newborns.
1 Health Sciences, Vu University, Amsterdam, Netherlands
2 CeSSIAM, Guatemala City, Guatemala
3 CeSSIAM Quetzaltenango, Quetzaltenango, Guatemala
Background: Linear growth is very dependent on the differential elongation of the two major body components: trunk and legs. Photographic imaging could help to improve accuracy and limit subject burden.
Objective: This study aimed to apply photographic images to quantify body segments in preschool children in 2 settings differing by socio-economic status (SES) in the Western Highlands of Guatemala
Methods: We measured standing height in children, aged 4-7 y from a lower SES (predominately Mayan-ascent) and a higher SES (largely European-ascent) from Sololá and Quetzaltenango, respectively. Height for age z-scores were calculated using the WHO Growth Standards to identify stunting (as ≤ -2 height for age z-score). A standard sagittal photograph with the child standing in erect posture with the Frankfort Gaze was taken from a 3-m distance with a digital camera. The length of the trunk and of the legs was measured in mm from printed images and used to calculate trunk-to-leg ratios and to compare between settings.
Results: The Quetzaltenango children were on average 7.0 cm taller than their Sololá- counterparts, 5.2 cm of the difference was attributed to leg length. Children in Sololá have a higher prevalence of stunting than children in Quetzaltenango (46.1% vs. 5.9%). The median trunk-to-leg ratio was higher in Sololá (0.82) than in Quetzaltenango (0.76).
Conclusion: Photographic imaging show the key population differences in these settings relates to the shorter relative leg lengths in Sololá. These findings are congruent with population differences in child stunting as well as ethnicity.
1 CeSSIAM, Guatemala City, Guatemala
2 Health Sciences, Vu University, Amsterdam, Netherlands
3 CeSSIAM Quetzaltenango, Quetzaltenango, Guatemala
Background: Photographic imaging may be used to assess height and its components (legs and trunk) in an accurate way. Nonetheless, inter- and intra-rater variations represent a potential source of error in this novel method.
Objective: To determine the inter- and intra-rater reliability when using photographic imaging for the estimation of total length (TL), leg length (LL) and the trunk-to-leg ratio (TLR) in preschool children from the Western Highlands of Guatemala.
Methods: Photographs from 247 preschool children aged 4-7 y were taken from a 3-m distance with the child standing sideways in front of a color-coded metric ruler and looking forward with a Frankfort plane gaze. TL and LL were estimated from paper printouts, measured to the nearest mm, and both served to calculate TLR. Height was compared to the gold standard stadiometer. Image-derived TL and LL were measured on 3 different occasions by the same researcher (R1) for intra-rater correspondence and by 2 other researchers (R2 & R3) for inter-rater reliability assessment.
Results: The mean measured height and estimated photo height were 109.7±0.46 cm (stadiometer) and 109.9±0.45 cm (photo). Mean TL and LL were 228±1.0 mm and 128±0.7mm, respectively. The Pearson correlation coefficients for intra-rater reliability for TL, LL and TLR on all 3 occasions were consistently higher than 0.9 (p<0.05); and for inter-rater reliability these values were 0.997, 0.996 & 0.974, (R1 vs. R2), 0.997, 0.996 & 0.979 (R1 vs. R3), and 0.999, 0.997 & 0.982 (R2 vs. R3) (p<0.05).
Conclusion: The results from this study highlight strong inter- and intra-rater concordances for height and body components derived from photographic imaging, which makes this innovative method a promising tool for growth studies in humans.
1 CeSSIAM Quetzaltenango, Quetzaltenango, Guatemala
2 Department of Health Sciences, Vu University, Amsterdam, Netherlands
3 CeSSIAM, Guatemala City, Guatemala
Background: Overweight and obesity prevalences are emerging rapidly among children in low- and middle-income countries, especially in urban environments. In this population of urban Guatemala, chronic undernutrition is prevalent in low Socio-Economic Status pre-schoolers (46%) but only 6% in the higher SES children. Little is known about overweight and obesity in urban pre-schoolers from high and low SES settings.
Objective: To compare height, weight and BMI by socio-geographical location in two urban settings in the Western Highlands of Guatemala.
Methods: A cross-sectional study collected data from private and public urban preschool centres of Quetzaltenango and Sololá, respectively. Informed consent was attained from the parents, and a total of 249 children, 4-7 years old, were measured. The contrast in socio-economic status (SES) was captured by selecting public pre-schools from a low socio-economic area of Sololá and private pre-schools from the relatively affluent Quetzaltenango. WHO growth references (≥5y) and standards (<5y) were used to calculate BMI-for-Age z-scores. Age appropriate definitions were used, with overweight and obesity for children < 5y defined as ≥ 1 SD WHO BMI-for-Age Z score and for > 5y defined as ≥ 2 SD WHO BMI-for-Age Z score).
Results: Children from the high SES private preschool were on average 6.7 cm taller and 3.2 kg heavier than children from the low SES public preschools. In the youngest age group, the higher SES children had a higher prevalence of overweight (9.6%) whereas the lower SES children had virtually no overweight (0.9%) in the same age group. The same pattern was seen in the >5y children, with 20.9% overweight in the high SES children and less than half that prevalence (9.6%) for low SES children of the same age.
Conclusion: In this population of urban Guatemala, preschool children from a high SES environment are taller and heavier in comparison to their low-SES counterparts. These results show a growing public health concern of overweight and obesity in higher SES preschool children.
1 Nutrition Research, Center for Studies of Sensory Impairment, Aging and Metabolism (CESSIAM), Guatemala
2 Scientific, Ibero American Nutrition Foundation, Armilla, Spain
3 Biochemistry and Molecular Biology II, Universidad de Granada, Armilla, Spain
4 ZIEL – Institute for Food & Health, Technische Universität München, Freising, Germany
Objective: To explore the presence and magnitude of paired associations between diagnostic biomarkers of oxidation and inflammation from the same or different anatomical compartments.
Methods: 82 children, 38 girls and 44 boys (median age 56 mo), attending 3 daycare centers from a government-subsidized system in Quetzaltenango, Guatemala, delivered single samples of urine, whole blood, saliva, and feces for one or more of the selected determinations. We were able to make pairing correlations among 23 biomarker variables, paired Spearman rank-order correlations could be made from 12 from the inflammatory domain (White blood cells, plasmatic and salivary IL-1β, IL-6, IL-8, IL-10 and TNFα, and fecal calprotectin) and 11 from the oxidation domain (urinary markers of oxidation {15-Isoprostane-F2t and 8-hydroxy-deoxy-guanosine}; erythrocyte activity of antioxidant enzymes {catalase, superoxide dismutase, glutathione reductase and glutathione peroxidase}; and plasmatic concentrations of antioxidant nutrients {retinol, tocopherols, β-carotene and Coenzymes Co-Q9 and Co-Q10}). The SPSS version 20 software program was used.
Results: Within the 132-cell full matrix, 13 statistically-significant associations were found (9.8% of possible), seven at a p-value of <0.01 and 6 from <0.05 to 0.01. Superoxide dismutase and β-carotene were each associated with 5 and 6 inflammatory biomarkers, respectively. Backward-elimination multiple-regression analyses with both as dependent variables showed the same two predictors, plasmatic TNF-α and salivary IL-8, with an r2-value of 0.155 for superoxide dismutase and r2 0.136 for β-carotene.
Conclusion: Significant associations in an inter-class context between paired, oxidation-vs-inflammation biomarker variables represent only a 10th of the possible associations and a fraction of the 33-57% association seen with the same data, previously analyzed on an intra-class hemi-matrix basis.
Funded by: Fundación Iberoamericana de Nutrición (FINUT), Spain and The Hildegard Grunow Foundation (HGF), Germany
1 CeSSIAM, Guatemala, Guatemala
2 Creighton University, Omaha, NE
3 USDA Human Nutrition Research Center on Aging Tufts University, Boston, MA
4 Sight & life, Basel, Switzerland
Background: Nutritive beverages can be important sources of micronutrients. There is a need and an opportunity to determine how beverages can play their most healthful and nutritionally-relevant role in the diets of rural populations at risk of nutrient deficiencies.
Objective: To compare the evolution of biomarkers of nutritional status with respect to four vitamins (riboflavin, folate, vitamins B12 and D) across two rural samples (schoolchildren and women of fertile age), randomized to receive supervised consumption of a daily serving of a beverage.
Methods: A total of 236 women, and 156 schoolchildren of both sexes in 12 villages, all with informed consent, were enrolled in the baseline sampling of blood for circulating concentrations of riboflavin, folate, vitamins B12 and D in March, 2011. As of May, 2011, 10-month, household-level, stratified-randomization intervention commenced, distributing 350 mL bottles of a fortified or non-fortified beverage available to participants. Nutritional evaluation was repeated at the endline in March 2012 in the same individuals.
Results: Important differential (baseline-to-endline) increases, contrasting between fortification and non-fortification groups, existed for children with riboflavin (+16.4 vs +5%), vitamin B12 (+33.9 vs +6.5%) and vitamin D (+23.3% vs +5.0%), but not for folate. The corresponding analysis for adult women revealed an effect for folate (+30.4 vs +11.5%), but not for the remaining vitamins. All children were folate adequate at all stages. Differentially greater endline adequacy of biomarker status was seen in the fortification vs non-fortification groups for riboflavin (25.5% vs 6.5%), vitamin B12 (46.2% vs 6.2%) and vitamin D (41.0% vs 8.6%). For women and folate, the two treatment groups had 92.3% vs 43.7% reaching normal levels at endline. Among the other three vitamins, only up to a third of women had normal status at endline without a treatment-wise effect.
Conclusion: Increases in circulating biomarkers occurred for most nutrients, variously among adult women and children, but complete resolution of initial low-vitamin status was not seen for any nutrient.
Support or Funding Information
cbc, Guatemala; DSM Nutritional and Sight & Life, Basel, Switzerland
1 CeSSIAM, Guatemala-City, Guatemala
Background: Although the consumption of sweetened drinks contributes to the energy requirements of children, high consumption of sugary drinks have been linked to the risk of chronic, non-communicable diseases.
Objective: To describe the sources, volumes and costs of sugar-sweetened beverages in a convenience sample of school-aged children from public schools in a suburban setting in the greater metropolitan Guatemala City area.
Methods: We recruited a total of 150 schoolchildren, 67 boys and 83 girls, from grades 1 to 6 in 4 elementary schools in the municipality of Amatitlán, 27 km south of Guatemala City. They were given crayons and a pre-formatted work booklet, along with instructions to make a pictorial record of each meal and snack over the following 24 h. Upon returning the booklets, participants were interviewed concerning the portion size of all items consumed. A full analysis of 24-h energy intake from all sources was compiled. With a focus on liquid items, they were classified into subgroups, and the packaging and nutrition labeling on each sugary drink reported was consulted to determine energy content and sales price.
Results: Median 1-day consumption of all liquids was 1628 mL, providing 479 kcal of energy, with 390 mL as non-caloric drinking water. Caloric density varied widely according to beverage group. The mean contribution of sweetened drinks was 428±237 kcal, representing 20.2% of the total daily energy intake. There were no significant differences in the pattern of drinks consumption between boys and girls. The most common beverage packaging was plastic bottles and Tetra Pak® cartons. The unit price by retail presentation ranged from Q.0.40 to 21.00. ($0.05 to 2.76 USD).
Conclusions: Pictorial recording of diet is a promising approach for child nutrition. Carbonated soda beverages were not the major sweetened drink in this sample, but the calories from all sugar-containing drinks constitute a fifth of the reported energy for the single-day records.
1 Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala
2 Hormel Foods Corporation, Austin, USA
Background: Current diets of school-aged children in Guatemala are nutritionally inadequate. Spammy®, a meat-based fortified food product was developed to complement the local diet.
Objective: To develop food-based recommendations (FBRs) using linear programming for children from a low socio-economic, rural area in the department of Quetzaltenango according to habitual dietary practices and the local food supply, and to examine the effect of this modeling with the addition of Spammy® given as food aid.
Methods: 24-h dietary recall data for 100 school-aged children were used to derive linear programing inputs, including foods consumed, their portion sizes and frequency of intake. Optifood was used to develop FBRs based on existing dietary patterns using locally available and acceptable foods, and with the addition of Spammy®. The cost of the most affordable and nutritionally best diet was also modeled.
Results: A total of 5 food-based recommendations (promoting dairy, fortified grains, eggs, meat/poultry and fruit consumption) can help achieve nutrient adequacy for 7 of 12 nutrients examined. With the additional of a daily portion of Spammy®, 4 food-based recommendations (promoting dairy, fortified grains, eggs, and tortillas) can help achieve nutrient adequacy for 10 of 12 nutrients examined and the daily cost of the most affordable and nutritionally best diet is reduced from $2.23 to 1.75 (USD).
Conclusion: Context-specific FBRs could ensure adequate levels of most nutrients examined. Used alone, however, the proposed FBRs are unlikely to contribute sufficiently to calcium, vitamins C and D, iron and zinc intakes. With the addition of Spammy®, more nutrient requirements are met, but calcium and iron intakes remain problematic.
Financed by Hormel Foods Corporation, Austin, USA.
1 University of California, Davis, CA, USA
2 USDA, ARS Western Human Nutrition Research Center, Davis, CA, USA
3 Center for Studies of Sensory Impairment, Aging and Metabolism, Guatemala City, Guatemala
4 Center for Atitlán Studies, Universidad del Valle de Guatemala, Sololá, Guatemala
Background: Malnutrition is highly prevalent in the Guatemalan population. Impaired nutritional status in lactating women results in decreased micronutrient content of breast milk. Supplementation with a lipid-based nutrient supplement (LNS) during lactation could augment breast milk nutrient content.
Objective: Our objective was to assess the efficacy of LNS comparing two dosing methods for increasing milk micronutrients in Guatemalan women.
Methods: The randomly-allocated, cross-over design included 30 mother-infant dyads 4-6 months postpartum in Quetzaltenango, Guatemala. In three 8-hour milk collection visits the participating mother received a single bolus dose of 30 g LNS (B), 10 g of LNS divided over 3 time points (D), or no LNS (C). Mid-feed milk samples were collected at each infant feed and total milk consumption measured. Maternal blood was collected at baseline, maternal dietary intake was assessed, and maternal and infant anthropometry was measured. The primary outcome was area- under-the-curve (AUC) of breast milk B-complex vitamins. Clinicaltrials.gov (NCT02464111on).
Results: Of 26 dyads completing the study, results for 8 are included in this preliminary data analysis. For milk riboflavin, the mean increase in AUC vs. C was 300±173% for B (p=0.002) and 164±105% for D (p<0.0001). For milk thiamin, this comparison was 25±19% for B (p=0.049) and 24±24% for D (p=0.087). For milk pyridoxal, the B increase was 65±61% (p=0.015) and D was 45±62% (p=0.123). Neither B nor D supplementation strategy increased milk niacin with respect to C, with B increasing 55±137% (p=0.689) and D, decreasing 6±37% (p=0.591).
Conclusion: Supplementation with the bolus dose rapidly and substantially increased the amount of thiamin, riboflavin, and pyridoxal in breast milk, but did not significantly affect niacin. With the current preliminary number of dyads, interpreting the responses for D remains provisional.
Funding: UC Global Health Initiative, Blum Center for Developing Economies, UC Davis, USDA ARS Western Human Nutrition Research Center.