Abstracts eingereicht zum EB-Kongress 2017

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Nutrition
Iron

ID: 1170

Liza Alejandra Diaz­-Jereda, Gabriela Montenegro­-Bethancourt, Marieke
Vossenaar, Noel W. Solomons

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CeSSIAM, Guatemala City, Guatemala

Background: Physiological indications from urinary osmolality in Guatemala show a mixed picture of hydration adequacy, with professional women and daycare­-attending preschool children having superior hydration status, whereas lactating women had precarious hydration states bordering on – and occasionally extending over into – hypohydration. Dietary intake data on water in schoolchildren has shown evidence of deficits relative to recommended volumes. Data on water intake in pregnant and lactating women are largely unavailable.

Objectives: To determine and compare and contrast the consumption of total daily water and liquid drinks among low-­income pregnant and lactating women from urban and rural areas of the Western Highlands of Guatemala.

Methods: A single previous-­day intake recall was obtained in 234 women [n=116 pregnant and n=118 lactating], of whom 121 were living in Quetzaltenango City and 113 were from 8 hamlets of a nearby, rural municipality. For purpose of comparative evaluation, they were classified into 4 subgroups as: urban pregnant (UP, n=58); rural pregnant (RP, n=58]; urban lactating (UL, n=63]; and rural lactating (RL, n=55]. The Adequate intakes (AI) of the Institute of Medicine of the US (2005) are 3000 mL for TDWA and 2300 mL for LD in pregnancy and, respectively; 3800 mL and 3100 mL for lactation. Water­-orgin data were summed to provide estimates of total daily water acquisition (TDWA), expressed in mL, and then reduced to the 4 components: liquid drinks (LD); water added to dishes (AW); intrinsic water of foods (IW); and metabolic water (MW) for illustration. Median intakes were finally compared and contrasted by subgroups.

Results: The respective median TDWA [and %AI] were: 2299 mL [77%] (UP); 1964 mL [65%] (RP); 2286 mL [60%] (UL); 2121 mL [56%] (RL); volumes consumed were not significantly different within settings (p=0.922, U; p=0.059, R), but AIs were vastly disparate. The respective median LD were: 1215 mL [53%] (UP); 908 mL [39%] (RP); 1216 mL [39%] (UL); 803 mL [26%] (RL); again, volumes did not differ (p=0.997, U; p=0.127, R) despite disproportionate recommendations. Only 2 women (1%) consumed the AI level for TDWA, and only 16 (7%) consumed adequate volume of LD. Across groups the relative contribution of IW and MW were constant, but AW contributed as little as 2 – 5% of TDWA in the urban groups and as much as 16-­18% in the rural groups. Reciprocally, the contribution of LD was less than 43% in rural areas and greater than 52% in the urban zone.

 
Conclusion: Deficits with respect to recommended water intakes of up to a liter per day are seen, with lactating women showing the greater shortfall. Concerted public health action is warranted to assure adequate hydration status in these vulnerable periods of the lifespan.

ID: 1186

Raquel Campos, Liza Alejandra Diaz-­Jereda, Marieke Vossenaar, Noel W.
Solomons

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CeSSIAM, Guatemala City, Guatemala

Background: Physiological indications from urinary osmolality in Guatemala show a mixed picture of hydration adequacy, with professional women and daycare-­attending preschool children having superior hydration status, whereas lactating women showing lower hydration status including instances of hypohydration. Estimation of daily acquisition of total water in women in reproductive states and urban schoolchildren in Guatemala consistently showed deficits. Data on NPNL women are largely unavailable.

Objectives: To determine, compare and contrast the consumption of total daily water and liquid drinks among NPNL women from various socio-­geographic groups in Guatemala.

Methods: A single previous-­day intake recall was obtained in 240 NPNL women, in groups of 40 each, from 6 different socio­-geographic settings: western highlands, rural peasantry (WHRP); urban low-­income (WHUL); urban middle­-class (WHUM); pacific coastal urban middle-­class (PCUM); and urban central highlands: low­-income (CHUL) and middle­-class (CHUM). Data were summed to provide total daily water acquisition (TDWA) estimates, expressed in mL, and then reduced to the 4 components: liquid drinks (LD); added to dishes (AW); intrinsic water of foods (IW) and metabolic water (MW), and finally compared and contrast by subgroups. The Adequate Intakes (AI) for NPNL women are TDWA (2700 mL) and LD (2200 mL).

Results: The respective median TDWA [and %AI] were, in descending order: 2408 mL [89.1%] (WHRP); 2274 mL [84.2%] (PCUM); 2008 mL [74.3%] (WHUM);1902 mL [70.4%] (WHUL); 1890 mL [70.0%] (CHUM) and 1530 mL [56.7%] (CHUL) (p=0.001). The respective median LD in descending order were: 1274 mL [57.9%](WHRP); 946 mL [43.0%] (WHUL); 830 mL [37.7%] (WHUM); 650 mL [29.5%] (CHUM); 563 mL [25.6%] (PCUM) and 467 mL [21.2%] (CHUL (p=0.001). The first and the last position in the rank­-order are conserved with both TDWA and LD, but overall rank correspondence was only modest in magnitude with a Spearman correlation coefficient (rho) of 0.588 (p<0.001). Moreover, relative adequacy for TDWA, although low, far exceeds that for LD. Median AW varied from 373 mL to 17 mL of daily contribution, with the 3 low­-income groups in the first 3 places. In fact, the IW exceeded LD in its contribution to TWDA in 4 subgroups. MW contributed from 15.1% to 8.8%. 

Conclusion: Estimated median TWDA and LD intakes of NPNL women varied across the socio­-geographic sites of Guatemala, with over a liter of difference from high to low in TWDA and with almost a 3­-fold differential in LD. At the extreme low ends of the distribution, deficits of over a liter with respect to the respective AIs are seen. Not achieving proper and healthful hydration may be an unrecognized public health problem in Guatemala even among NPNL women. 

ID: 1189

Rosario García-­Meza, Elena Diaz-­Ruiz, Deborah Fuentes, Alejandra
Maldonado, Marta Escobar, Claudia Lorena Arriaga, Noel W. Solomons

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CeSSIAM, Guatemala City, Guatemala

Background:  Worldwide, traditional foods are mainly starch-­based, derived from cereals such as maize, wheat, oats and rice, often consumed in porridge or thin-­gruels preparations.  In Guatemala, thin gruels (atoles) are widely consumed across the population, especially by lactating women. By recent consensus, drinking beverages above 65°C is a risk factor for esophageal cancer. Little is known about the temperature of consumption of gruels in the Guatemalan population. A pair of small studies provides initial insights into this health­ relevant behavior.

Objective:  To explore practices surrounding temperature preparation and consumption of thin gruels among low- income women from rural, semi-­urban and urban areas in the Department of Quetzaltenango, Guatemala.

Methods: Study 1: 11 low-­income homes in San Mateo (rural), La Esperanza (semi­-urban) and Quetzaltenango City (urban) were visited to enroll women to prepare a gruel of their choice for a visit on the subsequent morning. The temperature of the gruel at the moment it was served from the pot into a cup and at that of the consumption by the host­-preparer was assessed by holding a pocket digital food thermometer (Johnson­Rose® brand) half way into the cup without stirring the contents. Study 2: 72 low-­income women, 24 each from 3 areas were recruited at health centers and invited to participate. The areas were: San Juan Ostuncalco (rural); La Esperanza (semi­-urban); and Quetzaltenango City (urban). Women were asked to prepare a gruel of election, and bring it to the study site in the vacuum flasks provided. A survey tool to register observations and questions regarding gruel preferences and consumption temperatures was employed. Data on drinking temperature of the participant-­selected gruels was registered with the same brand of food thermometer. The thermal flasks were gifted to participants as compensation for their time and effort .

Results: Study 1: Median serving temperature was 76.0°C (58.3­-83.8°C) at 11 homes, with 82% exceeding 65.0°C, but consumption temperature was 59.2°C (47.7-­65.7°C), with 18% above the critical level. Study 2: Median consumption-­temperature of gruels was 63.9°C (39.0-80.0°C). A total of 33 of the 72 consumers (46%) began drinking with gruel temperatures above 65°C. Frequencies of >65°C consumption-­temperatures were: 11{rural}, 9{semi­-urban}, and 13{urban}, by respective site. In responses to qualitative questioning of the 24 participants, frequencies of gruel consumption-­temperature habitual preferences per the respective study sites were: “Hot” (11, 12, and 7, respectively); “Lukewarm” (12, 10, and 12, respectively); “Cold” (0, 2, and 3, respectively); and “Variable” (1, 0 and 2, respectively).

Conclusion: Although 42% reported preferring their gruel “hot” and 46% were able to tolerate consumption at a temperature above 65°C under our contrived testing conditions, usual thermal tissue exposure from this frequently ingested beverage remains unknown. Given the relation of temperature to cancer risk, more investigation is warranted.

ID: 1194

Heike B. Rolker1, Alejandra Maldonado2, Maria­-Jose Soto­-Méndez2, Alida B.
Melse­-Boonstra1, Noel W. Solomons2

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1 Wageningen University, Wageningen, Netherlands

2 Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala

Background: Total daily water requirements rise by 1 L while food taboos and altered feeding practices may intercede in lactation. In fact, our group’s studies on hydration status in lactation in the Western Highlands of Guatemala were inferior to those of non-lactating controls.research professionals. Presented elsewhere (Diaz- Jereda et al. 2017) we document water-­intake deficits in of over a liter compared to the Adequate Intake recommendations for lactation (IOM, 2005). These convergent findings raise concerns about hydration status during lactation in Guatemala and all valid options for assessing hydration status should be available to researchers and public health personnel. 

Objectives: To compare 4 urinary hydration biomarkers – osmolality (UOSM), specific gravity (USG), volume (UVOL) and color (UCOL) among lactating women in the Western Highlands of Guatemala. 

Methods: Lactating women (n=13) with infants aged 3-­6 months came in twice as part of an interventional, cross- over study on the modifiability of breastmilk osmolality. Baseline and endline urine specimens were collect in both Treatment 1 (consisted of 1 L water ingestion within 90 min), and Treatment 2 (90­-min fluid abstention), resulting in 4 samples per woman (pooled n=52). Urine was measured for volume, aliquoted and stored at -­20°C. At analysis, samples were thawed to room temperature and mixed by agitation prior to measuring UOSM and USG. UCOL was read by one rater using an 8-­scale urine color chart. Hydration status was estimated using only baseline samples (n=26), according to cut-­off values recently validated for lactating women (McKenzie et al., 2015). Hypohydration criteria: UOSM >500 mOsm/kg; USG >1.010; and UCOL >4. We used untimed spot-­urine volume for UVOL, as the rate expression of UVOL/h could not be calculated for baseline.

Results: Respective medians of the urinary biomarkers were: UOSM 618 mOsm/kg; USG 1.015; UVOL 75 mL; and UCOL 3. Spearman’s correlation coefficient (r) showed significant inter-­correlations (p<0.01 2-­tailed) for all biomarkers: UOSM = ­UCOL (r=0.933); UOSM = USG (r=0.880); USG -­ UCOL (r=0.851); UOSM -­ UVOL (r=­0.756); UVOL ­- UCOL (r=­0.742); and UVOL – USG (r=­0.664). The classification prior to Treatments 1 and 2, respectively, revealed 69 and 77% (UOSM), 92 and 84% (USG), and 46 and 62% (UCOL) as hypohydrated. Sensitivity for hypohydration at >500 mOsm/kg was 100% with USG values and 80% with UCOL. Specificity for <500 mOsm/kg was 100% for UCOL

Conclusion: The hydration biomarkers indicate a state of hypohydration among at least half of the lactating women on two separate occasions. A firm generalization however requires a larger and representative sample. All urinary biomarkers show high correlation with one another, while the classification based on the current cut­-off values show differences between methods. USG has the highest specificity whereas UCOL has the highest sensitivity against UOSM . In the field setting, USG and UCOL analysis are an inexpensive, easy and accurate hydration-­status option.

ID: 1197

Claudia Lorena Arriaga1, Carlos Tanchez1, Liza Alejandra Diaz-­Jereda1, Noel
W. Solomons1, Klaus Schümann2

weiterlesen

1 Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala

2 Hildegard Grunow Foundation, Munich, Germany

 

Background: Common measurements in health diagnosis are those related to body size: height and weight, which are used to obtain the body mass index. But height and weight are not enough to estimate values for muscle, fat and skeletal mass let alone give any information on the individual’s hydration status, which are also significant indicatives of body health diagnosis. Bioelectrical impedance analysis (BIA) on the other hand is a technique that uses the properties of conductivity capacitance and restriction of electron flow, to measure both conductive (hydrated tissues) and non-­conductive (adipose tissues) components, modeling the responses for the quantification of total body water, fat and lean tissue. Guatemala´s conjunct problems of short stature (stunting), emergent excess weight (overweight, obesity) and suspected hypohydration present challenges worthy of investigative address. Therefore, assessment of body composition with a new generation of BIA promises a useful public health applications.

Objective: Apply the SECA mBCA 525 BIA instrument when measuring 33 Guatemalan adults, to assess the within-individual test-retest reproducibility during various intervals of time.

Methods: Basic data on age, sex, weight, height, waist­-circumference and habitual physical activity were combined with measurements using the BIA for intervals of 60 min (n=9, x5), 24 h (n=12, x2) and 7 days (n=12, x2) among male (n=14) and female (n=19) Guatemalan adults. The most relevant BIA related-variables were: energy stored in body (kcal): fat mass (kg); fat mass (%); fat mass index (kg/m2); fat­-free mass (kg); fat-­free mass (%); fat-­free mass index (kg/m2); skeletal muscle mass (kg); visceral fat (kg); total body water (L); total body water (%); extracellular water (l); extracellular water (%); hydration (%); phase angle (degrees), a derivative of the bioimpedance vector. Coefficients of variation and Pearson and Lin correlations were used to assess reproducibility.

Results: Across the 33 individuals, varying in BMI from 19.4­-39 kg/m2, all test-­retest variables were stable in all time-­intervals. Measurements made for the 60-­min group (n=9, x5) showed a range of Pearson coefficients between 0.841-­0.999 and Lin coefficients between 0.795­-0.999. All variables had values for both Pearson and Lin coefficient above 0.985 except for fat free mass (0.841, 0.795) and fat free mass index (0.972, 0.992). For the 24­-h group (n=12, x2), Pearson coefficients between 0.925-­0.993 and Lin coefficients between 0.910-­0.992 were found. The lowest correlations for Pearson and Lin were displayed in visceral fat (0.942-­0.916), hydration (0.926-­0.916) and phase angle (0.925­-0.910). As for the group measured in the time interval of 7 days (n=12, x2) the range of Pearson coefficients laid between (0.744­-0.996) and the Lin coefficients between (0.739­-0.994) the lowest correlations found in hydration (0.744–0.739) and the phase-­angle (0.935­-0.909).

Conclusions: The  SECA  mBCA  525  provides  plausible  body  composition  values,  with outstanding within-subject reproducibility at all intervals of time measured.

ID: 1199

Monica Orozco1, Claudia Lorena Arriaga1, Noel W. Solomons1 , Klaus
Schümann2

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1 Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala

2 Hildegard Grunow Foundation, Munich, Germany

Background:  Increasing  use  of  hepcidin  as  a  biomarker  of  iron  homeostasis, especially during infection and inflammation and other iron-related disorders, calls for affordable and convenient assessment methods capable of precisely quantifying a wide range of hepcidin concentrations.

Objective: To evaluate two different versions of a commercial competitive enzyme-linked immunosorbent assay (ELISA) kit for bioactive hepcidin-25 quantitation, with similar dynamic ranges but different specificities, within a large range of hepcidin concentrations. 

Methods: Plasma samples from 8 apparently healthy adults recruited in Sololá, Guatemala; 8 mildly sick patients attending clinical consultation at Sololá’s National Hospital, and 8 end­-stage renal failure juvenile patients undergoing hemodialysis in FUNDANIER,
Guatemala City, were collected to represent the widest possible range of continuous hepcidin concentrations in a human context: low (LH), middle (MH) and high (HH) levels. Hepcidin­-25 was quantified with two ELISA kits (DRG® EIA­-5258 & EIA­-5782) and the gold standard weak cation exchange time-­of-­flight mass-­spectrometry (TOFMS) method. Pearson product-moment correlation coefficient test was applied to the 3 data-sets to assess statistical dependence between the 3 methods to determine validity and repeatability.

Results: Average hepcidin concentrations (ng/ml) for LH subjects were: 9±5, 10±2, and 155±67; for MH patients: 29±12, 20±11, and 437±283; and for HH patients: 145±130, 212±295, and 3380±3486, with the TOFMS, EIA­-5258, and EIA­-5782 methods, respectively. Pearson rank correlation coefficients between TOFMS & EIA-5258 and TOFMS & EIA-5782 (validity) were 0.94 and 0.123, respectively, and between EIA-5258 & -5782 (repeatability), 0.061.

Conclusion: Despite the declared improved specificity of the newest version of the kit (EIA-5782), the older version (EIA-5258) revealed a higher validity when compared to the gold standard, making it a better option for the assessment of a wide range of hepcidin concentrations.

 

ID: 1204

Rosario García-­Meza1, Wendy González2, Allison Tumilowicz2, Noel W.
Solomons1

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1 CeSSIAM, Guatemala City, Guatemala

2 Global Alliance for Improved Nutrition, Geneva, Switzerland

 

Background: Micronutrients are essential for growth, development, and disease resistance in the period of complementary feeding. Infectious diseases and inadequate diets, among other factors, have led to micronutrient deficiencies. Home fortification programs are implemented worldwide, targeted to vulnerable population including children between 6-­24 months old. Micronutrient powders (MNP) and lipid-based micronutrient supplements (LNS) are commonly-­used home supplements in geographical areas in which micronutrient­-dense foods and healthy environments have not been achieved. Efforts to understand local knowledge and attitudes on the use of supplements are key elements to design and implement public and private complementation programs.

Objective: To describe knowledge and attitudes toward home fortification of complementary foods with micronutrient supplements, currently provided by the Public Health System, among mothers of 6­-24 months old children and health providers from two municipalities of Baja Verapaz, Guatemala.

Methods:  This reports from the first phase of a qualitative formative research study conducted in two health centers of Cubulco and Purulhá municipalities, Baja Verapaz, Guatemala. Ethical approval was obtained from the Human Subjects Committee of CeSSIAM. Participation was consented and voluntary. A total of 9 mothers of children, three each between 6-8, 9­-11 and 12­-24 month-­olds and 8 health providers (medial doctors, nurses and health educators) were interviewed. Face-­to-­face interviews were voice recorded and transcribed verbatim. Coding and analysis were done using NVivoPro 11® software and qualitative themes mainly defined in the Focalized Ethnographic Studies® -FES- methodology.

Results: Mothers identified supplements for complementary foods provided by health centers include MNP and LNS. Mothers that had use MNP (n=5) and LNS (n=2) described their use or preparation process at home and perceived benefits of their child included improved health and appetite. Challenges in the use of supplements at home comprised confusion on the instructions for use and perceived adverse secondary effects. For the MNP´s case, the refusal of supplemented food is usually due to perceived changes in the micronutrient supplement “package” (formula) that influences flavor. Health providers reported disposition to promote home fortification products if they are provided with training on their use and if the supply of the product is constant. Health providers also perceived mothers’ willingness to use MNP after 6 months and LNS after the children’s first year of age and when frequency of daily dosing does not exceed once per day.

Conclusion: Interviewed mothers and health workers were familiar with MNP and LNS; however, confusion existed on recommendations for appropriate use and inconsistent supply of products hampered promotion and utilization. Improved training and availability of products are needed to guarantee the success of extant home-­fortification programs in Baja Verapaz.

ID: 2023

Kimberly Shiu, Joni Beintema, Windy Mulia Liem, Rosario García­-Meza,
Collen Doak, Monica Orozco, Noel W. Solomons

weiterlesen

 CeSSIAM, Guatemala City, Guatemala

Background: CeSSIAM has an interest in the origins and biology of acquired linear growth retardation, also referred to as “stunting” or “chronic undernutrition”. Towards overcoming the tactile disadvantage of direct measuring tape assessment and the gluteal­-thickness artifact in sitting height, we developed a photographic approach to estimating differential body segment lengths: trunk vs leg. Current experience suggests photographic imaging to be easily reproducible, less invasive and more objective than the aforementioned techniques. Preliminary studies defined body segment lengths in normal-­height and modestly­-stunted Guatemalan preschoolers.

Objective: To document any further effects on the body­-segment ratios that might occur with the even more profound stunting occuring in the far western highlands of Guatemala.

Methods: The height and clothing-adjusted weight of 212 individuals between 4 – 7 y from zones of established high stunting prevalence (combining La Estancia and Santa María Chiquimula {Com}) were measured. Two, partly-­overlapping samples of 102 children each were pair-­matched by age and sex to a previous series of equal numbers of affluent (Quetzaltenango City {Que}) and of poor urban children (Sololá {Sol}). The former sample was derived from matching by sequential enrollment (Com1) and the latter was enriched for stunting using the shortest children available for matching (Com2). A sagittal photograph was taken with a digital camera with the child in an erect posture with the Frankfort gaze standing on a stadiometer platform. After printing out the photo, the lengths of the trunk and the legs were measured in mm, allowing the generation of trunk-­to-­leg ratios.

Results: The stunting prevalence for the four respective series increased progressively: 5.9% (Que) ; 46.1% (Sol) ; 68.6% (Com1); and 87.3% (Com2). Children in the Com1 sample were 9.2% shorter on average than those in Que and 3.4% shorter than Sol. Those in the Com2 sample were 10.9% and 5.0% shorter, respectively. The median trunk-­to-­leg ratios across thefour respective series were 0.76; 0.82; 0.81; and 0.82. This value declined to 0.85 for third degree stunting alone (n=52).

Conclusion:  As stunting prevalence increases in a population, the median trunk-­to-leg ratio initially falls to the 0.82 range and stabilizes thereafter, but in isolated third-­degree stunting, the median trunk-­to­-leg ratio reaches 0.85.

ID: 2051

Kimberly Shiu, Noel W. Solomons, Windy Mulia Liem, Rosario García­-Meza

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CeSSIAM, Guatemala City, Guatemala

Background: Failure to grow in length/height in relation to reference/standard growth curves and to fall below -­2 SD of the median (stunting) has been termed “chronic malnutrition.” Evidence suggests, however, that this condition is more a selective affliction of impaired elongation of the long bones of the lower extremities than a generalized malnourishing process affecting the whole individual. Only a harmonic and proportional reduction in body size would justify the connotation of “malnutrition” in situations of linear stunting.

Objectives: To compare the relative deficits in longitudinal (length) vis­- a­-vis circumferential (breadth) measurements and assess their interrelationships in underprivileged preschool children from stunting­endemic zones of the Western Highlands of Guatemala.

Methods: 212 preschool children aged 4 to 7 y were measured for height (without footwear and posture in the Frankfort plane with a wall stadiometer, in cm), weight (with daytime garb and without shoes and adjusting for clothing weight on a Rosthal EB9325 scale to the nearest 0.1 kg), head circumference (the maximal circumference with a SECA 212 tape measure, to nearest 0.1 cm), neck circumference (with a flexible metric tape, to 0.1 cm), and waist circumference (in expiration at the mid­-point of the lower rib and iliac crest with a flexible tape, in cm), this in 2 populations of suspected high prevalence of stunting (La Estancia, Quetzaltenango, n=75, and Santa María Chiquimula, Totonicipán, n=137) in the Western Highlands of Guatemala. Sagittal photographic images were taken with a visual marker tape on the iliac crest, allowing for assessment of the relative contribution of the trunk (crown to crest) and leg (crest to plantar surface of foot) to total height, with quantitative estimates derived in cm from the measured stature. Descriptive statistics (medians) and associated ratios were generated.

Results: Eighty-­seven (41%) were boys and 125 (59%) were girls, with a median age of 69 months. Median neck circumference (28.3 cm) proved to be ~48% of both head (median: 49.7 cm) and waist circumference (median: 49.8 cm), with the latter measures having a 1:1 ratio. The Spearman (rho) correlation coefficients were: 0.39 for head vs waist circumference; 0.46 for neck vs head; and 0.48 for neck vs waist. There was a significantly higher ratio of the neck-to-trunk (p=0.03) and waist­-to-­trunk (p=0.02), but not head­-to-­trunk (p=0.49) in the male subsample The paired inter-­site circumference ratios were generally unaffected by stunting. Median head circumference Z-­score (-0.65, CDC reference) was relatively preserved in relationship to the corresponding height-­for-­age Z-­score (­-2.35, WHO standard).

Conclusion: While the stature of stunted and short­-stature preschool children is severely compromised, there is relative conservation of the head circumference. Neither international nor national references or standards exist as yet for head or waist circumference, such that the exploration of concurrent length and circumference measurements and interrelationshipa should be extended to healthy Guatemalan children of adequate stature.

ID: 2057

Alana Platte1, Marieke Vossenaar1, Alejandra Zamora1, Claudia Lorena
Arriaga1, Noel W. Solomons1, Daniel Hirst2, Melissa JL Bonorden2

weiterlesen

1 CeSSIAM, Guatemala City, Guatemala

2 Division of Research and Development, Hormel Foods Company, Austin, MN, USA

Background: Convergent evidence from quantitative and qualitative dietary intake research
among low-­income lactating women in Guatemala shows an important contribution of thin
gruels (atoles)  to  their  total  daily  water  and  caloric  intakes.  These  same  dietary  studies,
furthermore, have revealed an additional failure to consume the amount of protein required
for the augmented demands of lactation. Moreover, despite generous daily portions of gruel
beverages in the intake records of lactating women, their total daily water consumption falls
over a liter below the Adequate Intake recommendations for this physiological state.

Objectives: To assess the pattern of habitual use of commercial flavored products for gruel,
the preference among a range of flavors, and the acceptability of their fortification with a
whey protein concentrate (WPC) in low-­income adult women in the Central Highlands of
Guatemala.

Methods: Phase 1 of the study consisted of 51 women who answered a questionnaire about
habitual  practices  regarding  selection,  preparation  and  consumption  of  gruel  beverages.
Phase 2 invited 36 of these women to express their preference ranking after tasting 4 flavored
varieties  of  prepared  Incaparina®  gruel  (Alimentos  S.A.,  Guatemala):  original;  vanilla;
chocolate; and strawberry. Phase 3 involved all but one of these women in a taste-detection
and forced-choice preference test with Incaparina(R) gruel of each subject’s preferred flavor,
served with or without added WPC.

Results: In the Phase 1 surveying, 72% of women reported consuming 2 or more gruel servings daily, usually adding sugar in 96%. Among 10 gruel varieties, Incaparina® was second to oatmeal (100%) in cumulative consumption, including its flavored forms. The preference ratings in Phase 2 found the chocolate flavor to be preferred (1 place) by 33%, followed by regular (unflavored) by 28%, with strawberry at 22% and vanilla at 16%. The least favored flavors (4 place) were, in descending order: strawberry (45%); vanilla (28%); chocolate and regular tied (14%)(decimals rounded). In the Phase 3 tasting exercise, 86% of participants were able to detect a difference between plain and WPC-­fortified gruel added to their preferential-­flavored gruel; when difference was detected, the whey-­fortified form was preferred over unfortified by 62% of these respondents.

Conclusion:  Gruel  consumption,  including  that  of  flavored  commercial  preparations,  is
common among adult women in the Central Highlands. A slight preference for chocolate
flavor was registered, with widespread least-­liked for strawberry. The addition of WPC is
highly  acceptable  and  its  appropriate  promotion  portends  a  practical  manner  to  address
deficits, during vulnerable periods such as lactation, of protein and liquids, as well as gaps in
micronutrient intakes were further fortifying the concentrate with vitamins and minerals to
be engaged.

Support or Funding Information
Financed by a Borlaug-­Ruan Fellowship of the World Food Prize Foundation, Des Moines,
IA, USA and the Hormel Foods Company, Austin, MN, USA

ID: 2071

Marta Lucía Escobar1, Claudia Lorena Arriaga1, Alejandra Maldonado1,
Deborah Fuentes1, Elena Diaz-­Ruiz1, Rosario García-­Meza1, Marieke
Vossenaar1, Noel W. Solomons1, Daniel Hirst2, Melissa JL Bonorden2

weiterlesen

1 CeSSIAM, Guatemala City, Guatemala

2 Division of Research and Development, Hormel Foods Company, Austin, MN, USA

Background:  Findings  suggest  that  dietary  intake  of  low-­income  lactating  women  in
Guatemala does not allow them to fully meet their requirements for energy nor recommended
intakes for daily protein and selected micronutrients. Background dietary survey research in
the Western Highlands shows that the deficit in protein intake ascends up to 19 g. Thin gruel
beverages (atoles)  are  considered  important  by  lactating  Guatemalan  mothers  to  support
production and quality of breast milk. This research is part of an effort to develop an effective
and  culturally-­acceptable  intervention  to  provide  additional  protein  to  their  diet.  An
understanding  of  the  characteristics  that  could  maximize  the  supplement  acceptability
among potential consumers was needed in the course of developing the initiative.

Objectives: Determine  the  spontaneous  selection  of  gruel  varieties  from  participants,  and
assess the ability to detect the presence of a whey-protein concentrate (WPC) supplement
when added to an assortment of customary Guatemalan thin gruels (atoles) and identify the
characteristics that improve its sensory acceptability.

Methods: 59  women  aged  20­-62  y,  were  recruited  at  local  health  centers  across  3  socio­
demographic  zones  in  Quetzaltenango  located  in  the  Western  Highlands  of  Guatemala.
Home  prepared  gruels  of  their  preference  were  poured  into  thermos  vacuum  flasks  and
brought to the testing site by the women. Two cups of 200 mL of the home-­made gruel were
poured  into  Styrofoam®  cups.  A  7  g  WPC  supplement  was  mixed  with  one  cupful  with
another offered plain, in a randomized presentation order. Sensory evaluation consisted of
asking participants to taste a sample and describe preferences between the presentations if
they could detect a difference. Sensory characteristics and gruel selection were evaluated.

Results:  The  overall  median  age  of  the  participants  was  35  y.  In  interviewing,  the
predominant  characteristics  that  influenced  the  selection  of  the  gruel  were:  taste  (85%),
texture (48%) and aroma (44%). Women reported that ingredients such as sugar, milk and vanilla were added to gruels. Thicker texture and different aroma and flavors were reported to
make gruels more appealing. The principal gruels varieties brought to the testing site were
(in descending frequency): Incaparina®, wheat germ, Pinol gruel, oatmeal and corn dough
gruel. In the format of addition of 7 g of WPC. 85% of women detected a difference between
the two gruels offered; 46% of these preferred the gruel with added supplement.

Conclusion: In the face of sub­-adequate habitual consumption of protein during lactation in
the Western Highlands, the WPC addition to gruels appeared to be an innovative approach.
The qualitative and quantitative data generated here add support to the feasibility of a WPC
supplement,  potentially  extended  in  its  nutritional  contribution  with  appropriate  further
addition of the micronutrients also not meeting recommendations for lactation in the usual
diets of nursing highland women.

Support or Funding Information
Financed by the Hormel Foods Company, Austin, MN, USA and the Maternal Intercedence
Initiative, Austin, MN, USA

 

ID: 2085

Marta Lucía Escobar, Marieke Vossenaar, Noel W. Solomons

weiterlesen

CeSSIAM, Guatemala City, Guatemala

Background: In  Guatemala  micronutrient  deficiencies  constitute  a  significant  nutritional
problem.  Some  of  the  problems  have  been  addressed  with  nationwide  public  health
interventions such as the vitamin A fortification in granulated table sugar, folic acid in wheat
flour,  iodine  in  salt,  among  others.  Little  is  known  on  the  adequacy  of  total  vitamin  A
(provitamin A carotenoids plus preformed vitamin A) intake among school­-aged children
and their main dietary sources. On the one hand, schoolchildren may avoid eating the plant
foods, rich in provitamin A, but they may be prone to seeking sugar-­sweetened beverages
and dishes (e.g. breakfast cereals) in disproportion, on the other hand.

Objective:  To  determine  aspects  of  the  adequacy  and  safety  of  vitamin  A  diet  intake  of
school children in rural western highlands of Guatemala.

Methods:  A  single  24­-h  self­-drafted,  pictorial  dietary  registry  was  administrated  to  115
school­-aged  children  between  8-11  y  (58  girls  and  57  boys),  in  a  rural  public  school  of
Chiquilajá,  Quetzaltenango  in  the  Western  Highlands  of  Guatemala.  Children  were
instructed in school as how to fill in the pages representing the meals and snacks of the day
and given color crayons for depicting all foods and beverages consumed over a 24­-h period. 
Upon returning their workbooks on the following day, portion sizes were estimated in the
interview  with  the  nutritionist  using  standardized  local  household  measures.  A  modified
USDA food composition table was used to calculate pro­-vitamin A and preformed vitamin A
intake and combine them to estimate total vitamin A. A standard fortification level of 10
µg/g  was  assumed  for  granulated  table  sugar  fortification.  Adequacy  of  total  vitamin  A,
proportion of children with estimated intakes below the WHO/FAO Recommended Nutrient
Intake (RNI) or above the Tolerable Upper Intake Level (UL) were evaluated. The RNI for
children aged 8-­9 y is 500 µg RE and that for children aged 10­-11 y is 600 RE. The UL
criterion for younger age-­group is >900 µg RAE, whereas that for the older group is >1,700
µg  RAE.    Only  preformed  vitamin  A  is  used  to  estimate  excess  intake,  whereas  dietary
carotenoids are not considered to contribute to toxicity.

Results: Median  estimated  total vitamin  A  intake  was  1436  RAE.  Preformed  vitamin  A
intake  median  (1270  µg  RAE)  was  10-­fold  higher  than  the  pro­-vitamin  A  contribution
(median=127 µg RAE). The median contribution of table sugar alone to the vitamin A in the
diet record was 743 µg RAE. In descending order representing the main sources of  both total
and preformed vitamin A intake were: table sugar; Incaparina®; chicken; and eggs. Total
vitamin A covered 100% of the daily RNI for 96% of 8­9 years old and 95% of 10-­11 years
old  children,  respectively.  On  the  day  of  data  collection,  35%  of  children  had  estimated
preformed vitamin A intakes above the UL.

Conclusion: Due to the sugar-fortification mandate, Vitamin A is not a commonly-deficient
nutrient in the diet of school­-aged children among the evaluated population. Almost 4 of 10
children  presented  excess  in  the  intake  of  preformed  vitamin  A.  Public  health  efforts  in
promoting the consumption of vegetables as more important sources of vitamin A are in need
of reinforcement.

Support or Funding Information
Financed by Hormel Foods Corporation, Austin, USA

ID: 5957

Hilary M Wren1, Noel W Solomons4, Marilyn E Scott2,5, Kristine G Koski3,5

weiterlesen

1McGill University, Ste-Anne de Bellevue, QC, Canada

2 Institute of Parasitology

3 School of Dietetics and Human Nutrition, Mc Gill University, Ste-Anne de Bellevue, QC, Canada

4 CeSSIAM, Guatemala City, Guatemala

5 Center for Host­-Parasite Interactions, Ste-­Anne de Bellevue, QC, Canada

Background: In Guatemala, emerging research reveals a diversity of stressors in pregnancy and lactation impact early infant growth. Most research has focused efforts on uncovering associations with infant stunting. In comparison, rates of low cranial size, as measured by infant head circumference for age z scores (HCZ) < ­2SD, and its potential causes are largely unknown. It is also unclear if a premature birth contributes to retarded infant HCZ in this population.

Objectives: The objectives were to: (1) quantify the prevalence of low cranial size at early (0­-6 wks) and later (4- 6 mo) post-partum in a cohort of Mam-Mayan infants; (2) investigate the ∆HCZ from 0-6 wks to 4-6 mo; and to (3) explore the relative contribution of infant prematurity and maternal anthropometric measures to infant HCZ at both 0-­6wks and 4- 6 mo.

Methods: This study followed a cohort of Mam­-Mayan mothers (n=81 mother­-infant dyads) in the Western Highlands of Guatemala from pregnancy through 6 months postpartum. Anthropometric measures were collected from mothers and infants at early (< 6 wks) and later (4-­6 mo) postpartum. Gestational age (GA) was based on last menstrual period; infant prematurity was defined as a delivery <37wks of gestation. Rate of change for infant HCZ was calculated based on ∆ HCZ from 0­-6 wks to 4-­6 mo divided by days postpartum. Correlations between HCZ, GA and anthropometric variables were explored. Separate multiple linear regression models for HCZ at 0-­6 wks and 4­-6 mo were investigated and unstandardized coefficients (B) reported. All models included the variables of GA (wks) and prematurity (yes/no). Statistical significance was set at p<0.05.

Results: At 0­-6 wks, the prevalence of low cranial size (HCZ <­-2SD) was 16%; the median HCZ was ­-0.30 (mean HCZ -0.48±1.57). At 4-­6 mo, the prevalence of low cranial size was 13%; the median HCZ was ­-0.48 (mean HZC ­-0.63±1.49). The mean infant ∆ HCZ was -­0.04±0.42/day with a mean GA of 34.49±1.4 wks; 23% of infants were premature. GA was positively correlated with infant HCZ (r=0.29, p=0.01) only at 0-­6 wks. In bivariate analyses, HCZ at 0-­6 wks was lower for premature (­-1.31±1.82) compared to non­-premature infants (­-0.25±1.42), but in unadjusted odds ratios (OR), premature birth (OR=2.64, p=0.134) was not associated with low cranial size at 0-­6 wks. At 0-­6 wks, multiple linear regression showed that only maternal weight during pregnancy (B=0.06, p=0.016) was positively associated with HCZ in a model that captured 16.3% of the variance while controlling for maternal height, GA, and prematurity, which were not significant. At 4-­6 mo, multiple linear regression showed that infant HCZ at 0-­6 wks (B=0.26, p=0.029) was positively associated with HCZ at 4-­6 mo in an adjusted model that captured 11.2% of the variance and that controlled for maternal weight during pregnancy, maternal height, GA and prematurity, none of which were significant.

Conclusion: In contrast to our expectation, prematurity did not contribute to low cranial size when adjusting for maternal variables during pregnancy. Our study showed that maternal weight during pregnancy was associated with infant HCZ at 0-­6 wks and that growth at 0­-6 wks is strongly associated with HCZ at 4­-6 mo. Our findings strongly suggest that both in utero and postnatal conditions contribute to low cranial size.

Support or Funding Information
CeSSIAM

 

ID: 902

Mallika Gopal1, Marta Escobar1, Rosario García-Meza1, Noel W. Solomons1, Odilia I Bermudez2.

weiterlesen

1 Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala

2 Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA

Background: Stunting is highly prevalent in the Guatemalan population and presents many health issues. In regards to growing children, stunting is defined by the WHO Child Growth Standards (2006) as a length or height below 2 SD of the median of the reference growth curve. Guatemala has highest prevalence of stunting in the Americas, with under-5yo children having rates of 49.8% in a 2009 survey and falling to 46.5% in the 2015 follow-up, with an even higher
proportion in the indigenous children (63.7%). It is associated with poverty, food insecurity, neglect and infection, with effects extending to health, social, and gender disparities. Stunting during childhood is the most common correlate of adult stunting, the latter defined as less than 145 cm in women and 150 cm in men. Humans develop in a cephalocaudal fashion – as extension of the lower part of the anatomy is delayed, body proportions are representative of childhood environment. A high torso-to-stature ratio is indicative of higher risk of cardiac arterial disease, liver disorders, and certain cancers. Segmental analysis, as in the NHANES, is conventionally assessed using sitting-height to indicate the torso, which is confounded by gluteal thickness. Body posture photographs have been shown to be a promising tool with high inter-rater reliability in calculating torso-to-height ratio in children.

Objective: This study aims to assess photography as an anthropometric tool to measure body proportions in Guatemalan women between the ages of 35-59 years, living in the city of Quetzaltenango, and to analyze the contribution of the torso-to-height ratio as a function of height (i.e. the effect that stunting has on segmental ratios).

Methods: Photographs and anthropometric measurements in a total of 105 women within the age criteria were collected. Their iliac crest was palpated and marked, representing their iliac height. Photographs were taken – with their right side facing the lens on a digital camera Samsung WB150F propped vertically on a tripod and positioned at about 5 feet from the objective. On the developed photo print, the distances on the page-printed paper from the bottom of the feet to the iliac-crest mark (leg), from the mark to the crown of the head (torso), and then the sole-to-crown (height) were registered. Segmental ratios were calculated from the measurements taken in millimeters. Total height (cm) was measured on a wall stadiometer.

Results: The median age of study participants was 47yo and standing height was 148 cm. 31 (29.5%) women were stunted and 74 (71.5%) were non-stunted. Their respective torso-to-height ratios were 0.57 and 0.51 (p=0.011). In a continuous-variable context, the ratio vs height Spearman correlation coefficient was -0.240 (p=0.014).

Conclusion: The photo-image method appears to be an effective tool for assessing body proportions in adults. The significantly different body proportions in the stunted versus non-stunted individuals may be indicative of growth disparities during the participants’ childhood.