Abstract

Background: Although the early years of life inherently pose nutritional vulnerability, geographical and cultural determinants dictate distinct patterns of nutrient deficiencies. Thus, tailoring responses holds the promise of more efficient and comprehensive redress.

Objective: To assess the efficacy of a poultry-based spread, fortified with between 20% and 333% of the RDA of 12 selected micronutrients, including vitamins D and B₁₂, both shown to be precarious among Guatemalan preschoolers in a previous survey.

Methods: A total of 167 preschoolers, aged 4-7 y were randomized to receive 43 g of fortified (FS) or unfortified (US) Spammy^TM during weekdays over 20 wks as part of the institutional breakfast at a faith-based day-care center on the outskirts of Guatemala City in a triple-blinded format. Circulating nutrient status indicators (ferritin, 25(OH)vit D, vitamin B¹²) were measured at both ends of the trial.

Results: Over 75% of the offered spread was consumed on 84% of serving days with no difference between treatment groups. At baseline, blood biomarkers were abnormally low for iron in 20%, vit D in 59% and vit B₁₂ in 19%. A significant 9% increase in vit D (p12 (p=0.0017) with FS, unmatched in the US group, were seen.

Conclusion: Regular consumption of a fortified spread during half of the school year support improvement in the status of two nutrients problematic for Guatemalan preschoolers.

Abstract

Background: Dietary improvements during early childhood have potential to both reduce nutritional deficiencies and improve cognitive outcomes.

Objective: To assess the efficacy to improve cognitive function of a poultry-based spread that provides between 20% to 333% of the RDA of 12 selected micronutrients, including vitamin D and iron.

Methods: Sixty preschoolers, aged 4-7 years, were randomized in a triple-blinded format to receive 43 g of fortified (FS) or unfortified (US) Spammy^TM during weekdays over a 20 week period as part of the institutional breakfast on the outskirts of Guatemala City. The Spanish language Bracken Basic Concept Scale- Receptive (BBCS-R) was administered and circulating nutrient status indicators (25(OH)vit D and ferritin) were measured at both ends of the trial.

Results: Reliability analyses for both the BBCS-R School Readiness Component (SRC) and total test (TT) were high (.96 and .95, respectively). Both FS and US groups had larger than expected gains on the age-standardized SRC scores (p=.068 and 0.03, respectively) with no difference between groups (p=.84). In the FS only, a significant, positive relationship was found between TT cognitive gain score and both endline vitamin D (Pearson r = .37) and ferritin (Pearson r = .42).

Conclusion: Regular consumption of a fortified poultry spread to breakfasts, combined with educational programming, set the stage for improved cognitive functioning.

Abstract

Background: Measures of the community nutrition environment are important to understanding the food environment, which affects individual diet.

Objective: To determine the reliability and validity of direct observation as a low-cost method in mapping a food environment in Guatemala.

Methods: Two teams of two raters were asked to walk two urban thoroughfares in urban Quetzaltenango, Guatemala. Both teams were instructed to record the address, food outlet type, and the main items sold by each food outlet. Teams walked each thoroughfare on separate days and in opposite directions, respectively. Mirror-image correspondence analysis was used to determine the inter-rater reliability between teams. The validity of direct observation in mapping a community food environment in Quetzaltenango was determined based on the face validity of this work by two experts who also walked the same thoroughfares.

Results: The inter-rater reliability between teams was moderate for both thoroughfares A and B (Percent agreement 65% and 60%), respectively. The face validity of this work was classified as also being moderate.

Conclusions: In Guatemala, where store listings are incomplete and addresses are not well-marked, we have shown that direct observation is a low-cost method that has the potential to be both reliable and valid to map the community food environment in a low- and middle income country.

Abstract

Background: Fe status determines intestinal Fe-absorption and internal metabolism. Recently, sex-associated effects on Fe handling have been suggested as well. These hold implications for prophylactic or therapeutic oral Fe supplementation.

Objective: To determine whether sex and/or Fe-status influence the NTBI response to oral Fe.

Methods: 40 subjects –10 men (LM) and 10 women (LW) with low Fe stores (70 µg ferritin/L) — provided blood samples at baseline and at 90, 180 and 270 min after ingesting 100 mg Fe as FeSO4. Fe and NTBI were quantified with ferrozine-based assay and a fluorometric competitive-binding assay, respectively.
Responses in serum were estimated as cumulative 3-h absolute concentrations.

Results: The respective ∑ 3-h absolute concentrations (in µg/dL) were 820±124, 560±115, 714±61, and 772±198 for serum Fe (p=0.004), and 12±3, 14±4, 16±4, and 11±6 for serum NTBI (p=0.218) for the LM, AM, LW, and AW groups. Two-way ANOVA interaction-terms for Fe status and sex were statistically significant for the serum Fe and NTBI responses (p=0.003 and p=0.05).

Conclusion: Among males, the serum Fe uptake response was diminished with adequate Fe status as compared to low status, but a corresponding status-related differential was not seen among women. The NTBI response was equally mitigated across the entire spectrum of subject groups.

Abstract

Background: Consumer nutrition environment measures are important to understanding the food environment, which affects individual diet. A paper version of the nutrition environment measures survey for supermarkets (NEMS-S) was modified for use in Guatemala. However, a paper survey is not an inconspicuous data collection method and is not well equipped for multiple languages in the same version.

Objective: To design, pilot test, and validate the paper NEMS-S for Guatemala in the form of a mobile phone application (mobile app).

Methods: CommCare, a free and open-source software application, was used to design the NEMS-S for Guatemala in the form of a mobile app. Two raters tested the mobile app in one Guatemalan supermarket. Both the inter-rater and test-retest reliability of the mobile app was determined using percent agreement and Cohen’s Kappa score; and compared to the paper version.

Results: The inter-rater reliability was very high between the paper survey and the mobile app (Cohen’s kappa > 0.90). Test-retest reliability ranged from Kappa 0.78-0.91. With experience, survey completion-time using the mobile app was 5 min less than the paper form (35 vs 40 min).

Conclusions: The NEMS-S mobile app provides for more rapid data collection, with equivalent reliability and validity of the NEMS-S paper version. And has advantages over a paper-based survey of multiple language capability and concomitant data entry.

Abstract

Background: The nutrition environment measures survey for stores (NEMS-S) is a way to assess the consumer nutrition environment, which affects individual dietary intake. While NEMS-S has high validity in the United States, its validity has not been tested in Guatemala. The standard US NEMS-S was tested, modified and re-tested in urban Quetzaltenango, Guatemala.

Objective: To compare the measurement performance between the standard NEMS-S (USA) and the modified NEMS-S (Guatemala), respectively.

Methods: Seven trained raters tested the modified NEMS-S in 3 supermarkets, and returned one week later at the same time. Inter-rater and test-retest reliability were assessed using percent agreement and Cohen’s kappa. Measurement validity was based on how well each item was found based on the modified NEMS-S. The reliability and validity of the modified NEMS-S were compared to the standard NEMS-S.

Results: Both the inter-rater and test-retest reliability were very high (Cohen’s kappa >0.78) and similar to the standard NEMS-S. The validity of many standard NEMS-S items improved in the modified NEMS-S, especially lean meat, milk, hot dogs, and diet soda.

Conclusions: The modified NEMS-S has a better measurement performance as compared to the standard NEMS-S. Therefore, the modified NEMS-S is a reliable and valid tool that can be used to measure the nutrient environment in Quetzaltenango, Guatemala.

Abstract

Objective: To describe and compare urine oxidative stress biomarkers and erythrocyte antioxidant enzymes activity, in preschoolers from 3 daycare centers in Guatemala

Methods: 74 (2-6 y/o) children (36 F / 38 M) attending 3 government-subsidized daycare centers identified by location, coded as Center (C) and as to unique location: A (semi-urban n=19); B (marginal-urban n=23); and C (rural n=32) enrolled to measure oxidative damage to DNA (8-hydroxydeoxyguanosine {8-OHdG}) and lipid (15-Isoprostane F2t {F2-Iso}) and the erythrocyte activity of Catalase (CAT), Superoxide Dismutase (SOD), and Glutathione Reductase (GSHR) and Peroxidase (GPx).

Results: 8-OHdG and F2-Iso median values were different between sexes (p=0.03 and p=0.04, respectively), even when calculating the total amount excreted per day and adjusting to weight. GPx also differed by sex (p=0.01). According to location 8-OHdG and F2-Iso were different between CA and CB (p < 0.01 and p < 0.01, respectively). CAT and GSHR were different in CB when compared to CA and CC (p < 0.01 in both cases). SOD activity was different among all 3 centers (p < 0.01), whereas GPx was different between CB and CC (p=0.02).

Conclusion: Differences in oxidative biomarkers between sexes, especially those biomarkers that are involved in lipid oxidation (F2-Iso and GPx), are seen.

Abstract

Objectives: To describe urine oxidative stress biomarkers and erythrocyte antioxidant enzymes activity, and explore any association with prevalence or intensity of Giardia intestinalis infection (Gi) in preschoolers attending 3 government-subsidized daycare centers in the Guatemalan Western Highlands.

Methods: 74 24-h urine, blood and fecal samples were collected the same week, among 36 F and 38 M to measure oxidative damage to DNA (8-hydroxydeoxyguanosine {8-OHdG}) and lipid (15-Isorpostane F2t {F2-Iso}), the erythrocyte activity of Catalase (CAT) and Superoxide Dismutase (SOD) Glutathione Reductase (GSHR) and Glutathione Peroxidase (GSHPx). Gi prevalence and intensity were assessed by ELISA kit procedures.

Results: CAT activity correlates significantly with 8OHdG (r=0.242, p=0.038) and F2-Iso (r=0.468, p < 0.001), whereas SOD activity correlates only with F2-Iso (r=0.256, p=0.028). Positive correlations were also found between Gi intensity and CAT (r=0.337, p=0.003) and F2-Iso (r=0.291, p=0.012). Median values of rbc CAT activity (p=0.016) and urine F2-Iso (p=0.023) differed between children who were Gi+ and Gi-.

Conclusion: We find heretofore unrecognized associations between rbc and urine oxidative stress biomarkers and with the prevalence and intensity of Gi in our study population.

Abstract

Background: We have recently signalled the poorly recognized high prevalence of stunting at birth – a challenge for prevention of linear growth retardation.

Objectives: To assess and compare the progression of mean HAZ and stunting rates between the 1st and the 4th-6th mo in rural R and urban U infants in the Western Highlands of Guatemala.

Methods: Two field studies in the Province of Quetzaltenango – Mam-Mamas (a saturation survey in 8 R Mam-Mayan-speaking communities) and Xela-Babies (a convenience sample from an U health clinic) – included anthropometry measurement in the first 45 and at 131-182 days of life, in a longitudinal format in both locations and in a transverse manner at the R site only. Stunting was defined as < −2 SD of HAZ (2006 WHO growth standards).

Results: In the cohort series, the HAZ declined at the R site from an initial median of -1.61 (stunting prevalence 34.9%) to -1.79 (39.8%) (n=129; ΔHAZ -0.009±0.070 units/wk); and rose at the U site from -1.45 (25.0%) to -1.38 (28.3%) (n=60; ΔHAZ +0.011±0.046 u/wk). The stunting prevalence was significantly higher at 4-6 mo at the R vs U site (p=0.012); HAZ progression was not statistically significant at either site. In the cross-sectional samples from the R site, the progression was -1.89 (40.8%) (n=71) to -2.06 (50%) (n=60; ΔHAZ -0.010 u/wk).

Conclusions: This, to our knowledge, is the first report on the progression of linear growth failure within the first 6 mo of life. Within our study setting, stunting begins in utero, and is worse at the R site, with no statistically significant progression in HAZ scores between the first 6 mo of life.

Abstract

Background: SCM is an asymptomatic inflammatory condition of the lactating breast associated with infant growth faltering. A breast milk Na/K ratio >0.6 is the current indicator for SCM whereas in cows SCC is considered the ‘gold standard’. Our objective was to determine if potential biomarkers of human SCM (SCC, pro-inflammatory cytokines) were associated with Na/K ratio at two stages of lactation.

Methods: Breast milk samples were collected from 53 lactating Mam-Mayan women with infants < 45d (early lactation) and 52 with infants 4-6mo (late lactation). Inductively Coupled Plasma Mass Spectrometry measured Na and K. Flow Cytometry was used to measure SCC. Luminex measured 3 pro-inflammatory cytokines (IL-6, IL-8, TNF-a).

Results: One fifth had a breast milk Na/K ratio >0.6; an elevated Na/K ratio was more common in early lactation (26%) compared to late lactation (15%). By contrast, both IL-8 (10.3 vs 38.3 pg/mL) and SCC (313K vs 457K cells/mL) were lower in early verses late lactation. The Na/K ratio was positively correlated with all 3 pro-inflammatory cytokines in early lactation whereas only IL-8 was associated in late lactation. SCC was not correlated with either Na/K ratio or pro-inflammatory cytokines in either stage of lactation.

Conclusion: Potential biomarkers of SCM vary by stage of lactation. Based on the Na/K ratio, SCM is more prevalent during early lactation. Results suggest that pro-inflammatory cytokines may emerge as possible biomarkers and that SCC may not be a useful biomarker of SCM in lactating mothers.

Grant Funding Source: McGill University International Mobility Award, NSERC

Abstract

Background: Human breast milk is the normal source of minerals for infant growth, development and metabolic function up to 6 months, but little information is available about how mineral concentrations vary throughout lactation in developing countries. Our objectives were to compare mineral concentrations between early (< 45d) and later (4-6mo) lactation periods, and to determine if mineral concentzrations varied with infant age within these two lactation periods.

Methods: Inductively Coupled Plasma Mass Spectrometry was used to analyze the concentration of 13 minerals (Na, K, Ca, Mg, Mn, Zn, Cu, Cr, Sr, Se, Rb, Fe, P) in early (n=54) and later (n=49) breast milk samples collected from Mam-Mayan women.

Results: Median concentrations of Na, K, Mn, Zn, Cu, Cr, Rb and Fe were significantly higher in early milk compared with later milk whereas Mg was lower in early milk. No differences were observed between lactation period for Ca, Se and Sr. Within the first 45d, Na, K, Cu and Zn were negatively correlated with infant age. During the 4-6mo interval, only Se was negatively correlated with infant age.

Conclusion: Our findings reveal that concentrations of Na, K, Cu and Zn decreased within the first 45d, that Mn, Cr, Rb and Fe had declined by 4-6mo, and that Se declined during the 4-6mo interval.

Grant Funding Source: McGill University International Mobility Award, NSERC