Rainer Gross Prize
Recent Innovations in Nutrition and Health in Developing Societies.
Rainer Gross Prize
Detailed information can be found here.
CeSSIAM was founded in Guatemala in 1985 and is a non-governmental, non-profit organization dedicated to nutrition research and education.
CeSSIAM works in partnership with the Hildegard-Grunow-Foundation for Nutrition Research (HGF) and the Nevin Scrimshaw International Nutrition Foundation (INF).
CeSSIAM Bulletins: Bulletin of Research Abstracts
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CeSSIAM in Guatemala, P.O. Box 02 –
5339, Section 3163/Guatemala,
Miami, FL33102-5339, U.S.A.
CeSSIAM, 17 Avenida # 16-89 (interior),
Zona 11 (Anillo Periferico),
Guatemala City, 01011
The Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM) is a biomedical research center in Guatemala City, with a concentration on human nutrition. It was co-founded by Dr. Noel W. Solomons along with three professional colleagues from the Guatemalan community in 1985. It had the vision to provide a forum for creative investigator-initiate research and for the motivation and training of students and young professionals in biomedical investigation. It has been affiliated with the International Nutrition Foundation continuously since 1988. Dr. Solomons serves ad honorem on the INF staff as its Program Director for CeSSIAM.
Iron is an essential nutrient, but its properties as an oxidant and as an essential nutrient for pathogens that infect humans raise issues of safety for iron in the diet, as well. This is a program led by Dr. Mónica Orozco. Also participating from the CeSSIAM staff is Ms. Sheny Romero-Abal along with assorted university students. Two assay systems for markers of mechanisms of adverse effects from iron are central to the program. One (fecal oxidation) looks at the effects of supplementation with oral iron on the anti-oxidation protection system in the large intestine by monitoring the buffering against formation of damaging free-radicals in the stool. The other (free-iron in the circulation) adopted and mounted in Guatemala an assay for loosely-bound iron that was learned by Dr. Orozco at the University of Utrecht in the Netherlands. This represents the iron that can become available to noxious microbes or damage cells and tissues. With both of these research tools in the Program’s tool-kit, concentration is focused on differences between men and women in the mobilization of defenses against iron exposure and its consequences and on the free-iron response in young children.
These represent two major field-study projects in the Quetzaltenango Province of Guatemala with separate funding and staffing streams, but with multiple points of common themes and interest related to maternal health, the adequacy of lactation, the early feeding practices and the nature of complementary feeding and growth of the offspring. Both have cross-sectional and longitudinal approaches to the description of behaviors and health and nutritional outcomes. Dr. Marieke Vossenaar was the co-Principal Investigator the Xela-Babies Project, with grants from the Nestlé Foundation and from Sight and Life. Ms. Rosario García was the expert on qualitative research including key informants and focus groups. In charge of the basic recruitment, interviewing and anthropometry measurements on children and mothers were a team of local nutritionists: Ms. Elena María Ruíz, Ms. Deborah Fuentes, and Ms. Alejandra Maldonado. The focus was on the urban experience of early-feeding, growth and illness and their interaction. It had a survey component with children from birth to 23 months of life, and a prospective, longitudinal component with serial measurements and interviews in the first, fourth and sixth month of life.
The Mam-Mamas Project is a research platform for addressing the dissertation hypotheses of two doctoral candidates from McGill University: Dr. Anne-Marie Chomat and Ms. Hilary Wren. It is based in seven remote hamlets in the Western Highlands among Mam-speaking families. These are areas of high rates of poor linear growth (stunting) in early life. The major objective is to link aspects of women’s health in late pregnancy and in the first 6 months of lactation as potential determinants of the offspring’s growth and disease resistance. It includes qualitative and quantitative interview methods and the collection of biological specimens, with a specific focus on those collected in a non-invasive manner, e.g. saliva, urine, feces and human milk. It explicitly eliminates the collection of blood. The project is conducting a survey among women in these reproductive phases, and performing a serial (longitudinal) screening of variables. The measurements include dietary intake of mother and child, body size of both parties, the parasites and infections in the dyad, and specifically in the mothers, the nutritional quality of milk, and the social and biological markers of maternal stress (including stress hormones in saliva and milk). The project also has a Positive Deviance dimension, in which factors common to the families with the most successful growth and health experience in the offspring are sought as potential clues to resolving the problem in these settings. Ms. Rosario García also coordinates the administrative issues for the regional center and Ms. Alejandra Maldonado, Ms. Marta Escobar and Ms. Maria Garcia participate in the field activities with local personnel and International students.
The Secretariat for Social Projects of the First Lady of Guatemala (SOSEP) supports the formation and maintenance of Hogares Comunitarios (HC), day-care centers allowing both parents of a family to work outside of the home in low-income communities. A notable feature of the SOSEP HCs is the provision of a well-planned and standardized dietary fare including a breakfast, a lunch and two snacks over 5 days per week in a 40-day (8 week) rotating official menu. This food plan applies to all HCs in the system, tending to normalize the dietary offering for all attendees across the nation, with the variation arising from what is consumed in the evenings at home. Ms. Liza Hernández and Ms. Sylvana Salguero quantified the intake of nutrients across all of the nutrients offered by use of the United States Department of Agriculture on-line composition tables. With a common general dietary pattern, variability in nutritional status and health from child to child will depend upon genetic and environmental peculiarities.
Ms. María José Soto-Méndez is examining how growth, hematological status, oxidative and inflammatory processes, parasite infestations and even hydration vary across individuals in the context of a fairly common dietary experience.
The requirements for dietary nutrients are higher during pregnancy and breast-feeding than during non-reproductive phases of the female lifespan. Whereas some habitual dietary patterns, including those in some low-income sectors of Guatemala, may come close to providing the standard for nutrients for women, it does not have the reserves needed to supply the extra nutrients for gestation and lactation. A public health strategy would be to get women to consume more nutrients from a fortified source to cover additional reproduction-based demands. In the Province of Quetzaltenango, CeSSIAM has two initiatives on this theme. Dr. Mónica Orozco took on the task to model a formula for maize flour for preparing maize-derived items such as tortillas and tamales that would enhance the intake of micronutrients for the needs of pregnant and nursing women. Ms. Alejandra Maldonado and Ms. Marta Escobar performed interviews regarding how the maize items are prepared and how they are distributed across family members within the household. Dr. Marieke Vossenaar worked with Ms. Elena María Ruíz and Ms. Deborah Fuentes to quantify the nutrient intake in pregnant and lactating women from rural and urban settings and identified the nutrient gaps as compared to the standard, international recommended intakes. It also inquires about specific avoidances and cravings or preferences during the two physiological conditions.
Ms. Rosario García, an expert in quantitative and formative-research procedures of key-informants and focus groups, contributed interviews and sessions for a study of attitudes and beliefs regarding food taboos, food avoidances and the cultural nuances surrounding views on equity versus hierarchy of food distribution within the household.
CeSSIAM has conducted sponsored research to investigate the efficacious nature of adding micronutrients to either a refreshing beverage or a turkey pate for correcting inadequate nutritional status. The beverage study was conducted in schoolchildren and adult women living in the sugarcane cultivation zones of the Pacific coastal plain, led by Ms. Raquel Campos and Ms. María José Soto-Méndez; the turkey pate trial was conducted in preschool children in a semi-urban setting outside of Guatemala City, led by Ms. Liza Hernández and Ms. Sylvana Salguero.
The Micronutrient Initiative of Ottawa, Canada, at the behest of the Ministry of Health of Guatemala, has requested assistance in the development of a communication strategy to enhance the adherence to the prescription to take oral zinc medication for a full 10 days following consultation at health centers or health posts in the San Marcos Province by young children for acute diarrhea or acute respiratory infection. Ms. Rosario García is leading the formative research which seeks to explore understanding of the diseases, understanding of the prescriptions, and attitudes at all levels of stakeholders from facility-directors, to medical, nursing and auxiliary staff to the families of patients, themselves.
Student research opportunities can be found in participation in the major projects and platforms or in specific, made-to-order projects, often piloting the application of new interview methods or measuring devices of potential research in more formal research.
The under-five population of Guatemala has the highest rate of linear growth retardation (stunting) in the Western Hemisphere; the reported prevalence is 54% below the minimum height standard. The loss of linear growth commences shortly after birth and produces dramatic rates of stunting in affected areas by 24 months of age. As official survey samples include infants as of 6 months of age, the amount of growth loss occurring before that age has remained obscure. Combined insights from the Xela-Babies and Mam-Mamas projects have recently revealed that rates of stunting are already high within the first month of life, in the order of 31%.
This has multiple implications for public health. The most obvious conclusion is that directing efforts against stunting after birth is too late, and any full redress of linear growth would have to begin during pregnancy or before. This implies attention to the maternal health to resolve the child-malnutrition problem. At the same time, with the short stature of women in this population, increase in utero growth would increase the risk of obstructed labor and obligate attention to provisions for appropriate obstetrical intervention.
During their reproductive years, women lose and gain three times as much iron as do men due to menstruation and birthgiving. Women also seem to be more resistant than men to certain diseases associated with oxidation, such as colonic disorders and cardiovascular disease. The data gathered by Dr. Monica Orozco in the Iron Safety and Efficacy Program points toward possible mechanisms of differential handling of iron in women. Comparing the background anti-oxidation buffering capacity of male subjects and female subjects in fecal oxidation testing protocols, the containment of free-radicals is 2.5 times greater in women’s intestinal excreta. Similarly, the circulation of loosely-bound iron is proportionally lower in women than in men for a given amount of oral iron taken up from the intestine into the blood stream. These observations may give clues as to how women’s metabolic handling of iron may differ from those of men in a manner in which the consequence of iron exposure is better tolerated.
A cultural practice, widespread in Guatemala, is the administration to infants of “ritual fluids” consisting of herbal infusions or dilute gruels, known as agüitas. Since this violates the tenets of exclusive breast feeding – but does not involve provision of nutrition – this constitutes “predominant breast feeding” by WHO terminology. The findings from Xela-babies’ dietary and morbidity survey identified the fact that early introduction of agüitas was associated with a greater risk of stunting up to 24 months of age.
Taking advantage of the population sample of school children and adult women on the coastal plain, the pattern of fatty acids in red cell membranes was studied. The specialized collection and preservation of the specimens was led by Ms. María José Soto-Méndez. In collaboration with the Lipid Division of DSM Nutritionals in Columbia, MD, USA, the chemical analyses have revealed a low status for omega-3 essential fatty acids.
The World Health Organization advocates “exclusive breast feeding” (EBF) until 6 months of life of the infant. Individual nations perform the protocol of the Demographic and Health Surveys (DHS), from which an estimate of the prevalence of EBF is made, and these are compiled and posted by the UN agencies (WHO, UNICEF, etc.) in a comparative manner. The statistic is derived from the question to mothers of 6 month-old infants: What did your child consume on the previous day? From the most recent DHS in Guatemala, this nation is credited with having a 50% EBF rate. Systematic data from multiple lines of question show that the DHS estimate does not accurately reflect violations of EBF occurring prior to 6 months (but not on the day prior to interview). In the sense of cumulative infancy experience, the single, one-day recall greatly overestimates the true prevalence of EBF since birth.
The only official public health statistic for the vitamin A status of a population is that of low vitamin A levels (< 20 µg/dL of circulating retinol) in a representative sample of children aged 6 to 59 months of age. In the most recent Guatemalan survey of under-fives, only 3% of the vitamin A values were below the critical value, and hypovitaminosis A was excluded as a public health problem. In a convenient group of residents of the coastal plain of Guatemala, comprised of school children and adult women, CeSSIAM measured vitamin A levels, finding no values below the cut-off value whatsoever.
Using data from the Diet and Health Program, the concepts arising in the late 1990s of examining the nutrient requirements for a subcomponent of a diet in order to complement another component and reach the recommended daily standard. Three CeSSIAM publications (Vossenaar & Solomons, 2012; Vossenaar, Campos, Hernandez & Solomons, 2012; Vossenaar & Solomons 2013) have re-projected the utility of the critical nutrient density to understand the adequacy of different recommended approaches to distribute breast feeding and complementary food during the weaning period for infants and toddlers.
CeSSIAM has been the grateful recipient of a portable, battery-operated, digital rapid vitamin A assessment device (iCHECK™, BioAnalyt, Telbow, Germany), along with training in its use and a supply of iEX™ extraction vials, courtesy of Sight & Life and DSM Nutritionals. It has demonstrated the capacity to obtain credible vitamin A values for table sugar samples, dairy products, and human milk. Notably, we have demonstrated that freezing of samples is not an impediment to obtaining accurate values for vitamin A.
Sight & Life 2013: Report from Guatemala
The appropriate and responsible distribution of iron in areas of malaria transmission requires targeting only to those who require iron. CeSSIAM has been continuing its research agenda for many years to determine whether non-invasive, light-beam-based devices that accurately measure fluctuation of blood hemoglobin during surgery in the confines of operating rooms can provide valid screening in the field setting. We have been testing the application of new, miniaturized sensors for children under five years of age in terms of stability and accuracy of measurement – results are partly pending, partly they were not convincing.