Abstract

Background: The WHO recommends exclusive breastfeeding (EBF) during the first 6 mo of life. Evidence complied in earlier studies of CeSSIAM documented that mixed feeding often occurs earlier.

Objective: To compare the pattern of age of introduction of commonly consumed foods in the western highlands with what has been reported from the central highlands of Guatemala.

Methods: Age of introduction of 10 sentinel foods was queried by means of structured face-to-face interviews in 6 to 11 mo old infants living in 2 urban areas (Quetzaltenango, n=128 and Guatemala City, n=64) and 1 rural area (Santo Domingo Xenacoj, n=64).

Results: Items most frequently reported as introduced before 6 mo in Quetzaltenango were vegetables (28%), followed by fruits (27%), Incaparina® (23%), potatoes (20%), and sweet rolls (17%). These rates of premature introduction are higher than reported in a poor neighborhood in Guatemala City with a respective: fruits (18%); vegetables (17%); potatoes (14%); Incaparina® (13%); and rice (11%). The hierarchy in a Mayan village was: potatoes (15%); vegetables (13%); Incaparina® (13%); rice (12%); and oatmeal (11%).

Conclusion: Different patterns of early introduction of food and beverage items contribute to the precocious occurrence of mixed feeding in the first semester of infancy in distinct regions of Guatemala.

Funded by the Nestlé Foundation, Switzerland

Abstract

Background: The WHO recommends that fluid intake be increased during illness and that foods be offered more often after illness.

Objective: To describe feeding practices during and after illness in a sample of young Guatemalan children aged 6-23 mo.

Methods: Mothers of 300 young children attending two public health centers in the Western Highlands of Guatemala were interviewed regarding past feeding practices with a structured questionnaire.

Results: 238 mothers (79%) reported offering the young child additional liquids when ill; the most commonly reported liquids were water (offered by 41% of mothers), ritual fluids (28%), oral rehydration solutions (17%) and breastmilk (7%). 85 mothers (28%) offered different foods during illness. 132 mothers (44%) reported withholding certain foods, whereas some foods were specifically offered during child illness by 88 mothers (29%). Most commonly avoided foods were beans, eggs, fatty-foods and other items culturally believed to be “cooling” to the body (“cold foods”), as well as coffee. Most commonly promoted foods were soups, broths, ritual fluids, foods low in fat and breastmilk. Only 99 mothers (33%) reported offering the child more foods in convalescence.

Conclusion: A substantial proportion of mothers appropriately adapt feeding practices surrounding child illness in accordance with WHO guidance.

Funded by Sight and Life, Switzerland

Abstract

Background: Dietary intake during metabolic trials has been controlled using one or another assessment method. The luxury of comparison of mutual results is rarely available.

Objective: To compare data between self-reported nutrient intake from 24-h recall and FFQ at baseline among overweight and obese Spanish participants in a metabolic trial.

Methods: 151 volunteers (age 18-65 y) were enrolled in a randomized, placebo-controlled, double-blind, crossover trial. Subjects were interviewed by 2 standardized nutritionists in a baseline 24-h recall and a FFQ.

Results: At a group level, median FFQ-derived energy was estimated as higher than that with 24h-recall (2600 vs 1874 kcal) as were carbohydrates (273 vs 206 g), proteins (117 vs 87 g) and fats (116 vs 81 g), respectively. All differences were significant at p < 0.05. At the inf´dividual level, 83% of subjects reported more energy on FFQ and 17% more on 24-h recall interviews. Regarding macronutrients, 77% of subjects for carbohydrtaes, 81% for protein and 84% for fat reported greater intakes with the FFQ approach.

Conclusion: As expected, results from this study indicate that FFQ overestimated dietary intake in comparison to the 24-h recall.

This trial is registered at clinicaltrials.gov as NCT01290250 and it is funded by The Coca-Cola Company.

Abstract

Background: It has been suggested that the advance of processing of the foods in the human diets is causally associated with increasing chronic disease risk.

Objective: To classify the ingredients in the menu served to Guatemalan preschoolers in a day-care center system according to the Monteiro Scale of food-processing, modified for ingredient, scoring.

Methods: The menu of the SOSEP, a Guatemalan government subsidized community day-care system for low-income preschoolers prescribes breakfast, lunch and 2 snacks daily, over 5- d weekly, within a 8-wk (40-d) rotation. Dishes and recipes were reduced to their ingredients. Following the Monteiro Scale (Monteiro et al, Cad. Saúde Pública 2010), we classified each ingredient item as: GI, unprocessed/minimally processed; GII, processed; or GIII, ultraprocessed, and tabulated by menu appearance, and energy and weight contributions. Any item with added fortificant nutrients is classified as a GIII item.

Results: We identified 102 ingredients in the menu. 60 (59%) were GI, 12 (12%) GII, and 30 (29%) GIII. The percentage of energy provided by the respective classes was: GI 24%; GII 31% and GIII 45%. In terms of the proportion of the weight of menu offering, the respective contributions were: GI 66%; GII 11%; and GIII 23%.

Conclusion: Menus still conserve a predominance of unprocessed items. Association of energy density with ultra-processing clearly stands out.

Abstract

Objective: To determine the leading food sources of nutrients, principal mealtimes, and predominant presentation (solid/liquid) provided by the diet served in government sponsored day-care centers (SOSEP).

Methods: The SOSEP 8-week rotating menu, containing 102 items, was reduced to the content in gravimetric or IU units for 30 selected nutrients per menu cycle. The item, meal type (breakfast {B}/ lunch {L}/ snacks {S}) and presentation (solid/liquid) were ranked highest for each nutrient.

Results: 5 items were the leading sources of 19/30 nutrients of interest (vegetable oil, 5; table sugar, 4; corn tortilla 4; oatmeal, 3; Incaparina®, 3). An additional 9 items were leading sources for 2 or 1 item each. 4 main items were of animal origin. L was the predominant source for 25 nutrients, B for 5, and S for 2 (2 nutrients were tied across 2 meal types). The solid form was predominant for 26 nutrients, and liquid for 6 (2 nutrients were tied across forms).

Conclusions: Number-1 predominance of nutrient delivery to the SOSEP diet is limited to a few items, mostly of plant origin. As expected for Guatemala, L was the main meal type for most nutrients, which derived from solid foods.

Abstract

Background: Iron, vitamin A, iodine, zinc and folate are prominent on the public health nutrition agenda. Marginal or deficient vit B12 status was reported in 68% of peri-urban Guatemalan lactating mothers and 49% of the infants.

Objective: To assess vit B12 status in a convenience sample of 3-6 y/o preschoolers in disadvantaged urban and rural communities receiving subsidized meals.

Methods: 104 serum samples were obtained from boys and girls in 3 sites in the Central Highlands of Guatemala, 47 from 2 urban (U) centers and 57 from a rural (R) center. Circulating levels of vit B12 were measured by a chemiluminescent enzyme immunoassay method (Immulite 1000, Siemens, IL). Respective cutoff criteria for deficient and marginal for vit B12 were < 200 pg/mL and 200-309 ng/mL. The contribution of dietary vit B12 from center menus was estimated.

Results: Overall mean vit B12 concentration (pg/mL) was 459±271 (median: 357): 583±294 (median: 527)(U) and 339±181 (median: 289)(R) (p < 0.0001). Globally, 8.6% had deficient and 26.9% had marginal values, for a 35.6% subnormal prevalence. Deficient plus marginal rates by setting were 10.6% (U) and 56.0% (R), respectively, with all 9 deficient subjects of rural origin. The 1 or 2 meals offered by the centers provided averages of 0.15 – 1.50 μg vit B12/d.

Conclusion: Slightly over one-third of preschoolers had low vit B12 status, with a marked excess of low status in the rural setting.

Abstract

Background: Whereas iron, vitamin A, iodine, zinc and folate are prominent on the public health nutrition agenda, vitamin D has been lower on the interest horizon. Particular dietary or environmental characteristics of Guatemala may predispose to insufficient or deficient nutrient status.

Objective: To assess vit D status in a convenience sample of preschoolers in disadvantaged urban and rural communities receiving subsidized meals.

Methods: 104 serum samples were obtained from boys and girls meals in 3 sites in the Central Highlands of Guatemala, 47 from 2 urban (U) centers and 57 from a rural (R) center. Serum 25(OH)D was measured on a Liaison instrument (DiaSorin, Inc., Stillwater, MN) using a chemiluminescent assay in Omaha, Nebraska. Respective cutoff criteria for deficient and insufficient for 25(OH)D were < 20 and 20-30 ng/mL. The contribution of dietary vit D from center menus was estimated.

Results: Overall mean 25(OH)D concentration (ng/mL) was 26±6, 27±6 (U) and 25±7 (R) (p>0.05). Globally, 20.2% had deficient values and 56.7% had insufficient values. Deficiency rates by setting were 12.7% (U) and 26.0% (R), and insufficiency rates, 59.6% (U) and 54.4% (R). The 1 or 2 meals offered by the centers provided averages of 0.12-0.90 µg vit D/d.

Conclusion: Sub-adequate vit D status is a common feature of preschoolers in day-care center populations, without geographic distinction, related in part to low dietary intakes.

Abstract

Objectives: To explore mothers’ views and behaviors regarding infant feeding practices (IFP) and to determine how grandmothers and other actors’ influences might be leveraged for enforcing appropriate IFP.

Methods: Mothers of children, aged < 24 mo, of both Mayan and mixed-European ascent, were recruited for qualitative research inquiry in the urban area of Quetzaltenango, Guatemala. Data was collected using semi-structured informant interviews and reflective dialogues in focus groups. Sessions were recorded and transcribed. Information was synthesized around the concept of “agency”.

Results: The notion that infants require certain foods to avoid illness and suffering represents a powerful ideology that influential grandmother-generation females figures (mothers, mothers-in-law, aunts) transmit to nursling’s mothers through mechanisms such as fear messages. Moreover, both generations share a common belief that infants innately prompt mothers to begin introduction of certain foods; this reveals an infant-to-mother-directed influence on IFP.

Conclusions: Future community education initiatives should consider interpersonal and subjective determinants of IFP to promote maternal agency and the active participation of actors in both bracketing generations who influence the mothers’ IFP.

Financed by the Nestlé Foundation and Sight & Life, Switzerland

Abstract

Objectives: To explore mothers’ views and behaviors regarding infant feeding practices (IFP) and to determine how grandmothers and other actors’ influences might be leveraged for enforcing appropriate IFP.

Methods: Mothers of children, aged < 24 mo, of both Mayan and mixed-European ascent, were recruited for qualitative research inquiry in the urban area of Quetzaltenango, Guatemala. Data was collected using semi-structured informant interviews and reflective dialogues in focus groups. Sessions were recorded and transcribed. Information was synthesized around the concept of “agency”.

Results: The notion that infants require certain foods to avoid illness and suffering represents a powerful ideology that influential grandmother-generation females figures (mothers, mothers-in-law, aunts) transmit to nursling’s mothers through mechanisms such as fear messages. Moreover, both generations share a common belief that infants innately prompt mothers to begin introduction of certain foods; this reveals an infant-to-mother-directed influence on IFP.

Conclusions: Future community education initiatives should consider interpersonal and subjective determinants of IFP to promote maternal agency and the active participation of actors in both bracketing generations who influence the mothers’ IFP.

Financed by the Nestlé Foundation and Sight & Life, Switzerland

Abstract

Background: The WHO recommends exclusive breastfeeding (EBF) through the first 6 mo of life. EBF is defined as having received only breast milk during the previous day. Predominant breast feeding (PBF) allows the infant to receive certain liquids such as water, juices and ritual fluids.

Objective: To evaluate EBF and PBF rates in a sample of infants from a low-income, urban Guatemalan population using 3 different interview methods.

Methods: Mothers of 154 infants (77 boys) in their 6th mo of life, attending a public health center, were recruited and interviewed on a single occasion regarding previous day (as suggested by the WHO), current, and past (since birth) feeding practices.

Results: Using the previous day recall, EBF was reported by 86 (56%) of the mothers. Estimated EBF rates were much lower when based on current feeding practice questions (20%) and even lower when based on feeding practices since birth (9%). Using the less stringent recommendation allowing certain liquids, we observed PBF rates of 58%, 49% and 31% based on previous day, current and past reported feeding practices, respectively.

Conclusion: The WHO method overestimates the EBF rate compared to the recall since birth. Overall, adherence to the WHO guidelines for feeding in the first semester of infancy was much less than ideal and in need of strengthening.

Funded by the Nestlé Foundation, Switzerland

Abstract

Background: The Guatemalan national prevalence of stunting (chronic undernutrition) in children up to 60 months is 54%, which is the fifth highest in the world. As the stunting process continues out through the third year, stunting rates through 24 mo would expected to be lower.

Objective: To describe the rate of stunting in a sample of infants and toddlers recruited in Metropolitan Quetzaltenango.

Methods: A total of 300 young children (150 boys), ranging in age from 6 to 23 mo, equalized for months of life, were recruited at 2 public health clinics in metropolitan Quetzaltenango. Recumbent spine length and weight were measured according to standardized procedures and height-for-age (HAZ) were calculated. HAZ ≤ 2 SD of the WHO 2006 Growth Standards was considered stunting.

Results: The overall mean HAZ-score was –1.89±1.11 and 135 (45%) children were stunted. Children of women classified of Mayan ascent were significantly (p < 0.001) shorter (HAZ-score -2.20±1.03, and 54% stunted) than others (HAZ-score -1.71±1.11, and 40% stunted). The age-specific HAZ-scores were -1.71±1.13, -2.07±1.16 and -1.94±0.99 for the 6-11 mo, 12-17 mo and 19-23 mo old age groups, respectively, and stunting rates were 36%, 54% and 48%, respectively.

Conclusion: Stunting rates are high, progressing with aging through the first 2 years of life.

Funded by Sight and Life, Switzerland

Abstract

Background: Although the WHO recommends exclusive breastfeeding during the first 6 mo of life, evidence compiled in earlier studies of CeSSIAM documented that mixed feeding often occurs earlier.

Objectives: To examine the magnitude and manner or use of formula milk and to assess its energy contribution in breastfed infants aged 5 mo.

Methods: In the course of enrollment of 152 breastfeeding 5 mo old infants, recruited at a health clinic in metropolitan Quetzaltenango, a previous-day recall of all food and beverages consumed by the infant was performed.

Results: A total of 39 (26%) mothers reported feeding their infants formula or cow milk the day before the interview. The vast majority (92%) used a bottle as the means of delivery. Amongst consumers, the reported intake of milk ranged between 5 and 1206 mL/day with a median of 260 mL/day. Its energy contribution varied between 1 to 803 kcal/day, with a median of 139 kcal/day.

Conclusion: The use of formula in combination with breastfeeding, i.e. mixed feeding, is common in Guatemalan infants by the 6th month of life and apparently sustainable. Adherence to the internationally-recognized guidelines for early infant feeding is in need of strengthening among the population of this region.

Funded by the Nestlé Foundation, Switzerland

Abstract

Background: The WHO recommends exclusive breastfeeding (EBF) during the first 6 mo of life; however, violations are widespread.

Objective: To assemble among infants in Guatemala a retrospective record on the temporal pattern of introducing foods and beverages before 6 mo, constituting mixed feeding and violating the EBF or predominantly breast fed (PBF) patterns.

Methods: Mothers of 300 infants, aged 6 to 23 mo, attending a public health, equalized for months of life, were interviewed about early life practices with a structured questionnaire.

Results: At interview, continued BF was commonly reported: 6-11 mo (84%); 12-17 mo (90%); and 18-23 mo (53%). When questioned retrospectively, 90% of mothers reported BF for at least 6 mo. EBF was rare, with only 14% of infants receiving EBF for 5 mo, and just 9% for the recommended 6 mo. The most common violation was the premature introduction of liquids, such as ritual fluids, at a median age of 14 wks. The proportion of infants with PBF, which allows certain liquids such as water, juices and ritual fluids, was 33% through 5 mo and 23% through 6 mo. The median age of introduction among ever-consumers was 18 wks for infant formula; 14 wks for complex beverages; and 23 wks for other food items.

Conclusion: Overall adherence to the WHO guidelines for feeding in the first semester of infancy was much less than ideal and in need of strengthening.

Funded by Sight and Life, Switzerland

Abstract

Background: In many cultures, simple herbal infusions, thin gruels or sweetened water (‘agüitas’ in Guatemalan parlance) are given to infants and toddlers.

Objective: To examine the prevalence and timing of introduction of agüitas during early life in a low-income population of metropolitan Quetzaltenango.

Methods: 452 responses about ever introduction of agüitas through ages 5 to 23 mo were analyzed using logistic regression to explore relationships between growth (stunting) and morbidity (diarrheal and respiratory infection) and timing of first consuming agüitas.

Results: For 452 dyads, 354 (78%) were agüitas-users, independent of sex or ethnicity. Of those given agüitas, half were introduced within the first 2 mo. These subjects were 1.6 times more likely to be stunted (CI=1.0, 2.5) after adjusting for ethnicity. Early introduction of agüitas was strongly associated with more reported instances of diarrhea (OR=3.4; CI=2.1, 5.4) and respiratory infections OR=2.5 (CI=1.6, 4.0), irrespective of ethnicity.

Conclusion: The high prevalence and early introduction of agüitas are consistent with other findings showing agüitas to be deeply rooted in the culture of infant rearing. Understanding these associations requires an in-depth understanding of the meaning and use of agüitas.

Funded by the Nestlé Foundation and Sight and Life, Switzerland

Abstract

Background: The combination in a maternal-child dyad of an overweight/obese mother and a stunted child has been termed the household-level dual burden of malnutrition. An important consequence is that a stunted child, more susceptible by short stature to metabolic conditions in later life, is being raised in a proven obesogenic milieu.

Objective: To determine the prevalence of 5-23 month olds in this dyadic relationship in the metropolitan Quetzaltenango area.

Methods: Anthropometric measures (weight and length), were collected in 449 mother-infant dyads, with subsequent classification of infants for stunting (25 kg/m2) or obesity (BMI >30 kg/m2).

Results: 200 (44%) mothers were overweight or obese and 50 (11%) were classified as obese. 172 (37%) children were stunted. Of the 172 children who were stunted, 75 (44%) were living in an environment permissive for adult overweight or higher order body composition abnormality. The combination of stunted children living in an obesogenic milieu comprised 75 (17%) children.

Conclusion: The prevalence of stunted child and overweight or obese mother is high relative to other studies. The exposure of stunted children to household obesogenic factors may present hazards for health in later life.

Funded by the Nestlé Foundation and Sight and Life, Switzerland