Certain population groups are particularly endangered to suffer from impaired health due to inadequate nutrition related to their age or gender group. These are pregnant and lactating women as well as small children from suckling to school age. Therefore, field-studies investigate the health and nutritional status of these vulnerable population groups in Guatemala in order to improve nutrition in a next step.
“Xela-Babies” and “Mam-Mamas” represent two major field-study projects in the Quetzaltenango Province of Guatemala with separate funding and staffing streams, but with multiple 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.
The focus is on the urban experience of early-feeding, growth and illness and their interaction. The projects have 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 investigate the impact 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 non-invasive methods, such as determination in 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 mothers and children, 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 problems in these settings.
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 “international 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 on the order of 31% in the first month of life.
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.
A cultural practice, widespread in Guatemala, is the administration to infants of ritual fluids consisting of herbal infusions or dilute gruels, known as agüitas (“little waters”). 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.
Stunting rates still seem to be very high in Guatemala. More results will be published.
Click for complete referenceN45: The stunted child with an overweight mother as a growing public health concern in resource-poor environments: A case study from Guatemala N40: Energy contribution from non-breastmilk items in low-income Guatemalan infants in their sixth month of life N37: Stunting at birth: recognition of early-life linear growth failure in the western highlands of Guatemala N35: Feeding patterns before 6 months of age: the relative validity of recall from interviews of mothers of Guatemalan infants and toddlers N32: Earlier introduction of aguitas is associated with higher risk of stunting in infants and toddlers in the Western Highlands of Guatemala N31: Highland Guatemalan women are extremely short of stature, and no lactation duration effects on body composition are observed in a cross-sectional survey N30: Nutrient density in complementary feeding of infants and toddlers N29: Stunting rates in infants and toddlers born in metropolitan Quetzaltenango, Guatemala N27: Estimates of exclusive breastfeeding rates among mother-infant dyads in Quetzaltenango, Guatemala, vary according to interview method and time frame N25: The concept of “critical nutrient density” in complementary feeding: the demands of the “family foods” for the nutrient adequacy of young Guatemalan children with continued breastfeeding N24: Ritual fluids in relation to early child nutrition in Quetzaltenango, Guatemala N19: Food variety, dietary diversity, and food characteristics among convenience samples of Guatemalan women N18: Contribution of complementary food nutrients to estimated total nutrient intakes for urban Guatemalan infants in the second semester of life N17: Reproducibility regarding the age of introduction of complementary foods to infants as self-reported by urban and rural low-income mothers in Guatemala N12: Contribution of complementary food nutrients to estimated total nutrient intakes for rural Guatemalan infants in the second semester of life N11: Contribution of complementary foods to the total daily water needs of urban Guatemalan infants N04: Dietary characteristics of complementary food offered to Guatemalan infants vary between urban and rural settings
Investigation of the impact of maternal health, the adequacy of lactation, the early feeding practices and the nature of complementary feeding on the growth and health of the offspring
M Vossenaar, R Garcia, A Maldonado, M Escobar, EM Ruíz, D Fuentes, I van Beusekom, C Doak
Data collection ongoing
The Secretariat for Social Projects of the First Lady of Guatemala (SOSEP) supports the formation and maintenance of Hogares Comunitarios (HC) (i.e. of 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 what is consumed in the evenings at home. The intake of nutrients across all of the nutrients offered were quantified by 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.
It is now examined 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.
Click for complete referenceN39: Associations among inflammatory biomarkers in the circulating, plasmatic, salivary and intraluminal compartments in apparently healthy preschool children, from the Western Highlands of Guatemala N36: The Nutritional Contribution of Foods and Beverages Provided by Government-Sponsored Day Care Centers in Guatemala N34: Urinary osmolality of preschool children with a largely common weekday meal offering, from the western highlands of Guatemala N28: Contribution of fruit and vegetable intake to hydration status in schoolchildren N26: Daily consumption of foods and nutrients from institutional and home sources among young children attending two contrasting day-care centers in Guatemala City N23: Evaluating food menus from day care centers in Guatemala City: Descriptive and analytical approaches for consideration in Nutrition N22: Beverage consumption and anthropometric outcomes among schoolchildren in Guatemala N16: Nutrient offerings from the meals and snacks served in four day care centres in Guatemala City N10: Dietary intakes and food sources of fat and fatty acids in Guatemalan schoolchildren: a cross-sectional study N09: Contribution of beverages to energy, macronutrient and micronutrient intake of third- and fourth-grade schoolchildren in Quetzaltenango, Guatemala N08: Volume, frequency and participation in plain drinking water consumption by third- and fourth-grade schoolchildren in Quetzaltenango, Guatemala N07: Total dietary water intake in Guatemalan Children N06: Ready-to-eat cereals are key sources of selected micronutrients among schoolchildren from public and private elementary schools in Quetzaltenango, Guatemala N05: Distribution of macro- and micronutrient intakes in relation to the meal pattern of third- and fourth-grade schoolchildren in the city of Quetzaltenango, Guatemala
Investigation of the impact of environmental and genetical factors on nutritional and health status in children
MJ Soto-Mendez, G Montenegro-Bethancourt, M Vossenaar
Data collection completed
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 reserve 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. One of these is 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.
A second focus is on interviews regarding how the maize items are prepared and how they are distributed across family members within the household and to quantify the nutrient intake in pregnant and lactating women from rural and urban settings to identify 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 and on food taboos, food avoidances and the cultural nuances surrounding views on equity versus hierarchy of food distribution within the household.
Click for complete referenceN19: Food variety, dietary diversity, and food characteristics among convenience samples of Guatemalan women
Development of an optimized nutrients enriched maize flour
M Orozco, L Hernandez, R Campos, A Maldonado, M Escobar, ED Ruiz, D Fuentes, R García, M Vossenaar, R Kanter, NW Solomons
Data collection ongoing