Nutrition transition in Amazonia: Obesity and socioeconomic change in the Suruí Indians from Brazil

Diet change and sustainability in Indigenous areas: characteristics, drivers, and impacts of diet change in Gunayala, Panama

Many Indigenous communities around the world have been experiencing rapid and profound diet changes. This case report uses a Sustainability Science lens to understand the characteristics of diet change in Indigenous Gunas communities of Panama, as well as its drivers and sustainability impacts. We use primary information collected through interviews with 30 experts and 232 household surveys in three Gunas islands  characterised by different levels of development, western influence, and cultural erosion. We observe a rapid westernization of diets that has been mainly driven by closer interaction with tourists and the Panamanian society, as well as broader development processes. However, this diet change has a series of intersecting sustainability impacts related to food security, health, and socio-cultural and environmental change. It is necessary to understand the intersection of these phenomena when designing programs and interventions that seek to prevent or mitigate negative diet changes in Gunayala, and other  Indigenous contexts more broadly.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11625-023-01325-0.

Arterial hypertension and its covariates among nomadic Raute hunter-gatherers of Western Nepal: a mixed-method study

OBJECTIVES

To determine the prevalence of, and understand the factors associated with, hypertension among the nomadic Raute hunter-gatherers of Western Nepal.

DESIGN

A mixed-method study.

SETTING

The study was carried out at Raute temporary campsites in the Surkhet District of Karnali Province between May and September 2021.

PARTICIPANTS

The questionnaire-based survey included all males and non-pregnant females of the nomadic Raute group aged 15 years and above. In-depth interviews were conducted among purposively selected 15 Raute participants and four non-Raute key informants to help explain and enrich the quantitative findings.

OUTCOME MEASURES

The prevalence of hypertension (defined as brachial artery blood pressure of systolic ≥140 mm Hg and/or diastolic ≥90 mm Hg) and its sociodemographic, anthropometric and behavioural covariates.

RESULTS

Of the 85 eligible participants, 81 (median age 35 years (IQR: 26-51), 46.9% female) were included in the final analysis. Hypertension was found in 10.5% of females, 48.8% of males and 30.9% of the total population. Current alcohol and tobacco use were high (91.4% and 70.4%, respectively), with concerning high rates among youths. Males, older people, current drinkers and current tobacco users were more likely to have hypertension. Our qualitative analysis suggests that the traditional forest-based Raute economy is gradually transitioning into a cash-based one that heavily relies on government incentives. Consumption of commercial foods, drinks and tobacco products is increasing as their market involvement grows.

CONCLUSION

This study found a high burden of hypertension, alcohol and tobacco use among nomadic Raute hunter-gatherers facing socioeconomic and dietary transitions. Further research is needed to assess the long-term impact of these changes on their health. This study is expected to help appraise concerned policymakers of an emerging health concern and formulate context-specific and culturally sensitive interventions to limit hypertension-related morbidities and mortalities in this endangered population.

Indigenous people from Amazon show genetic signatures of pathogen-driven selection

Ecological conditions in the Amazon rainforests are historically favorable for the transmission of numerous tropical diseases, especially vector-borne diseases. The high diversity of pathogens likely contributes to the strong selective pressures for human survival and reproduction in this region. However, the genetic basis of human adaptation to this complex ecosystem remains unclear. This study investigates the possible footprints of genetic adaptation to the Amazon rainforest environment by analyzing the genomic data of 19 native populations. The results based on genomic and functional analysis showed an intense signal of natural selection in a set of genes related to Trypanosoma cruzi infection, which is the pathogen responsible for Chagas disease, a neglected tropical parasitic disease native to the Americas that is currently spreading worldwide.

The rights way forward: reconciling the right to food with biodiversity conservation

The current paradigm of biodiversity conservation, with its continued focus on the notion of pristine nature, has resulted in the separation of humans and nature at the expense of both biological and cultural–linguistic diversity. The continued annexation of land for the cause of conservation has resulted in the curtailment of both rights and access to local and diverse food sources for many rural communities. Indigenous Peoples and local communities are fundamental to conserving biodiversity through sustainable use of nature despite repeated attempts to dispossess them from their lands, cultures and knowledge. It has been this traditional and land-based knowledge that has contributed to the conservation of biodiversity whilst also supporting healthy, diverse and nutritious diets. If we are to achieve a more just and sustainable future, we need to continue to centre conservation initiatives around rights, access and equity whilst respecting a plurality of perspectives, worldviews and knowledge systems. Here we review alternative approaches that help reconcile the right to food with biodiversity conservation, such as biocultural rights, rights-based approaches and integrated land management schemes, with the aim of identifying optimal ways forward for conservation that break away from the dichotomous view that pits people against nature and instead embrace the importance of this symbiotic relationship.

Amazonian Invertebrates in the Traditional diet of the Paiter Suruí in Southeastern Brazil

The Paiter Suruí people in the southwestern Brazilian Amazon have a complex food system that includes insects and crustaceans. We designed our study to systematize data about the invertebrates they incorporate into their traditional diet. After conducting a review of the literature, we verified and expanded the data through semi-structured interviews with Paiter Suruí volunteers, and traced trends in their consumption of invertebrates. We identified 61 invertebrates, including 58 insects of the orders Coleoptera, Lepidoptera, Hymenoptera, and three crustaceans. While beetle larvae remain a popular choice, consumption of other insects and crustaceans seems to have diminished over time.

The impact of urbanisation on the cardiometabolic health of Indigenous Brazilian peoples: a systematic review and meta-analysis, and data from the Brazilian Health registry

BACKGROUND

Indigenous Brazilian peoples have faced an unparalleled increase in the rate of cardiovascular diseases following rapid nutritional transition to more urban diets. We aimed to conduct a systematic review and meta-analysis to evaluate the association between urbanisation (including data from Amazon rainforest deforestation) and cardiometabolic risk factors and outcomes.

METHODS

In this systematic review and meta-analysis, we searched Pubmed, Embase, Web of Science, and Scopus for articles published in any language between the year 1950 and March 10, 2022. Studies conducted in Indigenous Brazilian adults that evaluated metabolic health were included. Data for deforestation was obtained by the Amazon Deforestation Monitoring Project. Cardiovascular mortality was obtained from the Brazilian Health registry. Two independent reviewers evaluated studies for risk of bias, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The main outcomes assessed were the prevalence of obesity and related cardiometabolic risk factors among Indigenous Brazilian peoples and its association with urbanisation. Summary data were extracted from published reports for the meta-analyses. We calculated pooled estimates of the prevalence of each cardiometabolic outcome by using a random-effects model (DerSimonian-Laird method). This study is registered with the International Prospective Register of Systematic Reviews, CRD42021285480.

FINDINGS

46 studies were identified, including a total of 20 574 adults from at least 33 Indigenous Brazilian ethnicities. Meta-analyses of the prevalence of obesity showed that there were higher rates of obesity (midwest region: 23% [95% CI 17-29]; and south region 23% [13-34]) and hypertension (south region: 30% [10-50]) in Indigenous peoples living in urban regions of Brazil, while the lowest rates of obesity (11% [95% CI 8-15]) and hypertension (1% [1-2]) were observed in those in the less urbanised (north) regions of Brazil. The prevalence of obesity was 3·5 times higher in participants living in urbanised Indigenous territories (28%) than in those living in lands with >80% native Amazon rainforest (8%). In meta-analyses that evaluated blood pressure level, there was no incremental change in blood pressure with ageing in Indigenous peoples who lived according to traditional lifestyle, in contrast to those living in urbanised regions. For Indigenous men with traditional lifestyles, systolic blood pressure changed from 109·8 mm Hg to 104·4 mm Hg between the youngest (<30 years) and the oldest (>60 years) age groups, and diastolic blood pressure changed from 69·8 mm Hg to 66·1 mm Hg. For Indigenous women with traditional lifestyles, systolic blood pressure was 100·0 mm Hg for the youngest age group with no changes for older age groups, and diastolic blood pressure was 62 mm Hg for the youngest age group with no changes for older age groups. For Indigenous men with urbanised lifestyles, systolic blood pressure changed from 117·3 mm Hg to 124·9 mm Hg between the youngest and the oldest age groups, and diastolic blood pressure changed from 72·7 mm Hg to 76·4 mm Hg. For Indigenous women with urbanised lifestyles, systolic blood pressure changed from 110·0 mm Hg to 116·0 mm Hg between the youngest and the oldest age groups, and diastolic blood pressure changed from 68·3 mm Hg to 74·0 mm Hg. For the years 1997 and 2019, the cardiovascular mortality rate in individuals living in the southeast region (the most urbanised) was 2·5 times greater than that observed in the north. Conversely, the incremental rise in cardiovascular mortality in the past two decades among Indigenous Brazilians living in the north or northeast (2·7 times increase) stands in stark contrast to the stable rates in those living in already urbanised regions.

INTERPRETATION

The macrosocial changes of Indigenous peoples' traditional ways of living consequent to urbanisation are associated with an increased prevalence of adverse cardiometabolic outcomes. These data highlight the urgent need for environmental policies to ensure the conservation of the natural ecosystem within Indigenous territories, as well as the development of socio-health policies to improve the cardiovascular health of Indigenous Brazilians peoples living in urban areas.

FUNDING

None.

Consumption and Preferences for Wild and Domestic Meat in Indigenous Communities in the Brazilian Atlantic Forest

Wild animals have traditionally been the main sources of protein available, if not the only, to numerous indigenous populations worldwide. However, greater access to markets, reduced availability or access to wildlife, and policies in support of agricultural development, have shifted food habits toward domestic and industrial sources of protein. In this study, we evaluated consumption patterns and preferences/avoidances for wild animals (wildmeat, crustaceans, and fish) in comparison to domestic sources of protein among the Potiguara living on the Brazilian coast. Using data from 843 semi-structured interviews applied to students from 28 indigenous villages, we found that domestic meats were more consumed and preferred as compared to wild animals (aquatic and game animals), despite the high abundance of fish and crustacean resources in the surveyed area. Consumption and preference for game were higher among male students while avoidance was higher among female students. The avoidance of domestic meats and fish was low for both genders. The occupation of the fathers affected students’ food habits, in those nature-related occupations (farmer, fisherman/woman, sugarcane worker) conditioned greater consumption of wildmeat and fish, while non-nature related occupations lead to greater consumption of protein from domestic sources. The consumption of protein from all sources increased with the distance between villages and a protected area. Our results indicate that the younger generation of Potiguaras does not regularly consume wildmeat and fish and their preference for domestic sources of protein is shaped by the socio-environmental context, access to different types of meat, and taste preferences.

Metabolic syndrome risk unexpectedly predicted by traditional food consumption: shifting food systems and health among the Awajún of the Peruvian Amazon

BACKGROUND

Dietary changes, especially declines in traditional food diversity and increases in the consumption of processed foods, have previously been shown to increase the risk of developing cardiovascular diseases.

AIM

We evaluated the prevalence and risk factors for metabolic syndrome in four Awajún communities in the Peruvian Amazon.

SUBJECTS AND METHODS

A total of 222 participants answered a socioeconomic questionnaire, a 24-h food recall, and completed a physical examination for metabolic syndrome diagnosis. A Poisson regression with robust variance was used in the statistical analysis of risk factors for metabolic syndrome.

RESULTS

We found an overall prevalence of 24% for metabolic syndrome. Being female, increased age and body mass index were significant risk factors for metabolic syndrome. Surprisingly, risk more than doubled with the ratio of traditional foods. However, this study revealed that there are fewer traditional foods being consumed in this study compared to prior studies among the Awajún.

CONCLUSION

We suggest that the unexpected relationship between traditional food consumption and metabolic syndrome may be due to substantial reductions in the diversity of traditional foods. Currently available traditional foods are primarily high in carbohydrates and are supplemented with cheap, non-perishable, and carbohydrate heavy market food items.

The "Double Burden of Malnutrition" in the Amazon: dietary change and drastic increases in obesity and anemia over 40 years among the Awajún

Undernutrition and overnutrition are interconnected. Yet few studies have examined the "double burden of malnutrition" (DBM) over time in indigenous communities. We investigated changes in the food systems and nutritional health of Awajún communities in the Peruvian Amazon in the 1970s and in 2013. Methods included ethnography, 24 hr food recalls, and biological measures. In 2013, the number of traditional foods consumed decreased to 10% of levels in the 1970s and the number of market foods consumed increased 40-fold. Rates of anemia and obesity were also substantially higher in 2013 compared to the 1970s (23% vs 6% for anemia and 30% vs. 0% for obesity) indicating a DBM has emerged. Examining the predictors of hemoglobin levels and body mass indices in the 2013 sample reveals that this DBM is differentially impacting women and that risk for obesity among the Awajún is associated with multiple proxies of market integration beyond just the consumption of market foods. These findings highlight the complex pathways by which rapid lifestyle changes are creating gendered health inequalities within indigenous communities over time.

Life course socioeconomic position and body composition in adulthood: a systematic review and narrative synthesis

INTRODUCTION

Multiple systematic reviews have investigated the relation between socioeconomic position (SEP) and body mass index (BMI) throughout the life course. However, BMI does not capture quantity and distribution of fat and muscle, which are better indicators of obesity than BMI, and have been independently linked to adverse health outcomes. Less is known about the relation between SEP and body composition, and the literature has not been reviewed. We therefore systematically reviewed the literature on the association between life course SEP and body composition in adulthood.

METHODS

A protocol was registered on PROSPERO (CRD42019119937), and the review followed PRISMA guidelines. An electronic search of three databases (MEDLINE, Embase Classic + Embase and SPORTDiscus) was conducted. Original studies in the English language were included that examine the association between any recognised measure of SEP at any age and body composition (fat mass, fat-free mass, ratio and distribution) in adulthood, measured using a direct technique, i.e., not an anthropometric measure. A narrative synthesis was conducted.

RESULTS

A total of 47 papers were included in the final review, none were from low-income countries (LICs). Greater advantage in childhood and adulthood was associated with lower fat levels in high-income countries (HICs). Associations in the opposite direction were found exclusively in middle-income countries (MICs). No studies in MICs reported associations for childhood SEP. For measures of lean mass, the majority of papers reported no association, or greater advantage in adulthood associated with higher lean mass, with little variation between HICs and MICs. Associations in HICs are more often observed in women than men.

CONCLUSION

The results indicate that fat measures follow similar patterns to those seen for BMI, and that women in HICs are more likely to experience inequalities in both fat and lean measures. Further research in LICs and MICs is needed.

The Retail Food Sector and Indigenous Peoples in High-Income Countries: A Systematic Scoping Review

Indigenous Peoples in high-income countries experience higher burdens of food insecurity, obesity, and diet-related health conditions compared to national averages. The objective of this systematic scoping review is to synthesize information from the published literature on the methods/approaches, findings, and scope for research and interventions on the retail food sector servicing Indigenous Peoples in high-income countries. A structured literature search in two major international databases yielded 139 relevant peer-reviewed articles from nine countries. Most research was conducted in Oceania and North America, and in rural and remote regions. Several convergent issues were identified across global regions including limited grocery store availability/access, heightened exposure to unhealthy food environments, inadequate market food supplies (i.e., high prices, limited availability, and poor quality), and common underlying structural factors including socio-economic inequality and colonialism. A list of actions that can modify the nature and structure of retailing systems to enhance the availability, accessibility, and quality of healthful foods is identified. While continuing to (re)align research with community priorities, international collaboration may foster enhanced opportunities to strengthen the evidence base for policy and practice and contribute to the amelioration of diet quality and health at the population level.

Multiple burdens of malnutrition and relative remoteness in rural Ecuadorian communities

OBJECTIVE

Social and economic changes associated with new roads can bring about rapid nutritional transitions. To study this process, we: (1) describe trends in adult overweight and obesity (OW/OB) among rural Afro-Ecuadorians over time and across a gradient of community remoteness from the nearest commercial centre; (2) examine the relationship between male and female adult OW/OB and factors associated with market integration such as changing livelihoods and (3) examine the co-occurrence of adult OW/OB and under-five stunting and anaemia.

DESIGN

Adult anthropometry was collected through serial case-control studies repeated over a decade across twenty-eight communities. At the same time, anthropometry and Hb were measured for all children under 5 years of age in every community.

SETTING

Northern coastal Ecuador.

PARTICIPANTS

Adults (n 1665) and children under 5 years of age (n 2618).

RESULTS

From 2003 and 2013, OW/OB increased from 25·1 % to 44·8 % among men and 59·9 % to 70·2 % among women. The inverse relationship between remoteness and OW/OB in men was attenuated when adjusting for urban employment, suggesting that livelihoods mediated the remoteness-OW/OB relationship. No such relationship was observed among women. Communities with a higher prevalence of male OW/OB also had a greater prevalence of stunting, but not anaemia, in children under 5 years of age.

CONCLUSIONS

The association between male OW/OB and child stunting at the community level, but not the household level, suggests that changing food environments, rather than household- or individual-level factors, drove these trends. A closer examination of changing socio-economic structures and food environments in communities undergoing rapid development could help mitigate future public health burdens.

Mapping carbon and nitrogen isotopic composition of fingernails to demonstrate a rural-urban nutrition transition in the Center-West, Northeast, and Amazon regions of Brazil

OBJECTIVE

The main objective of this study is to investigate diet patterns among rural and urban populations of the Center-West, Northeast, and Amazon regions of Brazil through the carbon and nitrogen isotopic composition of fingernails, recognizing that the extent of market integration is a key driver of food consumption.

MATERIALS AND METHODS

In the Center-West, Northeast, and Amazon regions of Brazil, fingernails were sampled in clusters encompassing a major city, town, and rural village. A total of 2,133 fingernails were analyzed. Fingernails were clipped by donors using fingernail clippers. In the laboratory, samples were cleaned then weighed in small tin capsules before being isotopically analyzed for carbon and nitrogen.

RESULTS

The overall mean δ¹³ C and δ¹⁵ N were -19.7 ± 2.8‰ and 10.6 ± 1.1‰, respectively. In the more remote villages, where access to food markets is more challenging, lower δ¹³ C prevails, suggesting that Brazilian staple foods (rice, beans, and farinha) still dominate. In areas with easier access to food markets, δ¹³ C values were higher, suggesting a change to a diet based on C₄ plants, typical of a Brazilian supermarket diet. The variability among inhabitants in the same location expressed by a significant inverse correlation between δ¹³ C and δ¹⁵ N fingernail values suggested that "market integration" does not affect everyone equally in each community.

DISCUSSION AND CONCLUSION

The nutrition transition has not yet reached some remote villages in these regions of Brazil or that the nutrition transition has not yet reached all residents of these remote villages. On the other hand, in several villages there is a considerable adherence to the supermarket diet or that some residents of these villages are already favoring processed food.

Socioeconomic determinants of excess weight and obesity among Indigenous women: findings from the First National Survey of Indigenous People's Health and Nutrition in Brazil

Objective:

This article assesses the nutritional status of Indigenous women from 14 to 49 years of age in Brazil.

Design:

Sample size was calculated for each region considering a prevalence of 50 % for all disease outcomes, a relative error of 5 % and a CI of 95 %. In the initial data analysis, the prevalence of excess weight and obesity was calculated according to independent variables. Multivariate multilevel hierarchical analyses were conducted based on a theoretical model of two ranked blocks.

Setting:

The 2010 Indigenous population in Brazil was 896 000, with approximately 300 Indigenous ethnic groups, making Brazil one of the most ethnically diverse countries in the Americas and the world.

Participants:

Of the total target sample of 6722 women evaluated by the National Survey, thirty did not participate, 939 were not eligible for analyses due to pregnancy or unknown pregnancy status, and thirty-nine were excluded due to missing anthropometric data.

Results:

The evaluation of nutritional status was completed for 5714 non-pregnant women (99·3 % of eligible participants for this outcome). High prevalence rates were encountered for both excess weight (46·2 %) and obesity (15·8 %) among the sampled women. In the multivariate analyses, higher socioeconomic indicators, market-integrated living conditions and less reliance on local food production, as well as increased age and parity were associated with excess weight and obesity.

Conclusion:

Results point to distinct patterns of associations between socioeconomic indicators and the occurrence of excess weight and obesity among Indigenous women, which have potentially significant implications from a public policy perspective for Indigenous peoples in Brazil.

Nutrition Transition and Health Outcomes Among Indigenous Populations of Chile

BACKGROUND

Over the past several decades, rural and indigenous populations in Latin America have experienced abrupt and profound transformations in their lifestyles and economies, many having remarkable health consequences. Yet, these changes have had heterogeneous effects on the population's biology in different local contexts.

OBJECTIVES

The primary goal was to characterize the nutrition transition and biomarkers of noncommunicable diseases (NCD) risk in 2 Chilean indigenous populations that have had divergent histories of subsistence strategies (agropastoralism compared with hunter-gathering) in the last few millennia and live in contrasting environments, and to identify context-specific factors driving the nutrition and epidemiological transitions.

METHODS

One-hundred-and-ninety (90 Pehuenche and 100 Atacameño) participants aged 18-87 y completed demographic, food-frequency, and physical activity questionnaires as well as measurements of some NCD risk biomarkers: blood pressure, weight, height, body fat percentage, waist circumference, blood total cholesterol, HDL cholesterol, triglycerides, and glucose. Framingham risk scores (FRSs) were calculated based on age, sex, total cholesterol, HDL cholesterol, systolic blood pressure, smoking, diabetes status, and hypertension medication.

RESULTS

Few differences in dietary composition and physical activity patterns were observed between the 2 populations. Multivariate analyses showed no differences between the 2 populations in any of the individual NCD risk biomarkers or FRSs after adjusting for age, sex, time since last meal, food insecurity in childhood, ultraprocessed food consumption, and physical activity.

CONCLUSIONS

Despite contrasting ecological and historical contexts, the 2 groups are converging into similar processes of market and wage-labor integration and transitioning to a Western diet high in processed and nonlocal foods, although some aspects of their "traditional" foodways are still in practice. The frequency of individuals exhibiting NCD biomarkers "at-risk" is relatively high and corresponds to other populations that have gone through nutrition transition. Furthermore, none of these biomarkers or FRSs differed between the 2 populations, suggesting a homogenization in the NCD risk factors.

Changes in food access by mestizo communities associated with deforestation and agrobiodiversity loss in Ucayali, Peruvian Amazon

Few longitudinal studies link agricultural biodiversity, land use and food access in rural landscapes. In this paper, we test the hypothesis that, in a context of economic change, cash crop expansion is associated with deforestation, reduced agrobiodiversity and changes in food access. For this purpose, we analysed data collected from the same 53 upland and floodplain mestizo households in Ucayali, Peru, in 2000 and 2015. We found an emerging transition towards less diversified food access coupled with loss of forest cover and reduced agricultural biodiversity. In 2015, diets appeared to rely on fewer food groups, fewer food items, and on products increasingly purchased in the market compared to 2000. Wild fruits and plants were mentioned, but rarely consumed. Agricultural production systems became more specialised with a shift towards commercial crops. Peak deforestation years in the 15-year period appeared linked with incentives for agricultural expansion. Our results suggest an overall trend from diversified productive and “extractive” systems and more diverse food access, towards specialized productive systems, with less diverse food access and stronger market orientation (both in production and consumption). The assumption in the food and agricultural sciences that increased income and market-orientation is linked to improved food security, is challenged by our integrated analyses of food access, agrobiodiversity, land use and forest cover. Our results highlight the importance of longitudinal, multidimensional, systemic analyses, with major implications for land use, food and health policies. The potential risks of parallel homogenisation of diets and agricultural production systems require interdisciplinary research and policies that promote integrated landscape approaches for sustainable and inclusive food systems.

Effectiveness of the Healthy Lifestyle Promotion Program for Yaquis with Obesity and Risk of Diabetes in the Short and Medium Term: A Translational Study

Type 2 diabetes (T2D) is a public health problem worldwide, and the main risk factor for its development is obesity. The Yaqui ethnic group of Sonora has serious obesity problems, resulting in an increased risk of T2D in its inhabitants. The objective of this study was to evaluate the effectiveness of a health promotion program on obesity parameters and cardiovascular risk factors in short- (6 months) and medium-term periods (12 months) in indigenous Yaquis of Sonora. The design is a translational clinical study of a single cohort with prepost intervention measurements in a sample of 93 subjects. The effectiveness of the program was evaluated by comparing obesity parameters, metabolic markers, and physical activity 6 and 12 months with those measured under basal conditions using a paired t-test or Wilcoxon rank-sum test. The short-term retention percentage was 58.0%. There was a decrease in body weight (Δ = -3.9 kg, p ≤ 0.05) and other obesity parameters, and an increase in physical activity and improvements in metabolic markers (p ≤ 0.05) was observed. Similar findings were obtained for the medium-term period; body weight loss was also -3.9 kg (p ≤ 0.05). The short and medium-term results of the program showed improvements in the obesity parameters and other cardiovascular risk factors of the participants. These results support the effectiveness of the program and its translation in this ethnic group.

Perceptions of the healthiest body in a market-integrating indigenous population in Argentina: Fat idealization and gendered generational differences

OBJECTIVES

Market integration seems to induce gender-specific generational change in health-related perceptions of body size. We predicted that among the Qom of Argentina, younger women would perceive comparatively thinner bodies as healthiest, demonstrating thin-idealizing body norms, and older women would retain culturally rooted perceptions of heavier bodies as healthiest. As traditional and globalized body size ideals are different for men, we predicted that men would perceive normal bodies as healthiest and would not exhibit generational differences.

METHODS

We asked Qom adults (n = 273) residing in Namqom, Argentina to choose the healthiest body size from the Stunkard Figure Rating Scale (FRS). We performed multiple linear regression with age, gender, and body mass index (BMI) predicting healthy-body perception score.

RESULTS

A majority of women chose overweight bodies as healthiest. As predicted, older women preferred heavier bodies compared to their younger peers; this generational effect was stronger among women clinically defined as underweight (BMI ≤19.99 kg/m² ), and "normal" weight (20.00 kg/m²  ≤ BMI ≤24.99 kg/m² ), as compared to women clinically defined as overweight (25.00 kg/m²  ≤ BMI ≤29.99 kg/m² ) or obese (≥30.00 kg/m² ). Men exhibited no generational effects and largely perceived bodies corresponding to a "normal" BMI as healthiest.

CONCLUSIONS

Among Qom women, there is evidence for the adoption of the idealization of thinness as healthy alongside traditional perceptions that fat bodies are healthy.

The Xavante Longitudinal Health Study in Brazil: Objectives, design, and key results

OBJECTIVE

The Xavante Longitudinal Health Study was developed to permit granular tracking of contemporary health challenges faced by indigenous communities in Brazil, taking into consideration ongoing historical processes that may be associated with increases in child undernutrition, adult obesity, and cardiovascular disease risks.

METHODS

This was an open-cohort study with six semiannual data collection waves from 2009 to 2012. The study was undertaken in two Xavante villages, Pimentel Barbosa and Etênhiritipá, State of Mato Grosso, Central Brazil. No sampling technique was used. Data collection placed emphasis on growth and nutrition of children under five and nutrition status, blood pressure, and blood glucose levels of adolescents and adults.

RESULTS

Baseline data collection began in July/August 2009 with a population census (656 individuals). Between the first and final waves, the study population increased by 17%. At baseline, stunting and wasting was elevated for most age groups <10 years. Overweight, obesity, and increased risk of metabolic complications were expressive among individuals >17 years, disproportionately affecting females. Anemia was elevated in most age groups, especially among females. Mean systolic and diastolic blood pressure was moderate. The overall prevalence of high blood pressure was relatively low.

CONCLUSIONS

Our findings reveal marked health disparities relative to the Brazilian national population and a complex dietary health epidemiology involving the double burden of malnutrition, rapidly changing nutritional indicators, and elevated metabolic disease risk. The topically broad multidisciplinary focus permitted construction of the richest longitudinal data set of socio-epidemiological information for an indigenous population in Brazil.

Conditional Cash Transfers in the Amazon: From the Nutrition Transition to Complex Dietary Behavior Change

Nutrition transition theory describes a progressive substitution of local staples for industrialized processed foods in local diets, a process documented diversely across world regions, and increasingly observed in rural areas of the global south. Here we examine the role of conditional cash transfer programs, in particular the emblematic Brazilian Bolsa Família (BFP), in driving nutritional transition in rural areas of the Amazon. Based on ethnographic research with both participating and nonparticipating women in the Amanã Sustainable Development Reserve (SDR), our analysis integrates Food Frequency Questionnaires (FFQ), seasonal 24-hour food intake recalls, and stable isotope ratios in fingernails to examine dietary behavioral change. Contrary to dietary changes observed elsewhere in the Amazon, participation in the BFP is not associated with a significant substitution of local staples for industrialized processed foods in Amanã. While an increase in the consumption of some industrialized foods was observed, it has been selective and it has not changed the structure of diets. Factors such as social and cultural value of local staples, resident's involvement with the SDR, their relationship with lake and upland forest and agricultural environments, and limited market access have buffered the expansion of industrialized processed foods as observed elsewhere.

[Excess weight in Xukuru indigenous children in Ororubá, Pernambuco State, Brazil: magnitude and associated factors]

The few studies on health and nutrition in indigenous peoples in Northeast Brazil point to some differences with indigenous peoples in the North and Central of the country. This study estimated the prevalence rates and risk of overweight and excess weight in Xukuru children in the village of Ororubá, Pernambuco State, and assessed the socioeconomic and demographic factors potentially associated with these conditions. This cross-sectional study analyzed the associations between adequate weight, excess weight (overweight and obesity), and risk of overweight according to the indices and cutoff points of the World Health Organization for children and the explanatory variables, using multinomial logistic regression. Prevalence of excess weight was 7.7% and risk of overweight was 24.2%. The odds of risk of overweight and excess weight were higher in children < 2 years. Children of obese mothers showed higher odds of excess weight. Prevalence of risk of overweight was 97% higher when compared to households with fixed income. The findings suggest that the Xukuru are experiencing an accelerated nutritional transition, with a paradoxical situation to which other indigenous peoples in Brazil are also exposed.

Longitudinal Changes in Measures of Body Fat and Diet Among Adult Tsimane' Forager-Horticulturalists of Bolivia, 2002-2010

OBJECTIVE

This study examined changes in body fat and diet among Tsimane' forager-horticulturalists and assessed how dietary shifts relate to increases in adiposity between 2002 and 2010.

METHODS

Longitudinal anthropometric and household-level dietary recall data from 365 men and 339 women aged ≥20 years in the Tsimane' Amazonian Panel Study were used. Multilevel mixed-effects models estimated how BMI, body fat percentage, waist circumference, skinfolds, and fat-free mass relate to household consumption of crops, hunted or fished foods, domesticated animal products, cooking oil, and refined grains and sugar.

RESULTS

Women's prevalence of overweight and obesity increased from 22.6% and 2.4% in 2002 to 28.8% and 8.9% in 2010, respectively, and BMI increased by 0.60% ± 0.12% per year (P < 0.001). Increases in fat-free mass accounted for some of this observed weight gain among women. Men's prevalence of overweight and obesity increased from 16.2% and 0.7% to 25.0% and 2.2%, respectively, and BMI increased by 0.22% ± 0.09% per year (P = 0.009). Household use of cooking oil increased and was positively associated with female BMI. Consumption of domesticated animal products did not change significantly but was positively associated with female BMI and male waist circumference.

CONCLUSIONS

Even small increases in energy-dense market-based foods can contribute to adiposity gains among a moderately active, subsistence-based population.

Prevalence of overweight and obesity in the adult indigenous population in Brazil: A systematic review with meta-analysis

To carry out a systematic review to identify the prevalence of overweight and obesity in the adult indigenous population in Brazil. The databases used were PubMed, Scopus, Virtual Health Library (VHL), and Science Direct, with the following search strategy: "overweight" OR "obesity" AND "indigenous" OR "tribe" AND "Brazil". For the meta-analysis, RStudio^® software was used. Were 22 articles included. The combined effect of the meta-analysis studies showed a global prevalence of overweight and obesity of 45%. Approximately half (45%) of indigenous Brazilian adults have excess weight. These findings highlight the need to implement public policies for the prevention and treatment of these morbidities.

Cardiovascular Risk in Xavante Indigenous Population

Background

The prevalence of cardiovascular risk factors is little known in Brazilian indigenous populations. In the last two decades, important changes have occurred in the lifestyle and epidemiological profile of the Xavante people.

Objective

to assess the prevalence of cardiovascular risk factors in Xavante adults in São Marcos and Sangradouro/Volta Grande reserves, in the state of Mato Grosso, Brazil.

Methods

Cross-sectional study carried out with 925 Xavante people aged ≥ 20 years between 2008 and 2012. The following indicators were assessed: triglycerides (TG), total, LDL and HDL-cholesterol, Castelli index I and II, TG/HDL-cholesterol ratio, apo B / Apo A1 ratio, Framingham risk score, C-reactive protein, body mass index (BMI), waist circumference (WC), hypertriglyceridemic waist (HW), glycemia and blood pressure. Kolmogorov-Smirnov, Student's t test and Chi-square test (χ²) were used for statistical analysis, and significance level was set at 5%.

Results

High prevalence of elevated cardiovascular risk was observed in men and women according to HDL-cholesterol (66.2% and 86.2%, respectively), TG (53.2% and 51.5%), TG/HDL-cholesterol ratio (60.0% and 49.1%), C-reactive protein (44.1% and 48.1%), BMI (81.3% and 81.7%), WC (59.1% and 96.2%), HW (38.0% and 50,6%) and glycemia (46.8% and 70.2%). Individuals aged 40 to 59 years had the highest cardiovascular risk.

Conclusions

The Xavante have a high cardiovascular risk according to several indicators evaluated. The present analysis of cardiovascular risk factors provides support for the development of preventive measures and early treatment, in attempt to minimize the impact of cardiovascular diseases on this population.

Nutrition transition in 2 lowland Bolivian subsistence populations

Background

Traditional diets are often credited for the robust cardiometabolic health of subsistence populations. Yet, rural subsistence populations are undergoing nutrition transitions that have been linked to the increase in chronic noncommunicable diseases. Few studies have presented detailed dietary estimates in transitioning populations.

Objectives

We aimed to 1) characterize and compare dietary profiles of 2 neighboring subsistence populations in Bolivia who vary in market integration and 2) identify dietary factors contributing to low cardiovascular disease risk.

Design

We used a mixed longitudinal design to estimate nutrient intake via 24-h recall and dietary questionnaires among 1299 Tsimane (aged 30-91 y) and 229 Moseten (aged 30-84 y) men and women. We constructed population-level estimates of energy intake, dietary diversity, and nutrient shortfalls and analyzed dietary changes over time and space using multilevel models. Last, we compared Tsimane and Moseten dietary profiles with those of Americans (NHANES).

Results

The Tsimane diet was characterized by high energy (2422-2736 kcal/d), carbohydrate (376-423 g/d), and protein (119-139 g/d) intakes; low fat intake (40-46 g/d); and low dietary diversity relative to the average US diet. Most calories (64%) were derived from complex carbohydrates. Total energy and carbohydrate intake increased significantly during the 5-y study, particularly in villages near market towns. Tsimane consumption of food additives (lard, oil, sugar, salt) increased significantly [sugar (15.8 g ⋅ person-1 ⋅ d-1) and oil (4.9 mL ⋅ person-1 ⋅ d-1)] between 2010 and 2015. The more-acculturated Moseten consumed substantially more sugar (by 343%) and oil (by 535%) than the Tsimane.

Conclusions

A high-energy diet rich in complex carbohydrates is associated with low cardiovascular disease risk when coupled with a physically active lifestyle. A transition away from a high-fiber and low-fat, low-salt, and low-processed-sugar diet is a salient health risk for transitioning populations. Evidence of a nutrition transition in Bolivia parallels trends of increasing body fat and body mass index, which suggests that a low prevalence of cardiovascular disease may not persist.

Cardiovascular risk factors with an emphasis on hypertension in the Mura Indians from Amazonia

BACKGROUND

The Brazilian indigenous population is currently undergoing a process of epidemiological transition regarding the occurrence of communicable diseases, malnutrition and non-communicable chronic diseases. Chronic non-infectious diseases are the most common causes of death worldwide, and hypertension is one of the main cardiovascular risk factors. Thus, the main objective of this paper was to evaluate the prevalence of cardiovascular risk factors, with an emphasis on hypertension, in the Mura Indians living in the municipality of Autazes in the northern Brazilian state of Amazonas.

METHODS

This cross-sectional study was conducted among 455 natives (57.8% women, 42.2 ± 16.7 years) selected by simple random sampling. Sociodemographic variables, habits and lifestyles, anthropometric data, fasting glycaemia and lipid profiles were evaluated. Blood pressure was measured with a validated automatic device. Values of p ≤ 0.05 were considered significant.

RESULTS

The prevalence of hypertension was 26.6%. The other cardiovascular risk factors were as follows: increased waist-hip ratio (85.1%); increased neck circumference (60.2%); increased waist circumference (48.6%); overweight (57.1%); physical inactivity (52.7%); use of alcoholic beverages (40.2%); high total cholesterol (27.5%); increased triglycerides (23.5%); smoking (20.4%); and diabetes mellitus (3.0%). In relation to non-hypertensive individuals, indigenous hypertensive individuals were (p ≤ 0.05) older and had a higher proportion of individuals living with partners and individuals who were retired, as well as a lower level of schooling and higher family income. The indigenous people living in urban areas had a higher prevalence of hypertension than did those living in rural areas. In relation to habits and lifestyles, hypertensive Indians had a lower prevalence of smoking, higher frequency of the use of animal fat during meal preparation, lower frequency of vegetable oil use and lower frequency of salt addition to already-prepared meals. An assessment of anthropometric variables and laboratory markers showed that the hypertensive indigenous individuals had higher values of body mass index, neck circumference, waist circumference, visceral fat, Conicity Index, and body fat than did the non-hypertensive individuals.

CONCLUSION

The prevalence of hypertension and other important cardiovascular risk factors in the Mura Indians was high. This finding is probably due to the adoption of inappropriate habits and lifestyles.

Dietary sources of energy and nutrients in the contemporary diet of Inuit adults: results from the 2007–08 Inuit Health Survey

Objective

To characterize the major components of the contemporary Inuit diet and identify the primary sources of energy and essential nutrients.

Design

Dietary data were derived from the 24 h recall collected by the Inuit Health Survey (IHS) from 2007 to 2008. The population proportion method was used to determine the percentage contribution of each group. Unique food items/preparations (ninety-three country foods and 1591 market foods) were classified into eight country food groups and forty-one market food groups. Nutrient composition of each food item was obtained from the Canadian Nutrient File.

Setting

Thirty-six communities across three Inuit regions of northern Canada.

Subjects

A representative sample (n2095) of non-pregnant Inuit adults (≥18 years), selected through stratified random sampling.

Results

Despite their modest contribution to total energy intake (6·4–19·6 %, by region) country foods represented a major source of protein (23–52 %), Fe (28–54 %), niacin (24–52 %) and vitamins D (up to 73 %), B6(18–55 %) and B12(50–82 %). By contrast, the three most popular energy-yielding market foods (i.e. sweetened beverages, added sugar and bread) collectively contributed approximately 20 % of total energy, while contributing minimally to most micronutrients. A notable exception was the contribution of these foods to Ca (13–21 %) and vitamins E (17–35 %) and C (as much as 50 %). Solid fruits were consumed by less than 25 % of participants while vegetables were reported by 38–59 % of respondents.

Conclusions

Country foods remain a critical dimension of the contemporary Inuit diet.

[The nutritional status of Kaingang and Guarani indigenous peoples in the State of Paraná, Brazil]

This study arose from the need to comprehend epidemiological aspects to establish a policy for physical activity for indigenous peoples. Although infectious diseases are still the main causes of suffering in these ethnic groups, chronic diseases have emerged due to the process of epidemiological/nutritional change in indigenous peoples subject to the policy of life on reservations. The scope of this study was to evaluate the nutritional status of indigenous peoples belonging to two ethnic groups in the State of Paraná. Anthropometric data were collected on 178 adults belonging to the Kaingang (n = 117) and Guarani (n = 61) indigenous ethnic groups. The prevalence of being overweight in Guarani and Kaingang adults was 32.3% and 41%, respectively, detecting a prevalence of obesity in the order of 3.2% among the Guarani indigenous people and 12.8% among the Kaingang ethnic group. Anthropometric changes observed among the Guarani and Kaingang indigenous peoples of Paraná are of increasing concern according to some studies. Thus, the results of this study reinforce the need for integrated actions such as nutritional guidance and physical activity during leisure time for the promotion of the health of these populations.

Relationship between alcohol drinking and arterial hypertension in indigenous people of the Mura ethnics, Brazil

OBJECTIVE

To identify the consumption of alcoholic beverage and the relation with hypertension, their prevalence and associated factors, in indigenous Mura, Brazil.

METHODS

A cross-sectional population-based study was conducted with 455 adult indigenous aged 18 years or more of Mura ethnics in Amazonia, Brazil. Interview was conducted and the alcohol intake was assessed by the Alcohol Use Disorders Identification Test. Blood pressure was measured in three measurements and the mean of the last two measurements was used. Physical examination included the following data: weight, height, waist and neck circumference, bioimpedance, and capillary measurement of glucose, triglycerides and cholesterol. Through multivariate Logistic regression in stepwise, the odds ratios for alcohol consumption and associated factors were identified.

RESULTS

The prevalence of alcoholic beverage was 40.2%, with no significant difference for hypertension in those who drink (23.0%) and those who did not drink (29.0%). Referred hypertension in indigenous was associated to less use of alcoholic beverages (14.2% vs 24.3%, P = 0.009). After an adjusted analysis (Odds Ratio, 95% CI), there was a positive association between alcoholic drink intake and male sex (10.27, CI: 5.76-18.30), smoking (4.72, CI: 2.35-9.46) and live in rural areas (9.77, CI: 5.08-18.79). On the other hand, age (0.95, IC: 0.94-0.97), and absence of dyslipidemia (0.41, CI: 0.19-0.89) were associated to lower alcohol consumption.

CONCLUSION

The prevalence of alcoholic beverage was high and associated with referred hypertension, but this association was not maintained after adjusted analysis. Changes to habits and inappropriate lifestyles in indigenous populations and living in urban areas may contribute to increase risk for cardiovascular diseases. Therefore, health policies should be implemented to meet the uniqueness of indigenous people.

Heterogeneous effects of market integration on sub-adult body size and nutritional status among the Shuar of Amazonian Ecuador

BACKGROUND

Market integration (MI)-increasing production for and consumption from a market-based economy-is drastically altering traditional ways of life and environmental conditions among indigenous Amazonian peoples. The effects of MI on the biology and health of Amazonian children and adolescents, however, remain unclear.

AIM

This study examines the impact of MI on sub-adult body size and nutritional status at the population, regional and household levels among the Shuar of Amazonian Ecuador.

SUBJECTS AND METHODS

Anthropometric data were collected between 2005-2014 from 2164 Shuar (aged 2-19 years) living in two geographic regions differing in general degree of MI. High-resolution household economic, lifestyle and dietary data were collected from a sub-sample of 631 participants. Analyses were performed to investigate relationships between body size and year of data collection, region and specific aspects of household MI.

RESULTS

Results from temporal and regional analyses suggest that MI has a significant and overall positive impact on Shuar body size and nutritional status. However, household-level results exhibit nuanced and heterogeneous specific effects of MI underlying these overarching relationships.

CONCLUSION

This study provides novel insight into the complex socio-ecological pathways linking MI, physical growth and health among the Shuar and other indigenous Amazonian populations.

Total and Abdominal Adiposity and Hypertension in Indigenous Women in Midwest Brazil

Background

Obesity is a major risk factor for hypertension, and abdominal fat in particular has been more strongly associated with cardiovascular diseases and its prevalence has increased in Brazilian indigenous populations.

Objective

The objective of this study was to estimate the prevalence of hypertension among indigenous women and its association with total and abdominal obesity after adjustment for confounding factors.

Methods

This cross-sectional study evaluated indigenous non-pregnant women aged 20–59 years living in two villages of the indigenous reserve of Dourados, state of Mato Grosso do Sul, Brazil. Data were collected by trained interviewers. Households were visited and were selected by simple random sampling using SPSS software version 21. The casting of lots was performed from a list of households located on a map of villages. To locate the selected households, a Global Positioning System device was used. A questionnaire was used to obtain data on socio-demographic, lifestyle and health-related variables and to obtain anthropometric data on weight, height, and waist circumference (WC). Blood pressure was measured twice during home visits.

Results

Data were collected between June and October 2013 with 362 women. Most of them were aged <40 years (66.3%) and had low educational level (≤4 years of schooling, 82.0%), had overweight/obesity (74.0%), WC ≥80 cm (83.7%), and family history of hypertension (60.5%). The prevalence of hypertension was 42.0% (CI 95%: 37.0–47.2). In the multivariable analysis, respondents with WC 80–87 cm and ≥88 cm showed approximately 2 times higher prevalence rates of hypertension compared with those with WC <80 cm after adjusting for confounding factors. There was no association between body mass index (BMI) and hypertension in this study.

Conclusions

The overall prevalence of hypertension was high and associated only with abdominal adiposity but not with BMI.

[Obesity and overweight in adult Xukuru of Ororubá Indians, Pernambuco State, Brazil: magnitude and associated socioeconomic and demographic factors]

This cross-sectional study focused on the epidemiology of overweight and obesity and the association with demographic and socioeconomic variables in a sample of 794 Xukuru of Ororubá adults 19-59 years of age, from an indigenous reserve in Pesqueira County, Pernambuco State, Brazil. Descriptive analyses and multivariate logistic regression were carried out, using cut-off points of BMI > 24.99kg/m2 for overweight and > 29.99kg/m2 for obesity. Prevalence rates of overweight and obesity were higher in women (52.2% and 21%, respectively) than in men (44.1% and 7.5%, respectively). Female sex and age (> 30 years) were associated with both outcomes in the multivariate regression. For obesity, the following variable showed statistically significant associations: socioeconomic status and the interaction between male gender and per capita income. As in other indigenous populations in Brazil, the study's findings suggest that the Xukuru are experiencing a rapid nutritional transition.

Health of Indigenous Peoples

Indigenous populations worldwide are experiencing social, cultural, demographic, nutritional, and psychoemotional changes that have a profound impact on health. Regardless of their geographical location or sociopolitical situation, health indicators are always poorer for indigenous populations than for nonindigenous ones. The determinants of this gap are multiple and interactive, and their analysis requires a biocultural framework. Indigenous populations suffer from lower life expectancy, high infant and child mortality, high maternal morbidity and mortality, heavy infectious disease loads, malnutrition, stunted growth, increasing levels of cardiovascular and other chronic diseases, substance abuse, and depression. The devastating effects of colonization, the loss of ancestral land, and language and cultural barriers for access to health care are among the most salient themes characterizing the poor health situation of indigenous people. Anthropology is extremely well suited to address the interplay among social, economic, and political forces that shape the local experiences of illness.

Obesity-Related Behaviors among Poor Adolescents and Young Adults: Is Social Position Associated with Risk Behaviors?

HighlightsDifferent measures of social position capture unique dimensions of relative rank among youth.Youth-specific measures of social position may be important in identifying the most at-risk for obesity.Lower social status youth are more likely to be at-risk for obesity-related behaviors compared to those with a higher rank. This cross-sectional study examines multiple dimensions of social position in relation to obesity-related behaviors in an adolescent and young adult population. In addition to using conventional measures of social position, including parental education and household expenditures, we explore the usefulness of three youth-specific measures of social position - community and society subjective social status and school dropout status. Data are taken from a 2004 house-to-house survey of urban households within the bottom 20th percentile of income distribution within seven states in Mexico. A total of 5,321 Mexican adolescents, aged 12-22 years, provided information on obesity-related behaviors (e.g., diet, physical activity, sedentary behavior) and indicators of subjective and objective social position. A parent in each household provided information on socioeconomic status of the parent and household. Ordinal logistic regressions are used to estimate the associations of parental, household and adolescent indicators of social position and obesity-related risk behaviors. Those adolescents with the highest odds of adopting obesity risk behaviors were the ones who perceived themselves as lower in social status in reference to their peer community and those who had dropped out of school. We found no significant associations between parental education or household expenditures and obesity-related risk behaviors. Immediate social factors in adolescents' lives may have a strong influence on their health-related behaviors. This study provides evidence for the usefulness of two particular measures, both of which are youth-specific. Adolescents and young adults who have dropped out of school and those with lower perceived relative social position within their community are more likely to be at-risk for obesity-related behaviors than those with higher relative social position. We conclude that youth-specific measures may be important in identifying the most at-risk among relatively homogeneous populations of youth.

Nutritional Status of Maasai Pastoralists under Change

This study assesses the nutritional status of Maasai pastoralists living in a period of great social, economic and ecological changes in Kajiado County, southern Kenya. Data on weight, height, skinfolds, and circumferences were collected from 534 individuals in the year 2000. The data were used to describe mean differences in human nutrition between ages, sexes, and within and among three Group Ranches. Nutritional data and diet recall data were compared with past studies of Maasai nutrition from 1930 to 2000. Results indicate that nutritional status is poor and has remained so despite numerous changes to the social-ecological system including livelihood diversification, sedentarization, human population growth and decreased access to vegetation heterogeneity. Imbirikani Group Ranch had better access to infrastructure and markets and some measures of nutritional status were better than for individuals in other group ranches. However, nutritional status remains poor despite transitioning to greater market integration.

Global genetic analyses reveal strong inter-ethnic variability in the loss of activity of the organic cation transporter OCT1

BACKGROUND

The organic cation transporter OCT1 (SLC22A1) mediates the uptake of vitamin B1, cationic drugs, and xenobiotics into hepatocytes. Nine percent of Caucasians lack or have very low OCT1 activity due to loss-of-function polymorphisms in OCT1 gene. Here we analyzed the global genetic variability in OCT1 to estimate the therapeutic relevance of OCT1 polymorphisms in populations beyond Caucasians and to identify evolutionary patterns of the common loss of OCT1 activity in humans.

METHODS

We applied massively parallel sequencing to screen for coding polymorphisms in 1,079 unrelated individuals from 53 populations worldwide. The obtained data was combined with the existing 1000 Genomes data comprising an additional 1,092 individuals from 14 populations. The identified OCT1 variants were characterized in vitro regarding their cellular localization and their ability to transport 10 known OCT1 substrates. Both the population genetics data and transport data were used in tandem to generate a world map of loss of OCT1 activity.

RESULTS

We identified 16 amino acid substitutions potentially causing loss of OCT1 function and analyzed them together with five amino acid substitutions that were not expected to affect OCT1 function. The variants constituted 16 major alleles and 14 sub-alleles. Six major alleles showed improper subcellular localization leading to substrate-wide loss in activity. Five major alleles showed correct subcellular localization, but substrate-specific loss of activity. Striking differences were observed in the frequency of loss of OCT1 activity worldwide. While most East Asian and Oceanian individuals had completely functional OCT1, 80 % of native South American Indians lacked functional OCT1 alleles. In East Asia and Oceania the average nucleotide diversity of the loss-of-function variants was much lower than that of the variants that do not affect OCT1 function (ratio of 0.03) and was significantly lower than the theoretically expected heterozygosity (Tajima's D = -1.64, P < 0.01).

CONCLUSIONS

Comprehensive genetic analyses showed strong global variations in the frequency of loss of OCT1 activity with selection pressure for maintaining OCT1 activity in East Asia and Oceania. These results not only enable pharmacogenetically-based optimization of drug treatment worldwide, but may help elucidate the functional role of human OCT1.

Prevalence of metabolic syndrome in the Brazilian Xavante indigenous population

BACKGROUND

The raising prevalence of weight excess and of non-communicable diseases in indigenous populations, as well as changes in food consumption and reduction in the frequency and intensity of physical activity, suggest that the prevalence of metabolic syndrome (MS) is also elevated. The objective of this study was to evaluate the prevalence of MS and the frequency of its components in the Xavante adult population living in the Indian reservations of São Marcos and Sangradouro/Volta Grande, in the state of Mato Grosso, Brazil. A cross-sectional study was carried out among 932 Xavante Indians aged 20 years or more, in the 2008-2012 period. The variables analysed were gender, age, weight, height, waist circumference, blood pressure, initial and 2-h capillary glycemia in a 75 g OGTT, levels of triglycerides and HDL-cholesterol. The diagnostic criteria for MS proposed by the IDF and AHA/NHLBI were used.

RESULTS

The prevalence of MS was 66.1 % (95 % CI 63.0-69.2), being 76.2 % (95 % CI 72.4-80.0) in women and 55.6 % (95 % CI 51.0-60.2) in men. Women had higher prevalence of MS in all age groups. Elevated waist circumference and lower levels of HDL-cholesterol were the more frequent components in those with MS, and elevated blood pressure was the less frequent.

CONCLUSIONS

The high prevalence of MS in the Xavante Indians is mainly due to the increased prevalence of weight excess that resulted from an intense change in their life-style, in a short period of time in a population with a genetic predisposition. These findings highlight the magnitude of this health problem and make an alert about the necessity to implement specific preventive interventions.

[Management, operations, and menus in Kaingáng indigenous schools participating in the National School Nutrition Program in Rio Grande do Sul State, Brazil.]

Few studies have focused on the National School Nutrition Program (PNAE) in indigenous schools in Brazil. The current study describes the program's operations, management, and menus in 35 Kaingáng indigenous schools in Rio Grande do Sul State, Brazil. A cross-sectional study design was used to obtain information on the program through questionnaires submitted to the Regional Educational Offices (CRE) and to the schools. The menus suggested to the schools by the regional offices were obtained. There were no Centers for Indigenous Education in the regional offices. All the assistant principals were indigenous, 26 schools (74.6%) practiced local management of the meal program, and 34 (97.1%) reported purchasing food from local markets. Most cooks (63.9%) had temporary work contracts with the schools and 65.7% were indigenous. Low offerings of veges, milk and dairy products were observed in around 60% of the menus, and legumes and fruits low in around 80%. It points out the need for more studies about the indigenous PNAE and intends to support public policies in health, food and nutrition for the national indigenous school .

Incidence of metabolic syndrome and related diseases in the Khisêdjê indigenous people of the Xingu, Central Brazil, from 1999-2000 to 2010-2011

The aim of this study was to identify the incidence of metabolic syndrome and related diseases in the Khisêdjê population living in the Xingu Indigenous Park, Mato Grosso State, Brazil, from 1999‐2000 to 2010‐2011. The study included 78 individuals aged ≥20 years. Data were analyzed using Student t test, linear regression, and Poisson regression. In 10 years of follow-up, cumulative incidence rates were 37.5% for metabolic syndrome, 47.4% for hypetriglyceridemia, 38.9% for arterial hypertension, 32% for central obesity, 30.4% for excess weight, 29.1% for hypercholesterolemia, 25% for low HDLc, 10.4% for high LDLc, and 2.9% for diabetes mellitus. Age proved to be a risk factor for incidence of hypertension, diabetes, and elevated LDLc, regardless of gender; male gender was a protective factor against incidence of central obesity, independently of age. The study showed deterioration of most target health indicators and exposure of the Khisêdjê to high cardiometabolic risk. These results may be related to changes in traditional lifestyle.

[Overweight and abdominal obesity in adults in aquilombocommunity in Bahia State, Brazil]

This study analyzes nutritional status, estimates the prevalence of overweight and abdominal obesity, and investigates factors associated with these outcomes in a two-stage random sample of adults (> 20 years) in quilombos (communities that descend from African slaves) in Vitória da Conquista, Bahia State, Brazil, in 2011. Among 739 participants, prevalence rates were 31.8% and 10.2% for overweight and obesity, respectively, and 55.7% for increased waist-to-height ratio (> 0.50). Prevalence of overweight was higher among 30-39-year-olds, while abdominal obesity was more frequent among older individuals. Female sex, eating chicken or beef with untrimmed fat, and hypertension were associated with higher odds of overweight and abdominal obesity, while smoking and single marital status were associated with lower odds. The results show high prevalence rates for overweight and abdominal obesity in these very poor and socially isolated communities. Specific preventive and control measures are urgently needed.

Indigenous populations in transition: an evaluation of metabolic syndrome and its associated factors among the Toba of northern Argentina

BACKGROUND

The health problems associated with rapidly changing lifestyles in indigenous populations, e.g. cardiovascular disease, are becoming a public health concern.

AIM

The objective of this study was to evaluate the prevalence of metabolic syndrome and analyse the metabolic conditions that define this syndrome, in an indigenous Toba community of northern Argentina.

SUBJECTS AND METHODS

A total of 275 adults participated in this study. Anthropometric (BMI, body fat percentage, waist circumference) and clinical measures (blood pressure, cholesterol, glucose and triglycerides) were taken. Pearson and logistic regressions were used in the statistical analysis of risk factors for metabolic syndrome by sex and by reproductive status in women.

RESULTS

The overall prevalence of metabolic syndrome was 38%. Nearly a third (31%) of the population was overweight and 45% obese. Men had significantly higher blood pressure and levels of triglycerides than women, while women had higher percentages of body fat. BMI was significantly associated with most of the risk factors for metabolic syndrome. Menopausal women had a higher prevalence of metabolic syndrome than women of reproductive age.

CONCLUSION

Metabolic syndrome was highly prevalent in this indigenous community, which places them at an increased risk for cardiovascular disease.

The nutrition transition in the Venezuelan Amazonia: increased overweight and obesity with transculturation

OBJECTIVES

Amerindians have a particularly high propensity to overweight and obesity as they change lifestyle and experience a nutrition transition. The aim of this study was to evaluate the effects of transculturation on nutritional status in three Amazonian Amerindian villages.

METHODS

Nutritional status was assessed in 232 volunteers: 65 Yanomami from an isolated village and 167 Guahibo subjects from villages with intermediate and high levels of transculturation.

RESULTS

There was a significant pattern of decreasing stunting and increasing overweight and obesity across the gradient of transculturation. From the jungle Yanomami to the intermediate and transculturated Guahibo, stunting was respectively 72, 55, and 39%, and children /adult overweight was 0, 3/44, and 15/89%. These anthropometric-based patterns were confirmed by bioimpedance vector analysis.

CONCLUSIONS

Transculturation in these Amerindian populations is associated with an increase in overweight and obesity coexisting with undernourished children.

The effects of market integration on childhood growth and nutritional status: the dual burden of under- and over-nutrition in the Northern Ecuadorian Amazon

OBJECTIVES

Market integration is an important source of cultural change exposing indigenous populations to epidemiologic and nutrition transitions. As children and adolescents are biologically sensitive to the health effects of market integration, we examine community variation of anthropometric indicators of nutritional status and growth among a cross-cultural sample of Kichwa, Shuar, Huaorani, and Cofán indigenous groups in the northern Ecuadorian Amazon.

METHODS

We measured height, weight, body mass index (BMI), upper arm circumference, and triceps skinfolds of 186 children and adolescents aged 2 to 18 years from seven communities. Anthropometric z-scores were calculated based on the National Health and Nutritional Examination Survey. Comparisons were made with this US reference group, along with between community differences to contextually explore the impacts of varying degrees of market integration.

RESULTS

We found a high prevalence of stunting in both boys (40%) and girls (34%). Adiposity increased with age and 40% of girls between 15 and 18 years old were overweight. There were large sex differences in body composition with higher BMI, arm circumference, and triceps skinfolds in adolescent girls. The Kichwa demonstrated the poorest growth outcomes and nutritional stress followed by the Huaorani and Shuar; yet distinctions in under- and over-nutrition were evident within groups.

CONCLUSION

Market integration is a major factor influencing the developmental and lifestyle mismatch associated with the epidemiologic and nutrition transition in general, and the dual burden pattern of high rates of stunting yet adequate to above average short-term nutritional status indicators found among indigenous Amazonian populations.

Níveis tensionais de adultos indígenas Suruí, Rondônia, Brasil

Os povos indígenas no Brasil vivenciam acelerado processo de transição nutricional e epidemiológica, verificando-se a emergência de doenças e agravos não transmissíveis, como hipertensão arterial (HA). Realizou-se, em 2005, um estudo transversal para descrever os níveis tensionais em adultos (> 20 anos) indígenas Suruí, Rondônia, e investigar sua relação com o estado nutricional e o nível socioeconômico (SSE). Foram visitadas 9 aldeias e avaliados 251 indivíduos (87,4% dos elegíveis). As médias de pressão arterial sistólica (PAS) e pressão arterial diastólica (PAD) foram maiores no sexo masculino e superiores às verificadas em 1988, com incremento na média da PAS de 7,9 mmHg e de 1,4 mmHg, em mulheres e homens, respectivamente. A PAS correlacionou-se positivamente com a razão cintura quadril (RCQ) em ambos os sexos, e com a idade, no sexo feminino. A PAD apresentou correlações estatisticamente significativas com todas as variáveis antropométricas, exceto com estatura e área muscular do braço. A prevalência de HA foi de 2,8% (M: 2,4%; F: 3,1%). Essa prevalência foi maior nos indivíduos > 40 anos, com perímetro da cintura (PC) ou RCQ elevados, sobretudo no grupo feminino e também no grupo de mais baixo de SSE. A HA é um problema de saúde emergente entre os Suruí, devendo receber atenção do sistema de saúde e dos pesquisadores.