Assessment and characterization of the diet of an isolated population in the Bolivian Andes

Underpinnings of entangled ethnical and gender inequalities in obesity in Cochabamba-Bolivia: an intersectional approach

Background

Social inequalities in obesity have been observed not only by gender but also between ethnic groups. Evidence on combined dimensions of inequality in health, and specifically including indigenous populations, is however scarce, and presents a particularly daunting challenge for successful prevention and control of obesity in Bolivia, as well as worldwide.

Objective

The aims of this study were i) to examine intersectional inequalities in obesity and ii) to identify the factors underlying the observed intersectional inequalities.

Methods

An intersectional approach study was employed, using the information collected in a cross-sectional community-based survey. The sample consisted of youth and adults with permanent residence in Cochabamba department (N = 5758), selected through a multistage sampling technique. An adapted version of the WHO-STEPS survey was used to collect information about Abdominal obesity and risk factors associated. Four intersectional positions were constructed from gender (woman vs. men) and ethnic group (indigenous vs. mestizo). Joint and excess intersectional disparities in obesity were estimated as absolute prevalence differences between binary groups, using binomial regression models. The Oaxaca-Blinder decomposition was applied to estimate the contributions of explanatory factors underlying the observed intersectional disparities, using Oaxaca command in Stata software v15.1.

Results

The prevalence of abdominal obesity had a higher prevalence in mestizos (men 35.01% and women 30.71%) as compared to indigenous (men 25.38% and women 27.75%). The joint disparity was estimated at 7.26 percentage points higher prevalence in the doubly advantaged mestizo men than in the doubly disadvantaged indigenous women. The gender referent disparity showed that mestizo-women had a higher prevalence than indigenous-women. The ethnic referent disparity showed that mestizo-men had a higher prevalence than indigenous men. The behavioural risk factors were the most important to explain the observed inequalities, while differences in socioeconomic and demographic factors played a less important role.

Conclusion

Our study illustrates that abdominal obesity is not distributed according to expected patterns of structural disadvantage in the intersectional space of ethnicity and gender in Bolivia. In the Cochabamba case, a high social advantage was related to higher rates of abdominal obesity, as well as the behavioural risk factors associated with them.

Prevalence and determinants of cardiovascular disease risk factors using the WHO STEPS approach in Cochabamba, Bolivia

BACKGROUND

Cardiovascular diseases (CVDs) are considered the number one cause of death worldwide, especially in low- and middle-income countries, Bolivia included. Lack of reliable estimates of risk factor distribution can lead to delay in implementation of evidence-based interventions. However, little is known about the prevalence of risk factors in the country. The aim of this study was to assess the prevalence of preventable risk factors associated with CVDs and to identify the demographic and socioeconomic factors associated with them in Cochabamba, Bolivia.

METHODS

A cross-sectional community-based study was conducted among youth and adults (N = 10,704) with permanent residence in Cochabamba, selected through a multistage sampling technique, from July 2015 to November 2016. An adapted version of the WHO STEPS survey was used to collect information. The prevalence of relevant behavioural risk factors and anthropometric measures were obtained. The socio-demographic variables included were age, ethnicity, level of education, occupation, place of residence, and marital status. Proportions with 95% confidence intervals were first calculated, and prevalence ratios were estimated for each CVD risk factor, both with crude and adjusted models.

RESULTS

More than half (57.38%) were women, and the mean age was 37.89 ± 18 years. The prevalence of behavioural risk factors were: current smoking, 11.6%; current alcohol consumption, 42.76%; low consumption of fruits and vegetables, 76.73%; and low level of physical activity, 64.77%. The prevalence of overweight was 35.84%; obesity, 20.49%; waist risk or abdominal obesity, 54.13%; and raised blood pressure, 17.5%. Indigenous populations and those living in the Andean region showed in general a lower prevalence of most of the risk factors evaluated.

CONCLUSION

We provide the first CVD risk factor profile of people living in Cochabamba, Bolivia, using a standardized methodology. Overall, findings suggest that the prevalence of CVD risk factors in Cochabamba is high. This result highlights the need for interventions to improve early diagnosis, monitoring, management, and especially prevention of these risk factors.

Water from fruit or the river? Examining hydration strategies and gastrointestinal illness among Tsimane’ adults in the Bolivian Amazon

Objective

Water is an essential nutrient overlooked in many cross-cultural studies of human nutrition. The present article describes dietary water intake patterns among forager-horticulturalist adults in lowland Bolivia, compares daily intake with international references and examines if variation in how people acquire water relates to gastrointestinal illness.

Design

Cross-sectional observational study used survey, anthropometric and qualitative methods with Tsimane’ adults selected by age and sex stratification sampling in one community.

Setting

Research occurred in one Tsimane’ village in the Beni department, Bolivia with limited access to clean water. The 24 h diet and health recalls were conducted in July–August 2012 and qualitative interviews/ethnographic observation in September–October 2013.

Subjects

Forty-five Tsimane’ household heads (49 % men) took part in the first data collection and twenty-two Tsimane’ (55 % men) were included in the follow-up interviews.

Results

Men and women reported consuming 4·9 litres and 4·4 litres of water daily from all dietary sources, respectively. On average, water from foods represented 50 % of total water intake. Thirteen per cent of participants reported symptoms of gastrointestinal illness. In a logistic regression model adjusted for age, BMI, sex and raw water consumed, each percentage increase in water obtained from foods was associated with a reduced risk of gastrointestinal illness (OR=0·92; 95 % CI 0·85, 0·99).

Conclusions

Both total water intake and percentage of water from foods were higher than averages in industrialized countries. These findings suggest that people without access to clean water may rely on water-rich foods as a dietary adaptation to reduce pathogen exposures.

Making sense of agrobiodiversity, diet, and intensification of smallholder family farming in the Highland Andes of Ecuador

Methods are needed for helping researchers and farmers to interactively describe and analyze local practices in search of opportunities for improving health, environment, and economy. The authors worked with smallholder family farmers in five Andean villages in Ecuador to apply participatory four-cell analysis (PFCA) in characterizing agrobiodiversity. Margelef and Shannon indices examined ecological richness and evenness, and a simplified 24-hour dietary recall characterized food consumption. Cross-analysis tested interactions among agrobiodiversity, farm size, and diet. Overall trends appeared to work against sustainable intensification, with notable heterogeneity and positive deviance found in the practices of relatively smaller enterprises, representing a potential resource for sustainable intensification. The suite of methods was determined useful for initiating researcher-farmer explorations of promising innovation pathways.

The production diversity of subsistence farms in the Bolivian Andes is associated with the quality of child feeding practices as measured by a validated summary feeding index

Objective

To determine the validity of a summary infant and child feeding index (ICFI) and the association with the index of factors related to agricultural production.

Design

A cross-sectional survey in eight health-post jurisdictions identified as priority nutrition regions. All households with children aged 6–23 months in eligible communities were administered an integrated survey on agricultural production and nutrition-related practices. Quantitative 24 h dietary recall, food frequency data and anthropometric measurements were collected for each child. Ninety-one per cent of eligible families participated.

Setting

The northern region of the Potosí department in the Bolivian highlands.

Subjects

Two hundred and fifty-one households with children aged 6–23 months.

Results

In multiple regression models controlling for potential confounding variables, infant and young child feeding (IYCF) practices as measured by an ICFI showed positive associations with child length-for-age Z-score (mean difference of 0·47 in length-for-age Z-score between children in the high ICFI tertile compared with the low tertile), child energy intake (mean difference of 1500 kJ between tertiles) and the micronutrient adequacy of child diets (mean difference of 7·2 % in mean micronutrient density adequacy between tertiles; P < 0·05). Examining determinants of IYCF practices, mother's education, livestock ownership and the crop diversity of farms were positively associated with the ICFI, while amount of agricultural land cultivated was negatively associated with the ICFI. Crop diversity and IYCF practices were more strongly positively correlated among households at high elevations.

Conclusions

Nutrition-sensitive investments in agriculture that aim to diversify subsistence agricultural production could plausibly benefit the adequacy of child diets.

Intrahousehold Distribution of Food: A Review of the Literature and Discussion of the Implications for Food Fortification Programs

Background

The selection of food vehicles and fortification levels in food fortification programs may be made on the assumption of equitable intrahousehold distribution of food. There are concerns that biased intrahousehold distribution of food will make food-based interventions ineffective or unsafe.

Objective

To review available data documenting intrahousehold energy intake (as a proxy for food distribution) in low- and middle-income countries, and discuss the relevance for food fortification programs.

Methods

A literature search was done, selecting reports from low- and middle-income countries that included dietary data from adults and children. The references of relevant reports and all citations of relevant reports were scanned. Intrahousehold distribution of dietary energy was compared with individual energy requirements.

Results

Twenty-eight studies were identified covering 18 countries with as few as 20 and as many as 3,000 households per study. Intrahousehold distribution of food in most countries is relatively equitable, within a 20% margin.

Conclusions

Within the limits of the available data, and in the absence of contrary data, it is reasonable to assume equitable intrahousehold distribution of food when designing food fortification programs; however, for program evaluation, individual assessment of intake is still needed.

Heavy agricultural workloads and low crop diversity are strong barriers to improving child feeding practices in the Bolivian Andes

Most nutrition initiatives to date aimed at improving infant and young child feeding (IYCF) have emphasized addressing knowledge gaps through behavior change messaging with less focus on addressing the underlying environmental barriers that may shape these behaviors. This research integrates an analysis of longitudinal dietary data with qualitative data on barriers to improved child feeding to identify the nature and extent of the barriers caregivers face to improving IYCF practices in a farming region of the Bolivian Andes, and to determine the relative influence of these barriers on caregivers' abilities to improve IYCF practices. Sixty-nine caregivers were selected from a sample of 331 households that participated in a longitudinal survey assessing changes in IYCF practices among caregivers with children aged 0-36 months from March 2009 to March 2010. Forty-nine barriers within 12 categories of barriers were identified through semi-structured interviews with the 69 caregivers. The most frequently reported barriers were those related to women's time dedicated to agricultural labor, the limited diversity of household agricultural production, and lack of support for child feeding from spouses and mothers-in-law. In multivariate analyses controlling for several variables that could potentially influence IYCF practices, these barriers were negatively associated with changes to the diversity of child diets, child dietary energy intake, and child meal frequency. While knowledge gaps and individual-level influences affected IYCF practices, physical and social caregiving environments in this region of Bolivia were even more important. Behavior change communication alone will likely not address the social and environmental barriers to improved child feeding that often prevent translation of improved knowledge into action. Particularly in rural regions, agriculture may strongly influence child feeding, not only indirectly through household food security, but also directly by affecting women's caregiving capacity.