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

Variation in diurnal cortisol patterns among the Indigenous Shuar of Amazonian Ecuador

OBJECTIVES

The hypothalamic-pituitary-adrenal (HPA) axis and its primary end product, the glucocorticoid cortisol, are major components of the evolved human stress response. However, most studies have examined these systems among populations in high-income settings, which differ from the high pathogen and limited resource contexts in which the HPA axis functioned for most of human evolution.

METHODS

We investigated variability in diurnal salivary cortisol patterns among 298 Indigenous Shuar from Amazonian Ecuador (147 males, 151 females; age 2-86 years), focusing on the effects of age, biological sex, and body mass index (BMI) in shaping differences in diurnal cortisol production. Saliva samples were collected three times daily (waking, 30 minutes post-waking, evening) for three consecutive days to measure key cortisol parameters: levels at waking, the cortisol awakening response, the diurnal slope, and total daily output.

RESULTS

Age was positively associated with waking levels and total daily output, with Shuar juveniles and adolescents displaying significantly lower levels than adults (p < .05). Sex was not a significant predictor of cortisol levels (p > .05), as Shuar males and females displayed similar patterns of diurnal cortisol production across the life course. Moreover, age, sex, and BMI significantly interacted to moderate the rate of diurnal cortisol decline (p = .027). Overall, Shuar demonstrated relatively lower cortisol concentrations than high-income populations.

CONCLUSIONS

This study expands the documented range of global variation in HPA axis activity and diurnal cortisol production and provides important insights into the plasticity of human stress physiology across diverse developmental and socioecological settings.

How market integration impacts human disease ecology

Market integration (MI), or the shift from subsistence to market-based livelihoods, profoundly influences health, yet its impacts on infectious diseases remain underexplored. Here, we synthesize the current understanding of MI and infectious disease to stimulate more research, specifically aiming to leverage concepts and tools from disease ecology and related fields to generate testable hypotheses. Embracing a One Health perspective, we examine both human-to-human and zoonotic transmission pathways in their environmental contexts to assess how MI alters infectious disease exposure and susceptibility in beneficial, detrimental and mixed ways. For human-to-human transmission, we consider how markets expand contact networks in ways that facilitate infectious disease transmission while also increasing access to hygiene products and housing materials that likely reduce infections. For zoonotic transmission, MI influences exposures to pathogens through agricultural intensification and other market-driven processes that may increase or decrease human encounters with disease reservoirs or vectors in their shared environments. We also consider how MI-driven changes in noncommunicable diseases affect immunocompetence and susceptibility to infectious disease. Throughout, we identify statistical, survey and laboratory methods from ecology and the social sciences that will advance interdisciplinary research on MI and infectious disease.

Factors related to knowledge, attitudes, and behaviors regarding cervical cancer among Yemeni women

BACKGROUND

Cervical cancer (CxCa), although preventable, is still among the most prevalent cancers in women. Mortality from this cancer is high, especially in low-income countries where preventive strategies are often lacking. We studied the knowledge, attitudes, and practices regarding CxCa among Yemeni women.

METHODS

This cross-sectional study was conducted in 2019 among 399 women in five major hospitals in Sanaa, the capital city of Yemen. Data were collected through face-to-face interviews using structured questionnaires. We used logistic regression models to analyze the likelihood of hearing about CxCa, believing that CxCa is treatable and preventable, awareness of the Pap smear test, and ever having this test, in relation to participant's age, education level, working outside the household, and family history of CxCa.

RESULTS

Only 66.7% of the women had heard of CxCa. Women with higher education, working outside the household, and with a family history of CxCa were more likely to be aware of CxCa. Working outside the household was the only variable related to a higher likelihood of knowing that CxCa is a treatable and preventable. Furthermore, women with a family history of CxCa were more likely to have knowledge about Pap smear test and were more likely to have Pap smear test in the past.

CONCLUSION

This study identified a low awareness of CxCa and its prevention among Yemeni women. In order to reduce the burden of CxCa in Yemen and save women's lives, it is necessary to raise women's awareness of this disease, especially among those with lower education and those not involved in work outside their homes.

Human biology and the study of precarity: How the intersection of uncertainty and inequality is taking us to new extremes

Inequality represents an extreme environment to which humans must respond. One phenomenon that contributes to this growing extreme is precarity or the intersection of uncertainty and some form of inequality. While precarity has an important intellectual history in the fields of sociology and sociocultural anthropology, it has not been well studied in the field of human biology. Rather human biologists have engaged with the study of closely related concepts such as uncertainty and resource insecurity. In this article, we propose that human biology take on the study of precarity as a novel way of investigating inequality. We first provide a brief intellectual history of precarity which is followed by a review of research on uncertainty and resource security in human biology which, while not exhaustive, illustrates some key gaps that precarity may aid us in addressing. We then review some of the pathways through which precarity comes to affect human biology and health and some of the evidence for why the unpredictable nature of precarity may make it a unique physiological stress. A case study based on research in Nuñoa, Peru provides an important example of how precarity can elucidate the influences of health in an extreme setting, albeit with insights that apply more broadly. We conclude that precarity holds important potential for the study of human biology, including helping us more effectively operationalize and study uncertainty, encouraging us to explore the predictability of resources and stressors, and reminding us to think about the intersectional nature of stressors.

Healthy food, unhealthy food: Indigenous perspectives on the nutrition transition

Amazonian Indigenous Peoples are undergoing drastic changes in their ways of life including the quality and availability of food and its impact on their health and well-being. Indigenous populations have their own perspectives and interpretations of dietary changes unfolding in their communities. Based on in-depth interviews, observations and validation workshops we explored the way Awajún describe and problematise the concept of healthy and unhealthy food in the context of the nutrition transition. We learn that the characteristics of 'good food' are informed by their capacity to give strength, protect health and enable them to be hardworking people. On the contrary, food that comes from the city weakens the body and may result in health problems. For the Awajún, chicken with hormones, fish preserved in cans, and powdered milk negatively affect their health. We argue that the dichotomy 'healthy' and 'unhealthy' used to classify food provides information not only about Indigenous conceptualisations of health and die, but is also a critique of broader structural processes affecting their well-being. The terms, explanations and idioms used by the Awajún to talk about food, provide an insight into Indigenous perspectives and knowledge key to informing global health interventions in culturally appropriate ways.

Cardiometabolic risk factors in South American children: A systematic review and meta-analysis

BACKGROUND

Cardiometabolic risk factors (impaired fasting glucose, abdominal obesity, high blood pressure, dyslipidemia) cluster in children, may predict adult disease burden, and are inadequately characterized in South American children.

OBJECTIVES

To quantify the burden of cardiometabolic risk factors in South American children (0-21 years) and identify knowledge gaps.

METHODS

We systematically searched PubMed, Google Scholar, and the Latin American and Caribbean Health Sciences Literature via Virtual Health Library from 2000-2021 in any language. Two independent reviewers screened and extracted all data.

RESULTS

179 studies of 2,181 screened were included representing 10 countries (n = 2,975,261). 12.2% of South American children experienced obesity, 21.9% elevated waist circumference, 3.0% elevated fasting glucose, 18.1% high triglycerides, 29.6% low HDL cholesterol, and 8.6% high blood pressure. Cardiometabolic risk factor definitions varied widely. Chile exhibited the highest prevalence of obesity/overweight, low HDL, and impaired fasting glucose. Ecuador exhibited the highest prevalence of elevated blood pressure. Rural setting (vs. urban or mixed) and indigenous origin protected against most cardiometabolic risk factors.

CONCLUSIONS

South American children experience high rates of obesity, overweight, and dyslipidemia. International consensus on cardiometabolic risk factor definitions for children will lead to improved diagnosis of cardiometabolic risk factors in this population, and future research should ensure inclusion of unreported countries and increased representation of indigenous populations.

Dietary Patterns of Children from the Amazon Region of Ecuador: A Descriptive, Qualitative Investigation

Many young children in Ecuador suffer from high rates of malnutrition and stunting that affect their long-term growth and development. Little is known about the dietary patterns of children from the Amazon region who experience some of the highest rates of stunting (height-for-age) within Ecuador. Semi-structured interviews were conducted with 50 mothers of young children living in the Ecuadorian Amazon. In addition to descriptions of overall dietary patterns, three themes emerged from the interviews relating to strengths mothers have in feeding their children healthy diets: knowledge, autonomous and independent children, and supportive and responsive parenting. Five themes were found relating to barriers mothers have in feeding their children healthy diets. The first four themes concerned barriers (lack of knowledge of healthy foods, lack of access to healthy foods, not enough money, and child's health) related to multidimensional poverty. All these influenced the last theme found, namely, how difficult of an eater the child was. The implications of intervention efforts to reduce undernutrition and promote children's development by building on specific family and community strengths and identified barriers are also discussed in this paper.

Determining the Factors That Influence Stunting during Pandemic in Rural Indonesia: A Mixed Method

OBJECTIVE

Pandemic causes an increase in the poverty rate. The consequences will be many, including the birth of stunting babies. The COVID-19 pandemic has had an impact on stunting. Analyzing the factors that cause stunting during a pandemic will provide suggestions for effective stunting prevention strategies at the national, regional, community, and household levels. This study aims to determine the factors that influence stunting during the pandemic.

METHOD

We use mixed methods. The respondents of this study were 152 mothers of the Maternal and Child Nutrition Security project, and the sampling technique is Cluster Sampling. Quantitatively using a baseline survey whose analysis uses multiple logistic regression to determine the unadjusted and adjusted odds ratio. The qualitative data used focus group discussions which were analyzed using Nvivo 12 with a questionnaire, and anthropometric measurements of children from surveyed households.

RESULTS

This study summarizes the multivariate analysis of stunting determinants in the pandemic era, revealing statistically significant interactions between household sanitation facilities and household water treatment. Significant risk factors for severe stunting during the pandemic were male gender, older child age, coming from a low socioeconomic quintile, not participating in prenatal care at a health facility, and mother's involvement in choices about what to prepare for Community House. The FGDs identified misinformation about childcare and consumption of sweetened condensed milk as significant contributors to child malnutrition.

CONCLUSIONS

Lack of sanitation facilities and untreated water are contributing factors. Water, sanitation, and hygiene initiatives must be included into Indonesian policies and programs to combat child stunting during a pandemic. The need for further research related to government assistance for improving toddler nutrition, as well as the relationship between WASH and linear development in early infancy should be explored.

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.

Double Burden of Excess Weight and Anemia in Latin American Children up to 2019

The double burden of malnutrition is the coexistence of two different conditions, mainly reflected as excess or deficit in weight. Anemia is a specific nutritional deficit not always included in the double burden assessment. We reviewed overweight and/or obesity (OW/OB) and anemia studies from Latin-American Children over the last ten years up to 2019. Two authors evaluated the MEDLINE, SCOPUS, and LILACS databases. A scale of ten questions was used to assess the risk of bias in prevalence studies. Fourteen studies were selected. The population studies' size ranged from 147 to 20,342 children with different socio-economic backgrounds, such as urban, peri-urban and rural settings, socio-economic status, schooling, population (ethnic minorities and indigenous), and environmental differences (sea level or high altitude). The prevalence of OW/OB ranged from 4.9% to 42%. The prevalence of anemia was from 3.4% to 67%. The double burden, including OW/OB and anemia, ranged from 0.7% to 67%. A higher prevalence of excess weight and anemia was found in rural and high altitude above sea level environments, extreme poverty, low education level, and indigenous communities. These heterogeneous data, before the 2020 (COVID-19 pandemic), reflect the vast inequities between countries and within each country. Food insecurity linked to poverty and the induced change in eating habits and lifestyles threaten optimal child nutrition in ongoing and future scenarios. The existence of OW/OB and anemia and their simultaneous coexistence in the community, home, and individual levels, indicates that interventions should be comprehensive to face the double burden of malnutrition.

The Double Burden of Malnutrition: A Systematic Review of Operational Definitions

BACKGROUND

Despite increasing research on the double burden of malnutrition (DBM; i.e., coexisting over- and undernutrition), there is no global consensus on DBM definitions.

OBJECTIVES

To identify published operational DBM definitions, measure their frequency of use, and discuss implications for future assessment.

METHODS

Following a structured search of peer-reviewed articles with terms describing "overnutrition" [e.g., overweight/obesity (OW/OB)] and "undernutrition" (e.g., stunting, micronutrient deficiency), we screened 1920 abstracts, reviewed 500 full texts, and extracted 623 operational definitions from 239 eligible articles.

RESULTS

We organized three identified DBM dimensions (level of assessment, target population, and forms of malnutrition) into a framework for building operational DBM definitions. Frequently occurring definitions included coexisting: 1) OW/OB and thinness, wasting, or underweight (n = 289 occurrences); 2) OW/OB and stunting (n = 161); 3) OW/OB and anemia (n = 74); and 4) OW/OB and micronutrient deficiency (n = 73).

CONCLUSIONS

Existing DBM definitions vary widely. Putting structure to possible definitions may facilitate selection of fit-for-purpose indicators to meet public health priorities.

The Influence of Markets on the Nutrition Transition of Hunter-Gatherers: Lessons from the Western Amazon

For many centuries, hunter-gatherer societies relied on subsistence practices and traditional diets. However, forces of globalization have increased market involvement, thereby fueling the nutrition transition of hunter-gatherer societies. We review the academic literature on market involvement of hunter-gatherer societies in the Western Amazon and its consequences on diet, health and well-being. First, we elaborate on four main determinants of market involvement (accessibility, monetary income, wild meat trade and social capital), showing how each determinant draws individuals toward or away from markets. Thereafter, we discuss how these determinants alter diet, health and well-being. Our results add to the understanding of the complex relations between market involvement, dietary change, health and well-being of indigenous societies. Furthermore, they bring to light that additional research is needed on the topic to support decision-makers and help preserve indigenous values.

Food Insecurity and the Double Burden of Malnutrition of Indigenous Refugee Épera Siapidara

The goal of this paper is to assess food and nutritional security status of an indigenous population who migrated from Colombia to Ecuador. We collected data about the perception of food insecurity, anthropometric and food intake (n = 104). An analysis multivariate (Generalized Linear Model) we used to know the adequacy to the Dietary Reference Intake (DRI). All the households were food insecure, stunting affected 45.1% of children and adolescents and the 60% were overweight or obese women. Significant differences were observed by gender for energy, lipid, carbohydrate, fiber, and iron (p < 0.001). No age group meets the DRI for fiber, calcium and potassium (except in children 24-59 months) and iron. There was a deficiency in vitamins A, D, folic acid and thiamine. The Epera Siapidara people in Ecuador experience acute food insecurity and a double burden of malnutrition, which may seriously affect their health and general progress.

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.

Caracterización de la alimentación del pueblo indígena Épera Siapidara en Ecuador

Las poblaciones indígenas y campesinas son los que más han sufrido las consecuencias del conflicto armado en Colombia. Tras un proceso de despojo de tierras y desplazamiento, el pueblo Épera Siapidara se asentó en Ecuador y se encuentra en una grave situación de inseguridad alimentaria. El objetivo de este estudio fue caracterizar la alimentación del pueblo Épera Siapidara en Ecuador. Tras la aplicación de 3 R24h a 111 Épera Siapidara, se seleccionaron las preparaciones más consumidas en base al número de apariciones. Las recetas (ingredientes y cantidades) fueron estandarizadas por 6 mujeres de la comunidad. Su composición nutricional se calculó con el software Nutriplato 2.0 y, para un tamaño medio de ración, se comparó con las recomendaciones de ingesta dietética (IDR). Se calculó la contribución de macronutrientes a la energía total de cada plato. Como resultado, 30 preparaciones y 3 guarniciones fueron seleccionadas (85,6% de los registros). El tamaño de ración medio fue 197,84g ± 7,54g (bebida), 225,04g ±50,53g (sopa), 79,89g ± 27,01g (plato principal) y 157,05g ±14,22g (guarnición). En relación al aporte a las IDR, destacan sopa de res y encocado de iguana (54% y 43% IDR proteína), tapado de carne de monte (25% IDR hierro) y sopa de verduras (99% y 89% IDR vitaminas A y C). Diseñar políticas públicas integrales que permitan potenciar las fortalezas de su sistema alimentario tradicional y atenuar riesgos asociados a la alimentación será clave para mejorar su seguridad alimentaria.

Community factors associated with stunting, overweight and food insecurity: a community-based mixed-method study in four Andean indigenous communities in Ecuador

OBJECTIVES

We aimed to implement participatory research to answer a question posed by four Kichwa indigenous communities in Andean Ecuador about what actionable factors are associated with childhood stunting, overweight and food insecurity among their people.

DESIGN

We used mixed methods including household questionnaires, discussion groups with respondents of the questionnaires and anthropometric measurement of children (6 months to 12 years) from surveyed households.

SETTING

The study involved four Andean indigenous communities transitioning from traditional to Western lifestyles. They subsist mainly on small-scale agriculture and have a rich cultural heritage including their traditional language.

PARTICIPANTS

Anthropometric data were collected from 298 children from 139 households in four communities; all households completed the questionnaire. We held five discussion groups (6-10 participants each): three composed of mothers and two of farmers.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcomes were stunting, overweight, food insecurity and their relationship with demographics, dietary habits and agricultural habits.

RESULTS

Of 298 children, 48.6% were stunted and 43.3% overweight for age. Stunted children were more likely to live in households that sold livestock (ORa 1.77, 95% CIa 1.06 to 2.95) and with illiterate primary caretakers (ORa 1.81, 95% CIa 1.07 to 3.06), but were less likely to live in households with irrigation (ORa 0.47, 95% CIa 0.27 to 0.81). Overweight children were more likely to be male (ORa 1.87, 95% CIa 1.02 to 3.43) and live in a household that sold livestock (ORa 2.14, 95% CIa 1.14 to 4.02). Some 67.8% of children lived in a household with food insecurity, more frequently in those earning below minimum wage (ORa 2.90, 95% CIa 1.56 to 5.41) and less frequently in those that ate quinoa in the past 24 hours (ORa 0.17, 95% CIa 0.06 to 0.48). Discussion groups identified irrigation and loss of agricultural and dietary traditions as important causes of poor childhood nutrition.

CONCLUSION

Many indigenous communities face tumultuous cultural, nutritional and epidemiological transitions. Community-based interventions on factors identified here could mitigate negative health outcomes.

The Impact of Road Construction on Subjective Well-Being in Communities in Madre de Dios, Peru

The interoceanic highway (IOH) in Madre de Dios, Peru has driven dramatic change in the Peruvian Amazon basin. We conducted a mixed methods study to examine the impact of these changes on the subjective well-being (SWB) of four communities on the IOH. Themes that emerged qualitatively included changing health threats, environmental degradation, and the impact of increased migration. To achieve a higher level of SWB, respondents emphasized the need for higher incomes, opportunities to learn new skills, and a better education for their children. Potential threats to SWB included marital problems and poorer health. Quantitative analyses suggested that social support and a sense of security impacted reported SWB scores based on life satisfaction, and the impact of income on life satisfaction was mediated by food security. Although long-term residents felt that specific determinants of SWB had both increased (food variety, transport and access to work) and decreased (access to natural resources and hunting), the majority reported that their lives had improved overall. Health had been affected by the IOH in both negative ways (increased dengue and road accidents) and positive ways (improved access to health services). Our results suggest that the rapidly-changing communities near the IOH link well-being to health, income, community, and the environment.

Trends of child undernutrition in rural Ecuadorian communities with differential access to roads, 2004-2013

Road access can influence protective and risk factors associated with nutrition by affecting various social and biological processes. In northern coastal Ecuador, the construction of new roads created a remoteness gradient among villages, providing a unique opportunity to examine the impact of roads on child nutritional outcomes 10 years after the road was built. Anthropometric and haemoglobin measurements were collected from 2,350 children <5 years in Esmeraldas, Ecuador, from 2004 to 2013 across 28 villages with differing road access. Logistic generalized estimating equation models assessed the longitudinal association between village remoteness and prevalence of stunting, wasting, underweight, overweight, obesity, and anaemia. We examined the influence of socio-economic characteristics on the pathway between remoteness and nutrition by comparing model results with and without household-level socio-economic covariates. Remoteness was associated with stunting (OR = 0.43, 95% CI [0.30, 0.63]) and anaemia (OR = 0.56, 95% CI [0.44, 0.70]). Over time, the prevalence of stunting was generally decreasing but remained higher in villages closer to the road compared to those farther away. Obesity increased (0.5% to 3%) over time; wasting was high (6%) but stable during the study period. Wealth and education partially explained the better nutritional outcomes in remote vs. road villages more than a decade after some communities gained road access. Establishing the extent to which these patterns persist requires additional years of observation.

Genome-nutrition divergence: evolving understanding of the malnutrition spectrum

Humans adapted over a period of 2.3 million years to a diet high in quality and diversity. Genome-nutrition divergence describes the misalignment between modern global diets and the genome formed through evolution. A survey of hominin diets over time shows that humans have thrived on a broad range of foods. Earlier diets were highly diverse and nutrient dense, in contrast to modern food systems in which monotonous diets of staple cereals and ultraprocessed foods play a more prominent role. Applying the lens of genome-nutrition divergence to malnutrition reveals shared risk factors for undernutrition and overnutrition at nutrient, food, and environmental levels. Mechanisms for food system shifts, such as crop-neutral agricultural policy, agroecology, and social policy, are explored as a means to realign modern diets with the nutritional patterns to which humans may be better adapted to thrive.

Early Childhood Dental Caries, Mouth Pain, and Malnutrition in the Ecuadorian Amazon Region

Malnutrition and dental caries in early childhood remain persistent and intertwined global health challenges, particularly for indigenous and geographically-remote populations. To examine the prevalence and associations between early childhood dental caries, parent-reported mouth pain and malnutrition in the Amazonian region of Ecuador, we conducted a cross-sectional study of the oral health and nutrition status of 1407 children from birth through age 6 in the "Alli Kiru" program (2011-2013). We used multivariate regression analysis to examine relationships between severe caries, parent-reported mouth pain measures, and nutritional status. The prevalence of dental caries was 65.4%, with 44.7% of children having deep or severe caries, and 33.8% reporting mouth pain. The number of decayed, missing and filled teeth (dmft) increased dramatically with age. Malnutrition was prevalent, with 35.9% of children stunted, 1.1% wasted, 7.4% underweight, and 6.8% overweight. As mouth pain increased in frequency, odds for severe caries increased. For each unit increase in mouth pain frequency interfering with sleeping, children had increased odds for being underweight (Adjusted Odds Ratio (AOR): 1.27; 95% CI: 1.02-1.54) and decreased odds for being overweight (AOR: 0.76; 95% CI: 0.58-0.97). This relationship was most pronounced among 3-6 year-olds. Early childhood caries, mouth pain and malnutrition were prevalent in this sample of young children. Parent-reported mouth pain was associated with severe caries, and mouth pain interfering with sleeping was predictive of poor nutritional status. We demonstrate the utility of a parsimonious parent-reported measure of mouth pain to predict young children's risk for severe early childhood caries and malnutrition, which has implications for community health interventions.

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.

Physical growth of the shuar: Height, Weight, and BMI references for an indigenous amazonian population

OBJECTIVES

Information concerning physical growth among small-scale populations remains limited, yet such data are critical to local health efforts and to foster basic understandings of human life history and variation in childhood development. Using a large dataset and robust modeling methods, this study aims to describe growth from birth to adulthood among the indigenous Shuar of Amazonian Ecuador.

METHODS

Mixed-longitudinal measures of height, weight, and body mass index (BMI) were collected from Shuar participants (n = 2,463; age: 0-29 years). Centile growth curves and tables were created for each anthropometric variable of interest using Generalized Additive Models for Location, Scale, and Shape (GAMLSS). Pseudo-velocity and Lambda-Mu-Sigma curves were generated to further investigate Shuar patterns of growth and to facilitate comparison with United States Center for Disease Control and Prevention and multinational World Health Organization growth references.

RESULTS

The Shuar are small throughout life and exhibit complex patterns of growth that differ substantially from those of international references. Similar to other Amazonians, Shuar growth in weight compares more favorably to references than growth in height, resulting in BMI curves that approximate international medians. Several additional characteristics of Shuar development are noteworthy, including large observed variation in body size early in life, significant infant growth faltering, extended male growth into adulthood, and a markedly early female pubertal growth spurt in height. Phenotypic plasticity and genetic selection in response to local environmental factors may explain many of these patterns.

CONCLUSIONS

Providing a detailed reference of growth for the Shuar and other Amazonian populations, this study possesses direct clinical application and affords valuable insight into childhood health and the ecology of human growth.

Translating human biology (introduction to special issue)

OBJECTIVES

Introducing a special issue on "Translating Human Biology," we pose two basic questions: Is human biology addressing the most critical challenges facing our species? How can the processes of translating our science be improved and innovated?

METHODS

We analyze articles published in American Journal of Human Biology from 2004-2013, and find there is very little human biological consideration of issues related to most of the core human challenges such as water, energy, environmental degradation, or conflict. There is some focus on disease, and considerable focus on food/nutrition. We then introduce this special volume with reference to the following articles that provide exemplars for the process of how translation and concern for broader context and impacts can be integrated into research.

CONCLUSIONS

Human biology has significant unmet potential to engage more fully in translation for the public good, through consideration of the topics we focus on, the processes of doing our science, and the way we present our domain expertise.

Health and disease: exploring the relation between parasitic infections, child nutrition status, and markets

Research in bioarchaeology and among living people provides insight into the biological and biocultural consequences of subsistence, political, and economic transitions. Central to this effort is examining infectious disease, such as diarrheal disease, respiratory infections, and parasitic infections because they are an important source of nutritional and energetic stress in both past and current groups. Although infection may not always result in overt disease, frequent exposure results in biological stress with a negative effect on child growth and, by extension, health. The goal of this article is to examine the association between a common class of infectious disease, soil-transmitted helminth worms, and nutritional status among youth living in communities that vary with respect to their distance from a commercial center. In 2007, anthropometric measurements and parasitological surveys were collected for 338 2-14-year-old children and adolescents living in lowland Bolivia as part of the Tsimane' Amazonian Panel Study. Associations between the presence of helminth infections and markers of both short- and long-term nutritional status were overall weak. Youth living in communities distant from the commercial center were more likely to be positive for multiple parasite species than youth in near communities, but youth in mid-distance communities had lower infection rates. This article demonstrates the challenge of identifying associations between nutritional and disease stress when individual and household factors are nested in a larger context of socioeconomic and environmental change. Increased collaboration between bioarchaeology and human biology should continue to examine the connections between stress and disease across time.

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.