Nutrition and physical activity transitions in the Ecuadorian Andes: Differences among urban and rural-dwelling women

Ultra-processed foods in a rural Ecuadorian community: associations with child anthropometry and bone maturation

Frequent ultra-processed food (UPF) consumption is consistently associated with poor health outcomes. Little is known about UPF intake during early childhood and its effects on growth. We assessed UPF in relation to child anthropometry, bone maturation, and their nutrition profiles in a rural Ecuadorian community. Covariate-adjusted regression models estimated relationships between UPF intake from a 24-hour Food Frequency Questionnaire and three outcomes: linear growth, weight status and bone maturation. Nutrient Profiling Models (NPM) evaluated a convenience sample of UPF (n 28) consumed by children in the community. In this cohort (n 125; mean age = 33·92 (sd 1·75) months), 92·8 % consumed some form of UPF the previous day. On average, children consuming UPF four to twelve times per day (highest tertile) had lower height-for-age z-scores than those with none or a single instance of UPF intake (lowest tertile) (β = -0·43 [se 0·18]; P = 0·02). Adjusted stunting odds were significantly higher in the highest tertile relative to the lowest tertile (OR: 3·07, 95 % CI 1·11, 9·09). Children in the highest tertile had significantly higher bone age z-scores (BAZ) on average compared with the lowest tertile (β = 0·58 [se 0·25]; P = 0·03). Intake of savoury UPF was negatively associated with weight-for-height z-scores (β = -0·30 [se 0·14]; P = 0·04) but positively associated with BAZ (β = 0·77 [se 0·23]; P < 0·001). NPM indicated the availability of unhealthy UPF to children, with excessive amounts of saturated fats, free sugars and sodium. Findings suggest that frequent UPF intake during early childhood may be linked to stunted growth (after controlling for bone age and additional covariates), despite paradoxical associations with bone maturation.

Characteristics and Motivations of Consumers of Direct Purchasing Channels and the Perceived Barriers to Alternative Food Purchase: A Cross-Sectional Study in the Ecuadorian Andes

Modern food systems generate social inequalities in the access to healthy food, but some families maintain behaviors that provide an alternative to these systems. Agroecological consumers (ACs) and non-agroecological direct market consumers (DMCs) are key actors in alternative food systems. We assessed the characteristics of ACs and DMCs using data from a representative sample of households in Ibarra, Quito and Riobamba (n = 2914). We also deepened the exploration of motivations for adopting these practices through mini-ethnographies with families who were identified as ACs or DMCs (n = 15). We found motivations related to personal health problems, food quality (e.g., taste, freshness), and safety (e.g., avoiding pesticides) to be key. Other motivations were price and community solidarity with farmers. Barriers included inconvenience, lack of awareness, and insecurity of market location. Using Chi-square tests, we found differences between ACs and DMCs on place of residence, education, employment, health, and diet. Controlling for socioeconomic and health variables using logistic regressions, we found DMC dietary habits to be similar to the remainder of the study population, except that they were less likely to eat processed foods less frequently (adjusted odds ratio (AOR) 0.6, 95% confidence interval 0.4–0.9). In contrast, ACs were more likely than the remainder of the study population to control their salt intake (3.2, 1.9–5.2) and have greater knowledge of nutrition labels (2.8, 1.7–4.6). They were more likely to eat traditional foods frequently (1.9, 1.1–3.3), fruit and vegetables daily (1.6, 1.0–2.8), and processed foods less frequently (2.7, 1.5–4.8). Hence, these two types of alternative food provisioning practices (AC and DMC) were adopted by different types of consumers, with heterogenous motivations and food consumption practices. These findings have implications for public health initiatives aiming to scale up the nutrition and ecological potential of alternative food systems.

Agricultural Food Production Diversity and Dietary Diversity among Female Small Holder Farmers in a Region of the Ecuadorian Andes Experiencing Nutrition Transition

Some rural areas of Ecuador, including the Imbabura Province of the Andes Highlands, are experiencing a double burden of malnutrition where micronutrient deficiencies persist at the same time obesity is increasing as many traditional home-grown foods are being replaced with more commercially prepared convenience foods. Thus, the relationships among agricultural food production diversity (FPD), dietary diversity (DD), and household food insecurity (HFI) of the rural small holder farmers need further study. Therefore, we examined these associations in small holder farmers residing in this Province in the Andes Highlands (elevation > 2500 m). Non-pregnant maternal home managers (n = 558, x age = 44.1, SD = 16.5 y) were interviewed regarding the number of different agricultural food crops cultivated and domestic animals raised in their family farm plots. DD was determined using the Minimum Dietary Diversity for Women Score (MDD-W) based on the number of 10 different food groups consumed, and household food insecurity (HFI) was determined using the 8-item Household Food Insecurity Experience Scale. The women reported consuming an average of 53% of their total food from what they cultivated or raised. Women with higher DD [MMD-W score ≥ 5 food groups (79% of total sample)] were on farms that cultivated a greater variety of crops (x = 8.7 vs. 6.7), raised more animals (x = 17.9 vs. 12.7, p < 0.05), and reported lower HFI and significantly higher intakes of energy, protein, iron, zinc, and vitamin A (all p < 0.05). Multiple regression analyses demonstrated that FPD was only modestly related to DD, which together with years of education, per capita family income, and HFI accounted for 26% of DD variance. In rural areas of the Imbabura Province, small holder farmers still rely heavily on consumption of self-cultivated foods, but greater diversity of crops grown in family farm plots is only weakly associated with greater DD and lower HFI among the female caretakers.

Body mass index of women in Bangladesh: comparing Multiple Linear Regression and Quantile Regression

This study explored the association between socio-demographic factors and the body mass index (BMI) of women of reproductive age (15–49 years) in Bangladesh. Data from the 2014 Bangladesh Demographic and Health Survey (BDHS-14) were analysed using Multiple Linear Regression (MLR) and Quantile Regression (QR) analyses. The study sample comprised 15,636 non-pregnant women aged 15–49. The mean BMI of the women was 22.35±4.12 kg/m2. Over half (56.75%) had a BMI in the normal range (18<BMI<25 kg/m2), and 18.50%, 20.00% and 4.75% were underweight (BMI≤18 kg/m2), overweight (25≤BMI<30 kg/m2) and obese (BMI≥30 kg/m2), respectively. The results of the MLR found that age, wealth index, urban/rural place of residence, geographical division, womenʼs educational status, husbandʼs educational status, womenʼs working status and total number of children ever born were significantly (p<0.001) associated with respondents’ mean BMI. The QR results showed different associations between socio-demographic factors and mean BMI, as well as a different conditional distribution of mean BMI. Overall, the results indicated that women with uneducated husbands, with little or no education and from less-affluent households from rural areas tended to be more underweight compared with women in other groups. The inter-relationship between the study womenʼs mean BMI and associated socio-demographic factors was assessed using QR analysis to identify the most vulnerable cohorts of women in Bangladesh.

Double burden of underweight and overweight among women of reproductive age in Bangladesh

OBJECTIVE

Bangladesh, like many emerging economies of South-East Asia, has started to experience a double burden of continuing high rates of undernutrition and increasing rates of overweight and obesity. A lack of assessment of the nutritional shift leaves a gap in current policies: the growing overweight and obesity is yet to be addressed. The present paper investigates the change in nutritional status, particularly the shift in BMI, of Bangladeshi women of reproductive age (15-49 years) and characterizes the vulnerable households for both underweight and overweight status during a period of 10 years (2004-2014).

DESIGN

Generalized linear mixed-effect models were fitted for both urban and rural residents to assess underweight and overweight status.

SETTING

Bangladesh Demographic and Health Surveys.

PARTICIPANTS

Women aged 15-49 years (n 53 077).

RESULTS

The proportion of overweight increased during 2004-2014 from 10·7 to 25·1 % and the proportion of underweight decreased from 32·6 to 18·2 %. Prevalence of underweight status remained high in rural areas and prevalence of overweight increased rapidly in both rural and urban areas, creating a double burden. The significant contributors to this double burden were the change in women's level of education, increased household wealth, divisional location and rapid urbanization.

CONCLUSIONS

The findings indicate that specific cohort- or area-based intervention policy studies in line with the UN Decade of Action on Nutrition are required to address the nutritional double burden in Bangladesh.

Physically Demanding Labor and Health Among Indigenous Women in the Ecuadorian Highlands

Physically demanding work carried out during long workdays affects women's health. In rural and agrarian societies, women perform a variety of domestic and productive tasks, often from dawn to dusk, with little or no leisure time. This paper presents the results of a survey of indigenous women in six rural communities in the Ecuadorian highlands. It was conducted to measure the amount of time women spend on physically demanding work in the context of food security, parity outcomes, and access to prenatal health care. The findings demonstrate that these women work very long workdays and also experience food insecurity and poor access to prenatal health care.