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Varghese JS, Maluccio JA, Cunningham SA, Ramirez-Zea M, Stein AD. Development of a temporally harmonized asset index: evidence from across 50 years of follow up of a birth cohort in Guatemala. BMC Med Res Methodol 2021; 21:85. [PMID: 33902451 PMCID: PMC8074514 DOI: 10.1186/s12874-021-01263-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/30/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Asset-based indices are widely-used proxy measures of wealth in low and middle-income countries (LMIC). The stability of these indices within households over time is not known. METHODS We develop a harmonized household asset index using Principal Component Analysis for the participants (n = 2392) of INCAP Longitudinal Study, Guatemala using data from six waves of follow-up over the period of 1965-2018. We estimate its cross-sectional association with parental schooling (in 1967-75) and attained schooling (in 2015-18) of cohort members. We study how patterns of cross-sectional loadings change over time and between urban-rural settings. We assess its robustness to omission of assets or study waves and alternate specifications of factor extraction procedure (exploratory factor analysis, multiple correspondence analysis). RESULTS The harmonized index constructed using 8 assets and 11 housing characteristics explained 32.4% of the variance. Most households increased in absolute wealth over time with median wealth (25th percentile, 75th percentile; households) increasing from - 3.74 (- 4.42, - 3.07; 547) in 1967 to 2.08 (1.41, 2.67; 1145) in 2017-18. Ownership of television, electricity, quality of flooring and sanitary installation explained the largest proportion of variance. The index is positively associated with measures of schooling (maternal: r = 0.16; paternal: r = 0.10; attained: r = 0.35, all p < 0.001). In 2015-18, house ownership versus housing characteristics and ownership of electronic goods differentiate households in urban and rural areas respectively. The index is robust for omission of assets or study waves, indicator categorization and factor extraction method. CONCLUSION A temporally harmonized asset index constructed from consistently administered surveys in a cohort setting over time may allow study of associations of life-course social mobility with human capital outcomes in LMIC contexts. The approach permits exploration of trends in household wealth of the sample over a follow-up period against repeated cross-sectional surveys which permit the estimation of only the mean trajectory.
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Affiliation(s)
- Jithin Sam Varghese
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA
| | - John A Maluccio
- Economics Department at Middlebury College, Middlebury College, Middlebury, VT, USA
| | - Solveig A Cunningham
- Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, #7007, Atlanta, GA, 30322, USA
| | - Manuel Ramirez-Zea
- INCAP Research Centre for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Aryeh D Stein
- Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, #7007, Atlanta, GA, 30322, USA.
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Ramírez-Luzuriaga MJ, Hoddinott JF, Martorell R, Ramírez-Zea M, Stein AD. Early-Life Nutrition and Subsequent International Migration: A Prospective Study in Rural Guatemala. J Nutr 2020; 151:716-721. [PMID: 33382427 PMCID: PMC7948204 DOI: 10.1093/jn/nxaa379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/21/2020] [Accepted: 11/04/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is generally accepted that migrants are favorably self-selected for labor market skills such as higher schooling and greater cognitive capacity, which are highly correlated with early-life nutrition. However, the influence of early-life nutrition on later-life migration is understudied. OBJECTIVE The objective of this study was to examine prospectively the association between height-for-age z scores (HAZ) at 24 mo and subsequent international migration in a cohort of 2392 participants born between 1962 and 1977 in 4 rural villages in eastern Guatemala. METHODS Information on nutritional status and covariates was collected between 1969 and 1977 and migration status was determined as of 2017 (at ages 40-57 y). We used proportional hazards and logistic regression models to assess whether HAZ was associated with international migration, adjusting for early-life and adult characteristics. RESULTS Between 1978 and 2017 there were 297 international migrants (12.4% of the original cohort) during 99,212 person-y of follow-up. In pooled models that were adjusted for early-life characteristics, a 1-SD increase in HAZ was associated with a 19% increase in the risk of international migration (HR: 1.19; 95% CI: 1.02, 1.38). Further adjustment for village characteristics did not alter the estimate substantively (HR: 1.18; 95% CI: 1.02, 1.37), while additional adjustment for schooling attainment attenuated the estimate somewhat (HR: 1.14; 95% CI: 0.98, 1.33). In all models, effect sizes were stronger for men than for women. CONCLUSIONS Our results indicate that early-life nutrition is positively associated with subsequent international migration.
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Affiliation(s)
| | - John F Hoddinott
- Division of Nutritional Sciences and Charles H. Dyson School of Applied Economics and Management, Cornell University, Ithaca, NY, USA
| | - Reynaldo Martorell
- Nutrition and Health Science Program, Laney Graduate School, Emory University, Atlanta, GA, USA,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Manuel Ramírez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
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Melgar P, Maluccio JA, Arevalo AI, Alvarez A, Alvarez M. Social and Economic Development and Change in 4 Guatemalan Villages Over a Half Century. Food Nutr Bull 2020; 41:S69-S78. [PMID: 32238015 DOI: 10.1177/0379572120912876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article describes nearly 50 years of social and economic development and changes that have occurred in the 4 villages of the Institute of Nutrition of Central America and Panama (INCAP) Longitudinal Study (1969-1977). In doing so, it contextualizes the changes in health and nutrition for the study population over that period. Since the start of the INCAP Longitudinal Study, the original 4 villages, like their home country, have undergone tremendous demographic, social, and economic change. Originally rather isolated, road and transportation access for the villages has improved steadily and substantially. The population in the villages has more than doubled. Schooling access and outcomes have also improved substantially, with average grades of schooling tripling and literacy doubling, reaching levels currently on par with national averages. Occupations have also changed over the course of a generation. Early on, subsistence farming and agriculture in general were dominant but are now much less common. Much of this change is associated with declining agricultural markets alongside increased access to nonagricultural jobs near the villages and in the capital. With all these changes have come improvements in living standards. It is within this dynamic context that study participants for the INCAP Longitudinal Study were born and raised and where most now live as adults.
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Affiliation(s)
- Paúl Melgar
- INCAP Research Center for the prevention of Chronic Diseases-CIIPEC, Institute of Nutrition of Central America and Panama -INCAP, Guatemala City, Guatemala
| | - John A Maluccio
- Economics Department at Middlebury College, Middlebury College, Middlebury, VT, USA
| | - Aura Isabel Arevalo
- INCAP Research Center for the prevention of Chronic Diseases-CIIPEC, Institute of Nutrition of Central America and Panama -INCAP, Guatemala City, Guatemala
| | - Andrea Alvarez
- INCAP Research Center for the prevention of Chronic Diseases-CIIPEC, Institute of Nutrition of Central America and Panama -INCAP, Guatemala City, Guatemala
| | - Marvin Alvarez
- INCAP Research Center for the prevention of Chronic Diseases-CIIPEC, Institute of Nutrition of Central America and Panama -INCAP, Guatemala City, Guatemala
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Stein AD, Behrman JR, DiGirolamo A, Grajeda R, Martorell R, Quisumbing A, Ramakrishnan U. Schooling, Educational Achievement, and Cognitive Functioning among Young Guatemalan Adults. Food Nutr Bull 2016; 26:S46-54. [PMID: 16060211 DOI: 10.1177/15648265050262s105] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Quantity and quality of schooling obtained and the resulting skills and knowledge acquired are important components of human capital. We describe the distribution of selected measures of schooling, educational achievement, and cognitive functioning among individuals who participated as children in a nutrition supplementation trial in Guatemala and were followed up in 2002–04. Among 1,469 respondents (response rate 80%), who were 26–41 years of age in 2003, more than 90% of men and women had attended at least some school; more than half of men and more than one-third of women had completed sixth grade. Schooling attainment of both men and women has increased across birth cohorts but the schooling gap between men and women has increased. Parental socioeconomic status, as measured in 1975, is a strong predictor of schooling attainment. Basic literacy is high among those studied, with more than 80% able to read simple sentences. The gap in educational achievement favoring men narrowed across birth cohorts due to increases among younger women. The greater performance among men on the Raven's Progressive Matrices test persisted despite increased scores in the younger birth cohorts for both men and women. Migrants to Guatemala City have completed more years of school and scored higher on the tests of educational achievement and cognitive functioning than have cohort members who have remained in the study villages.
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Affiliation(s)
- Aryeh D Stein
- Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, N.E., Atlanta, GA 30322, USA.
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Maluccio JA, Murphy A, Yount KM. Research Note: A Socioeconomic Index for the INCAP Longitudinal Study 1969–77. Food Nutr Bull 2016; 26:S120-4. [PMID: 16060218 DOI: 10.1177/15648265050262s112] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this note, we calculate and describe proxy measures that account for variation in standard of living across subjects in the Institute of Nutrition of Central America and Panama (INCAP) Longitudinal Study (1969–77), at the time of the original intervention. Using principal components analysis, we construct two linear indices from an array of household consumer durable goods and housing characteristics, measured at the nuclear family level in the 1975 cross-sectional census. The two indices perform well on three dimensions. First, they are internally coherent in that average ownership and quality of housing characteristics increase with the principal component score. Second, they are robust in that the different approaches yield similar results, for example, in classifying nuclear families into tertiles. And third, they are consistent in that they yield results similar to scores constructed by previous researchers. The indices can be used as background controls in analyses of the INCAP Longitudinal Study (1969–77) data and subsequent follow-up studies, including the Human Capital Study 2002–04. Several articles presented in this supplement to the Food and Nutrition Bulletin used the 1975 index.
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Affiliation(s)
- John A Maluccio
- Food Consumption and Nutrition Division, International Food Policy Research Institute, 2033 K Street, NW, Washington, DC 20006, USA.
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Hoddinott J, Behrman JR, Maluccio JA, Melgar P, Quisumbing AR, Ramirez-Zea M, Stein AD, Yount KM, Martorell R. Adult consequences of growth failure in early childhood. Am J Clin Nutr 2013; 98:1170-8. [PMID: 24004889 PMCID: PMC3798075 DOI: 10.3945/ajcn.113.064584] [Citation(s) in RCA: 216] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Growth failure is associated with adverse consequences, but studies need to control adequately for confounding. OBJECTIVE We related height-for-age z scores (HAZs) and stunting at age 24 mo to adult human capital, marriage, fertility, health, and economic outcomes. DESIGN In 2002-2004, we collected data from 1338 Guatemalan adults (aged 25-42 y) who were studied as children in 1969-1977. We used instrumental variable regression to correct for estimation bias and adjusted for potentially confounding factors. RESULTS A 1-SD increase in HAZ was associated with more schooling (0.78 grades) and higher test scores for reading and nonverbal cognitive skills (0.28 and 0.25 SDs, respectively), characteristics of marriage partners (1.39 y older, 1.02 grade more schooling, and 1.01 cm taller) and, for women, a higher age at first birth (0.77 y) and fewer number of pregnancies and children (0.63 and 0.43, respectively). A 1-SD increase in HAZ was associated with increased household per capita expenditure (21%) and a lower probability of living in poverty (10 percentage points). Conversely, being stunted at 2 y was associated with less schooling, a lower test performance, a lower household per capita expenditure, and an increased probability of living in poverty. For women, stunting was associated with a lower age at first birth and higher number of pregnancies and children. There was little relation between either HAZ or stunting and adult health. CONCLUSION Growth failure in early life has profound adverse consequences over the life course on human, social, and economic capital.
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Affiliation(s)
- John Hoddinott
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC (JH and ARQ); the Departments of Economics and Sociology, University of Pennsylvania, Philadelphia, PA (JRB); the Department of Economics, Middlebury College, Middlebury, VT (JAM); The Institute of Nutrition of Central America and Panama, Guatemala City, Republic of Guatemala (PM and MR-Z); and the Hubert Department of Global Health, Rollins School of Public Health (ADS, KMY, and RM), and the Department of Sociology (KMY), Emory University, Atlanta, GA
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Yount KM, Maluccio JA, Behrman JR, Hoddinott J, Murphy A, Ramakrishnan U. Parental Resources, Schooling Achievements, and Gender Schooling Gaps: Evidence of Change over 25 years in Rural Guatemala. POPULATION RESEARCH AND POLICY REVIEW 2013; 32:495-528. [PMID: 23888089 DOI: 10.1007/s11113-013-9270-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We use village census data and linear regression models to examine changes between 1975 and 2002 in the associations of parental resources with boys' and girls' schooling in four rural Guatemalan villages. Levels of schooling in 1975 were universally low for children 7-17 years. Large increases in schooling achievements occurred between 1975 and 2002. By 2002, schooling levels were comparable for younger boys and girls (7-12 years, N = 3,525) and favored older boys compared to older girls (13-17 years, N = 2,440) by about 0.5 grades. The associations of household standard of living and maternal schooling with schooling among girls diminished over time and became more comparable with these associations among boys, and the associations of household standard of living with schooling among older boys declined and became more comparable with these associations among girls. Thus, as increased social investments reduce the costs of schooling or increase the supply and quality of schooling to families, the magnitudes of the associations between parental resources and children's schooling decline and become more gender equitable at all ages. However, our results show that older boys may benefit more than older girls from social investments in schooling. These changes suggest potential needs to monitor gender gaps in schooling retention among older children, to insure gender equitable access to social investments in schooling, and to encourage parents to invest in schooling as joint measures to achieve greater schooling achievements of girls and boys.
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Affiliation(s)
- Kathryn M Yount
- Hubert Department of Global Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA, Department of Sociology, Emory University, 1555 Dickey Drive, Atlanta, GA 30322, USA
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Parra-Cabrera S, Stein AD, Wang M, Martorell R, Rivera J, Ramakrishnan U. Dietary intakes of polyunsaturated fatty acids among pregnant Mexican women. MATERNAL AND CHILD NUTRITION 2011; 7:140-7. [PMID: 21410881 DOI: 10.1111/j.1740-8709.2010.00254.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Nutritional demands for docosahexaenoic acid (DHA) are high during pregnancy. Diets low in DHA and long-chain polyunsaturated fatty-acids (LC-PUFA) in pregnancy are associated with poorer DHA status and slower reestablishment of maternal stores. To assess intakes of LC-PUFA among urban pregnant women in Central Mexico, we conducted a cross-sectional survey in Prenatal Clinic at the General Hospital No. 1 of the Mexican Society Security Institute, Cuernavaca, Morelos, Mexico. We ascertained intakes over past three months of 110 food items using a food frequency questionnaire developed for this population. Among 1364 pregnant women 18-35 years of age (mean age 26.2 ± 4.7 years) who were interviewed at 18-22 weeks gestation, median (inter-quartile range) daily intakes of linoleic acid, alpha-linolenic acid (LA), arachidonic acid, eicosapentaenoic acid and DHA were 17.6 (13.6; 22.2) g, 1.4 (1.0; 2.0) g, 137 (102; 174) mg, 18 (10; 38) mg, and 55 (37; 99) mg respectively. The median ratio of n-6 to n-3 PUFA was 11.8:1. The main dietary contributions to DHA intake were eggs, chicken, and fresh canned fish. Intakes of PUFAs were higher among women who had completed high school (p<0.01). We conclude that intakes of DHA were much lower than recommended values; the high n-6 to n-3 ratio suggests a suboptimal balance of these PUFAs. Very few sources of DHA are commonly eaten.
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Affiliation(s)
- Socorro Parra-Cabrera
- Center of Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, México
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9
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Imhoff‐Kunsch B, Stein AD, Villalpando S, Martorell R, Ramakrishnan U. Docosahexaenoic acid supplementation from mid-pregnancy to parturition influenced breast milk fatty acid concentrations at 1 month postpartum in Mexican women. J Nutr 2011; 141:321-6. [PMID: 21178076 PMCID: PMC3021452 DOI: 10.3945/jn.110.126870] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
(n-3) PUFA, including DHA, are essential for neural development and accumulate extensively in the fetal and infant brain. (n-3) PUFA concentrations in breast milk, which are largely dependent on maternal diet and tissue stores, are correlated with infant PUFA status. We investigated the effect of prenatal DHA supplementation on PUFA concentrations in breast milk at 1 mo postpartum. In a double-blind, randomized, controlled trial conducted in Mexico, pregnant women were supplemented daily with 400 mg DHA or placebo from 18-22 wk gestation to parturition. Fatty acid concentrations in breast milk obtained from 174 women at 1 mo postpartum were determined using GLC and were expressed as % by weight of total detected fatty acids. Breast milk DHA concentrations in the DHA and placebo groups were (mean ± SD) 0.20 ± 0.06 and 0.17 ± 0.07 (P < 0.01), respectively, and those of α-linolenic acid (ALA) were 1.38 ± 0.47 and 1.24 ± 0.46 (P = 0.01), respectively. Concentrations of EPA and arachidonic acid did not differ between groups (P > 0.05). Maternal plasma DHA concentrations at 1 mo postpartum correlated positively with breast milk DHA at 1 mo postpartum in both the placebo and DHA groups (r = 0.4; P < 0.01 for both treatment groups). Prenatal DHA supplementation from 18-22 wk gestation to parturition increased concentrations of DHA and ALA in breast milk at 1 mo postpartum, providing a mechanism through which breast-fed infants could benefit.
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Affiliation(s)
- Beth Imhoff‐Kunsch
- Nutrition and Health Sciences Program and,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322
| | - Aryeh D. Stein
- Nutrition and Health Sciences Program and,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322
| | - Salvador Villalpando
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos 62100, Mexico
| | - Reynaldo Martorell
- Nutrition and Health Sciences Program and,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322
| | - Usha Ramakrishnan
- Nutrition and Health Sciences Program and,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322,To whom correspondence should be addressed. E-mail:
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Yount KM, Hoddinott J, Stein AD. Disability and self-rated health among older women and men in rural Guatemala: the role of obesity and chronic conditions. Soc Sci Med 2010; 71:1418-27. [PMID: 20813446 PMCID: PMC3699870 DOI: 10.1016/j.socscimed.2010.06.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 06/21/2010] [Accepted: 06/29/2010] [Indexed: 12/01/2022]
Abstract
Unprecedented population aging in poorer settings is coinciding with the rapid spread of obesity and other chronic conditions. These conditions predict disability and poor self-rated health and often are more prevalent in women than men. Thus, gender gaps in obesity and other chronic conditions may account for older women's greater disability and worse self-rated health in poor, rural populations, where aging, obesity, and chronic conditions are rapidly emerging. In a survey of 604 adults 50 years and older in rural Guatemala, we assessed whether gender gaps in obesity and other chronic conditions accounted for gender gaps in disability and self-rated health. Obesity strongly predicted gross mobility (GM) disability, and the number of chronic conditions strongly predicted all outcomes, especially in women. Controlling for gender gaps in body-mass index (BMI) and especially the number of chronic conditions eliminated gender gaps in GM disability, and controlling for gender gaps in the number of chronic conditions eliminated gender gaps in self-rated health. We recommend conducting longitudinal cohort studies to explore interventions that may mitigate adult obesity and chronic conditions among poor, rural older adults. Such interventions also may reduce gender gaps in later-life disability and self-rated health.
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Affiliation(s)
- Kathryn M Yount
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
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Graff M, Yount KM, Ramakrishnan U, Martorell R, Stein AD. Childhood nutrition and later fertility: pathways through education and pre-pregnant nutritional status. Demography 2010; 47:125-44. [PMID: 20355687 PMCID: PMC3000010 DOI: 10.1353/dem.0.0090] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Better childhood nutrition is associated with earlier physical maturation during adolescence and increased schooling attainment. However, as earlier onset of puberty and increased schooling can have opposing effects on fertility, the net effect of improvements in childhood nutrition on a woman's fertility are uncertain. Using path analysis, we estimate the strength of the pathways between childhood growth and subsequent fertility outcomes in Guatemalan women studied prospectively since birth. Height for age z score at 24 months was positively related to body mass index (BMI kg/m2) and height (cm) in adolescence and to schooling attainment. BMI was negatively associated (-0.23 +/- 0.09 years per kg/m2; p < .05) and schooling was positively associated (0.38 +/- 0.06 years per grade; p < .001) with age at first birth. Total associations with the number of children born were positive from BMI (0.07 +/- 0.02 per kg/m2; p < .05) and negative from schooling (-0.18 +/- 0.02 per grade; p < .01). Height was not related to age at first birth or the number of children born. Taken together, childhood nutrition, as reflected by height at 2 years, was positively associated with delayed age at first birth and fewer children born. If schooling is available for girls, increased growth during childhood will most likely result in a net decrease infertility.
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Affiliation(s)
- Mariaelisa Graff
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 West Franklin Street, Chapel Hill, NC 27516, USA.
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12
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Yount KM, Hoddinott J, Stein AD, Digirolamo AM. Individual capital and cognitive ageing in Guatemala. Population Studies 2010; 63:295-306. [PMID: 19851938 DOI: 10.1080/00324720903165464] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Using data from adults 50 years and older in Guatemala (N = 643), we assessed to what extent measures of individual capital-economic, social, intellectual, and biological-were associated with and account for variation in cognitive functioning, as measured by the Modified Mini-Mental Status Exam (M-MMSE). Measures of these components of individual capital are positively associated with cognitive functioning, and together with other attributes, account for 29.6 per cent of its variance. Schooling accounts for the largest unique share (5.3 per cent) of the variance, followed by household standard of living (2.0 per cent), church attendance (1.3 per cent), and z-score for height (0.9 per cent). In a setting like Guatemala-with low schooling, widespread poverty, malnutrition, and infectious disease-early life investments that increase schooling and improve nutrition may be valuable as investments to mitigate cognitive impairment in older adults and its contribution to the disease burden.
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Affiliation(s)
- Kathryn M Yount
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Cook I, Alberts M, Lambert EV. Development of a four-item physical activity index from information about subsistence living in rural African women: a descriptive, cross-sectional investigation. Int J Behav Nutr Phys Act 2009; 6:75. [PMID: 19909556 PMCID: PMC2780979 DOI: 10.1186/1479-5868-6-75] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 11/13/2009] [Indexed: 12/04/2022] Open
Abstract
Background We investigated the criterion validity of a physical activity index (PAI) derived from socio-demographic variables obtained from convenience samples of rural African women. Methods We used a sample (N = 206) from a larger dataset which surveyed adult rural Africans during 1997, and data collected during 2003/4 from 138 adult rural African women. A three-point PAI (low-, medium- and high-subsistence) was constructed from four socio-demographic questions related to electricity, cooking methods, water collection and availability of motorized transport. Criterion measures included measures of adiposity, blood biochemistry, resting blood pressure (RBP), physical fitness (VO2max) and single-plane accelerometry (ACC). Results Age, educational level and health status were not related to PAI level (p > 0.1). There was a significant negative, linear trend between the PAI level and adiposity level (p < 0.04), and fasting blood glucose concentration (p < 0.0001), while VO2max was positively related to PAI level (p = 0.0190). The PAI level was positively and linearly related to ACC output, namely counts.day-1 (p = 0.0044), steps.day-1 (p = 0.0265), min.day-1 of moderate-to-vigorous activity (p = 0.0040), and the percentage of subjects adhering to physical activity public health guidelines (p = 0.0157). Other criterion measures did not reach significance, but were in the expected direction (sedentary behaviour: p > 0.08, RBP: p > 0.07). Conclusion The PAI derived from a socio-demographic questionnaire is a valid instrument for broadly categorizing levels of physical activity for this specific population of rural African women. As the epidemiological transition progresses, validity will need to be re-established.
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Affiliation(s)
- Ian Cook
- Physical Activity Epidemiology Laboratory, University of Limpopo (Turfloop Campus), South Africa.
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Webb AL, Sellen DW, Ramakrishnan U, Martorell R. Maternal years of schooling but not academic skills is independently associated with infant-feeding practices in a cohort of rural Guatemalan women. J Hum Lact 2009; 25:297-306. [PMID: 19190253 PMCID: PMC3780574 DOI: 10.1177/0890334408330449] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The effects of maternal academic skills on infant-feeding practices are not clear. From 1996 to 1999, the authors collected information on infant-feeding practices from birth on infants born to 279 mothers from 4 rural villages in Guatemala. They examined associations between maternal academic skills and indicators for the initiation of exclusive breastfeeding (EBF) and timely introduction of complementary foods (CF). Mothers in the highest category of academic skills had greater odds of initiating EBF, but this association failed to remain significant after adjusting for schooling. Compared with mothers with < 1 year of school, mothers with > 3 to <or= 6 years had greater odds of initiating EBF; mothers with > 6 years of school had greater odds of introducing CF early, while mothers with >or= 1 to <or= 3 years had greater odds of introducing CF late. Unmeasured schooling-related factors influenced infant-feeding practices to a greater extent than academic skills.
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Affiliation(s)
- Aimee L Webb
- Canadian Institutes of Health Research, Initiatives in Global Health, Department of Anthropology, University of Toronto, Ontario, Canada
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Hoddinott J, Maluccio JA, Behrman JR, Flores R, Martorell R. Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults. Lancet 2008; 371:411-6. [PMID: 18242415 DOI: 10.1016/s0140-6736(08)60205-6] [Citation(s) in RCA: 275] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Substantial, but indirect, evidence suggests that improving nutrition in early childhood in developing countries is a long-term economic investment. We investigated the direct effect of a nutrition intervention in early childhood on adult economic productivity. METHODS We obtained economic data from 1424 Guatemalan individuals (aged 25-42 years) between 2002 and 2004. They accounted for 60% of the 2392 children (aged 0-7 years) who had been enrolled in a nutrition intervention study during 1969-77. In this initial study, two villages were randomly assigned a nutritious supplement (atole) for all children and two villages a less nutritious one (fresco). We estimated annual income, hours worked, and average hourly wages from all economic activities. We used linear regression models, adjusting for potentially confounding factors, to assess the relation between economic variables and exposure to atole or fresco at specific ages between birth and 7 years. FINDINGS Exposure to atole before, but not after, age 3 years was associated with higher hourly wages, but only for men. For exposure to atole from 0 to 2 years, the increase was US$0.67 per hour (95% CI 0.16-1.17), which meant a 46% increase in average wages. There was a non-significant tendency for hours worked to be reduced and for annual incomes to be greater for those exposed to atole from 0 to 2 years. INTERPRETATION Improving nutrition in early childhood led to substantial increases in wage rates for men, which suggests that investments in early childhood nutrition can be long-term drivers of economic growth.
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Affiliation(s)
- John Hoddinott
- International Food Policy Research Institute, Washington, DC, USA
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Gregory CO, Ramirez-Zea M, Martorell R, Stein AD. Activities contributing to energy expenditure among Guatemalan adults. Int J Behav Nutr Phys Act 2007; 4:48. [PMID: 17910754 PMCID: PMC2082276 DOI: 10.1186/1479-5868-4-48] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Accepted: 10/02/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Guatemala has experienced a substantial increase in overweight and obesity in recent years, yet physical activity patterns and consequent energy expenditure are largely unexplored in this population. METHODS To describe overall physical activity levels (PAL) and activities contributing to daily energy expenditure, we analyzed time spent in daily activities as reported by 985 women and 819 men, living in rural and urban areas of Guatemala in 2002-04. RESULTS Physical activity levels recommended to prevent obesity (PAL > or = 1.70) differed by residence/occupation among men (agricultural-rural: 77%; nonagricultural-rural: 36%; urban: 24%; P < 0.01), but not women (rural: 2%; urban: 3%; P = 0.5). Median energy expenditure was higher among agricultural-rural men (44 MET*h/d; MET = metabolic equivalent) compared to nonagricultural-rural (37 MET*h/d) and urban men (35 MET*h/d; P < 0.01); energy expenditure was slightly lower among rural compared to urban women (34 MET*h/d vs. 35 MET*h/d; P < 0.01). Occupation was the largest contributor to energy expenditure (19-24 MET*h/d); among women and nonagricultural-rural and urban men this was primarily of a light intensity. Energy expenditure in sedentary activities ranged from 2 MET*h/d among rural women to 6 MET*h/d among agricultural-rural men. Any sports/exercise time was reported by 35% and 5% of men and women, respectively. Nevertheless, the majority of participants believed they were significantly active to stay healthy. CONCLUSION Overall, energy expenditure was low in the population not dedicated to agricultural occupations; an increased focus on active leisure-time behaviors may be needed to counterbalance reductions in energy expenditure consequent to sedentarization of primary occupations.
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Affiliation(s)
- Cria O Gregory
- Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, USA
| | - Manuel Ramirez-Zea
- Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Reynaldo Martorell
- Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Aryeh D Stein
- Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Gregory CO, Dai J, Ramirez-Zea M, Stein AD. Occupation is more important than rural or urban residence in explaining the prevalence of metabolic and cardiovascular disease risk in Guatemalan adults. J Nutr 2007; 137:1314-9. [PMID: 17449598 PMCID: PMC1904431 DOI: 10.1093/jn/137.5.1314] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Diet and activity pattern changes consequent to urbanization are contributing to the global epidemic of cardiovascular disease; less research has focused on activity within rural populations. We studied 527 women and 360 men (25-42 y), all rural-born and currently residing in rural or urban areas of Guatemala. We further classified rural male occupations as agricultural or nonagricultural. Overweight status (BMI > or = 25 kg/m(2)) differed by residence/occupation among men (agricultural-rural, 27%; nonagricultural-rural, 44%; and urban, 55%; P< 0.01) and women (rural, 58%; and urban, 68%; P= 0.04). A moderate-to-vigorous lifestyle was reported by 76, 37, and 20% of men (agricultural-rural, nonagricultural-rural, and urban, respectively; P< 0.01); most women were sedentary, with no difference by residence. Prevalence of the metabolic syndrome was 17, 24, and 28% in agricultural-rural, nonagricultural-rural, and urban men, respectively (P= 0.2), and 44 and 45% in rural and urban women (P= 0.4). Dietary variables were largely unassociated with adiposity or cardio-metabolic risk factors; physical activity was inversely associated with the percentage of body fat in men. Percent body fat was inversely associated with HDL-cholesterol, and positively associated with triglycerides, blood pressure, and the metabolic syndrome in both men and women, and with LDL-cholesterol and fasting glucose in women. Differences in physical activity level, mainly attributable to occupation, appear more important than residence, per se, in influencing the risk for cardiovascular disease among men; differences among these sedentary women are likely related to other factors associated with an urban environment.
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Affiliation(s)
- Cria O Gregory
- Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, USA
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Kuklina EV, Ramakrishnan U, Stein AD, Barnhart HH, Martorell R. Early childhood growth and development in rural Guatemala. Early Hum Dev 2006; 82:425-33. [PMID: 16431042 DOI: 10.1016/j.earlhumdev.2005.10.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2005] [Revised: 08/31/2005] [Accepted: 10/31/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Small size at birth and in early childhood has been associated with impaired neurodevelopment in studies from developing countries, but few have examined associations with growth. AIMS The objective of this study was to assess the relationship between growth and neurodevelopment during early childhood (birth-36 months). DESIGN Multivariate regression models were used to analyze the data collected in the course of a study of pregnancy outcomes and early childhood growth and development carried out in rural Guatemala in 1991-1999. Motor and mental development scores were based on the Psychomotor and Mental Development Indices, respectively, derived from the administration of an adapted version of the Bayley Scales of Infant Development (Second Edition, 1993) at 6, 24 and 36 months. Z-scores for height-for-age (HAZ), weight-for-age (WAZ), and head circumference-for-age (HCZ) were used as indicators of attained size; changes in these Z-scores over time represent growth. RESULTS Birth size was significantly associated with child development at 6 and 24 months. Gains in length and weight during the first 24 months were positively associated with child development, whereas growth from 24 to 36 months age was not associated with child development at 36 months. Motor development was more strongly and consistently related to child growth than was mental development. Head circumference gain after 6 months was not a significant predictor of child development at 24 and 36 months. CONCLUSIONS Small size at birth and poor physical growth during the first 24 months are related to neurodevelopmental delays. More evidence from developing countries will help explain the underlying mechanisms and identify appropriate interventions to prevent neurodevelopmental delay in early childhood.
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Affiliation(s)
- Elena V Kuklina
- Program in Nutrition and Health Sciences, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, USA
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Grajeda R, Behrman JR, Flores R, Maluccio JA, Martorell R, Stein AD. The human capital study 2002-04: tracking, data collection, coverage, and attrition. Food Nutr Bull 2005; 26:S15-24. [PMID: 16060209 PMCID: PMC1978414 DOI: 10.1177/15648265050262s103] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Between 2002 and 2004, the Institute of Nutrition of Central America and Panama (INCAP), in collaboration with Emory University, the International Food Policy Research Institute (IFPRI), and the University of Pennsylvania, re-surveyed young Guatemalan adults who had, as children, been participants in a nutrition supplementation trial conducted by INCAP between 1969 and 1977. This "Human Capital Study 2002-04" complements and extends data obtained in previous studies by collecting new information on measures of physical health and well-being, schooling and cognitive ability, wealth, consumption and economic productivity, and marriage and fertility histories. This paper describes the study domains and data collection procedures. Among 2,393 members of the original sample, 1,856 (77%) were targets for enrollment. Response rates varied by gender, current place of residence, and domain of data collection, with 80% of males and 89% of females completing at least one data collection instrument. Attrition was not random and appears to be associated with a number of initial characteristics of individuals and their households that should be controlled for in future analyses. We conclude that data collection was successful and data quality is high, facilitating the successful undertaking of our planned investigation of important study hypotheses.
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Affiliation(s)
- Rubén Grajeda
- Institute of Nutrition of Central America and Panama, INCAP, P.O. Box 1188, Guatemala, Carretera Roosevelt, Zona 11 Guatemala, Central America.
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Maluccio JA, Martorell R, Ramírez LF. Household expenditures and wealth among young Guatemalan adults. Food Nutr Bull 2005; 26:S110-9. [PMID: 16060217 DOI: 10.1177/15648265050262s111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this article, we describe expenditure and wealth patterns, indicators of long-run economic well-being, for a sample of young Guatemalan adults interviewed for the Human Capital Study 2002-04, finding a number of differences across subgroups of the sample. The main difference across birth-year cohorts is that younger subjects tend to live in smaller households, with lower total annual household expenditures (and fewer durable goods), though per capita measures are similar across cohorts. This appears to be related to life-cycle fertility patterns. There is a clear positive association between parental socioeconomic status (SES) and current levels of expenditure and durable goods ownership. This association does not hold for all households, however, as there is both upward and downward "mobility" in the sample. Those living in the capital have the highest overall wealth levels, consistent with typical rural-urban patterns. Where there are expenditure differences across groups, they tend to be driven by differences in nonfood rather than food expenditures. Lastly, the study sample is relatively well off compared with their compatriots, with a poverty rate of 35% and an extreme poverty rate of only 3%, against national averages of 56% and 15%, respectively.
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Affiliation(s)
- John A Maluccio
- Food Consumption and Nutrition Division, International Food Policy Research Institute, 2033 K Street, NW, Washington, DC 20006, USA.
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Quisumbing AR, Behrman JR, Maluccio JA, Murphy A, Yount KM. Levels, correlates, and differences in human, physical, and financial assets brought into marriages by young Guatemalan adults. Food Nutr Bull 2005; 26:S55-67. [PMID: 16060212 DOI: 10.1177/15648265050262s106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article examines marriage patterns among individuals who participated as children in a nutrition supplementation trial in Guatemala and were followed up in 2002-04, at ages 25-42 years. Of all 1,062 known and alive couples, 735, or 69%, responded fully to the marriage assets questionnaire. Focus of the analysis is on the birth cohorts born prior to 1974, a total of 1,058 intervention participants, among whom four-fifths of men (82%) and of women (78%) were married at the time of the 2002-04 survey. Basic patterns are examined in current marital status, age at first marriage and related milestones, human capital assets brought to marriage (e.g., schooling attainment, cognitive ability, literacy, and pre-marital work experience), and physical assets and savings accounts brought to marriage. Measures of husbands' human capital at marriage are positively correlated with wives' human capital, but are consistently higher. Husbands also bring substantially more physical and financial assets than wives. A number of interesting patterns emerge, including (1) changes in the composition of assets that women bring to marriage from physical to human assets, (2) declining gaps in age and premarital work experience between husbands and wives, and (3) increasing gaps in schooling attainment and cognitive ability between husbands and wives. Given conflicting directions of change in spousal gaps in human, physical and financial assets, their net effect on changes over time in the bargaining power of husbands and wives is uncertain and deserves further investigation.
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Affiliation(s)
- Agnes R Quisumbing
- Food Consumption and Nutrition Division, International Food Policy Research Institute, 2033 K Street, NW, Washington, DC 20006, USA.
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