Protein-energy Supplementation in Early-life Decreases the Odds of Mental Distress in Later Adulthood in Guatemala

BACKGROUND

Prevalence of mental health concerns is growing worldwide, along with lack of access to and receipt of needed treatment. Current gaps in treatment provision have led to exploring alternative methods of prevention, with research linking nutrition and mental health, of particular relevance in low- and middle- income countries with high prevalence of undernutrition.

OBJECTIVES

To examine whether exposure to a protein-energy nutritional supplement during the first 1000 days of life decreased odds of mental distress in adulthood among men and women in Guatemala compared to receiving a low energy-no protein supplement or supplementation outside the 1000-day window.

METHODS

Data from participants (n = 1249) in a longitudinal cohort protein-energy supplementation trial (early life, supplementation data from 1969-77, ages 0-7 years; life course, outcome data from 2017-2018 follow-up, ages 40-57 years) were analyzed for associations between nutrition in the first 1000 days and mental distress in adulthood (SRQ-20), controlling for early life variables and current life stress; life course variables (e.g., education) were examined as potential mediators of this relationship. Generalized linear mixed models and zero-inflated Poisson generalized linear mixed models were utilized.

RESULTS

Both partial and full supplementation with Atole during the first 1000 days were associated with 63% (95% CI: 0.16, 0.87) and 56% (95% CI: 0.19, 1.03) lower odds, respectively, of experiencing mental distress in adulthood. Results did not differ by sex. These inverse relationships remained relatively unchanged (partial OR = 0.34 [95% CI: 0.14, 0.83]; full OR = 0.38 [95% CI: 0.16, 0.92]) after controlling for early life and life course variables, including life stress.

CONCLUSIONS

Protein-energy supplementation during the first 1000 days of life in Guatemala where undernutrition is prevalent may reduce prevalence of later mental distress in adulthood. This effect appears to occur directly, rather than indirectly through pathways of life course variables such as education, wealth, and marital status.

Influence of enhanced nutrition and psychosocial stimulation in early childhood on cognitive functioning and psychological well-being in Guatemalan adults

Rationale

Early-life nutrition interventions in low and middle-income countries have demonstrated long-term benefits on cognitive skills, however, their influence on socioemotional outcomes has not been fully explored. Moreover, the mediating processes through which nutrition intervention effects operate and are maintained over time are understudied.

Methods

We followed-up a cohort of Guatemalan adults who participated as children in a community randomized food-supplementation trial. We examined associations of exposure to nutritional supplementation from conception to age 2 years with executive function (measured using three sub-tests of the NIH Toolbox Cognition Battery) and psychological well-being (measured using two sub-scales of the NIH Toolbox Emotion Battery) at ages 40–57 years (n = 1268). We used structural equation modeling to investigate the mediating role of psychosocial stimulation (measured in childhood using parent reports and ratings of home environments), cognitive ability (measured at ages 26–42 years using standardized tests), and executive function on the association of early-life exposure to nutritional supplementation with adult psychological well-being (n = 1640).

Results

We found positive but inconsistent associations of nutritional supplementation in childhood with executive function and psychological well-being in adulthood. Psychosocial stimulation, cognitive ability, and executive function did not mediate the association of early-life nutritional supplementation with adult psychological well-being. We found strong and positive associations of psychosocial stimulation in childhood with cognitive ability, executive function, and psychological well-being in adulthood. Moreover, we observed no interaction of exposure to nutritional supplementation and psychosocial stimulation in childhood with cognitive and psychological well-being outcomes in adulthood.

Conclusion

Our findings suggest that childhood nutrition interventions have long-lasting effects on cognitive ability and psychological well-being outcomes.

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We assess the influence of early-life nutrition on neurodevelopmental outcomes.

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We use a theoretical approach to examine mediators of the association.

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We found no mediators of the association of early-life nutrition with adult psychological well-being.

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Psychosocial stimulation is strongly associated with neurodevelopmental outcomes.

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Improved child nutrition is positively associated with adult psychological well-being.

Early-Life Nutrition and Subsequent International Migration: A Prospective Study in Rural Guatemala

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.

History and Design of the INCAP Longitudinal Study (1969-1977) and Its Impact in Early Childhood

The Institute of Nutrition of Central America and Panama (INCAP) longitudinal study of 1969 to 1977 was a community randomized trial in which 2 pairs of matched villages received either a protein-rich gruel (atole) or a nonprotein, low-energy drink (fresco). Both contained equal amounts of micronutrients by volume. I review the history and design of the study and impact on dietary intakes and physical growth. The design dates from the 1960s when protein was seen as the main dietary deficiency. During the 1970s, emphasis shifted to energy deficiency and this influenced early analyses. Energy from the 2 drinks during pregnancy was associated with improved birthweights and whether protein was also provided along with energy appeared to make no difference. These analyses, observational in nature, were possible because there was substantial overlap in energy intakes from the supplements during pregnancy across village types. In children, analyses initially focused on energy but eventually relied on the original experimental design. Exposure to the atole compared to fresco was associated with improved physical growth at 3 years of age but not from 3 to 7 years. Consumption of the fresco in the first 3 years of life was low such that there was little overlap in energy intakes from the supplements, not allowing for the type of analyses done for pregnancy. Diets in atole villages were greater from 15 to 36 months in protein, energy, and micronutrients, making attribution of impact on growth to a specific nutrient impossible. The atole improved linear growth, arm, and calf circumferences at 3 years but not skinfold thicknesses.

Social and Economic Development and Change in 4 Guatemalan Villages Over a Half Century

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.

Infant Mortality Rates Before, During, and after a Nutrition and Health Intervention in Rural Guatemalan Villages

Village-level infant mortality rates (IMRs) before, during, and after a food supplement and health care intervention in four villages in eastern Guatemala 1969–1977 and in three control villages are compared. Data on all pregnancies and outcomes for 988 women were obtained by means of a retrospective women's life history survey. After controlling for baseline values, the average IMR in two villages receiving supplementation with a protein-and energy-rich drink and health care was 60 per 1,000 live births, compared with an average rate of 113 in the control villages (p<.05). The rate in two villages receiving the same type of health care but a low-energy supplement was 91 per 1,000 and not significantly different from that in the control villages. The decline in the IMR in these villages points strongly to the programme's impact, but the relative importance of food supplements and health care is ambiguous.

Overview of Long-Term Nutrition Intervention Studies in Guatemala, 1968–1989

This is an overview of ten papers published in this issue of the Food and Nutrition Bulletin dealing with two components of a nutrition intervention study: the INCAP longitudinal study, 1969–1977, and the follow-up study, 1988–1989. The latter is a continuation of the former and seeks to test the hypothesis that nutritional improvements in early childhood lead to improved human capital formation in adolescents and young adults. Beneficial outcomes have been found to include greater body size and fat-free mass (particularly in females), improved working capacity in males, and enhanced intellectual performance in bath sexes.

Social and Economic Development and Change in four Guatemalan Villages: Demographics, Schooling, Occupation, and Assets

This article uses census data and village histories to examine changes over the last 35 years in the four villages where the Institute of Nutrition of Central America and Panama (INCAP) Longitudinal Study (1969–77) was conducted and offers a rare picture of development and change in rural localities over a long period of time. In addition, by characterizing the environment in which the subjects of this study were raised, we provide context for and inputs into quantitative analyses of data collected at various points in time on these subjects. The villages have undergone massive demographic, social, and economic change. Initial differences have conditioned many of these changes, especially differences associated with agricultural potential and location. Originally these villages were rather isolated, but road and transportation access has improved substantially. The populations in the villages have more than doubled and also have aged. While marriage patterns have held steady, religious practice has changed a great deal. After many years of steady out-migration, three of the four villages are more recently experiencing net in-migration, a pattern associated with ease of access. Schooling access and outcomes also have improved, with average grades of schooling nearly tripling and literacy doubling to levels currently above national averages. Although agriculture remains an important component of individual livelihood strategies, non-agricultural sources of employment have become more important. Much of this change is associated with declining agricultural markets and increased access to non-agricultural jobs near the villages and in the capital. Accompanying these changes has been an improvement in living standards as measured by a number of indicators of household living conditions and consumer durable goods.

Research Note: A Socioeconomic Index for the INCAP Longitudinal Study 1969–77

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.

Height and calories in early childhood

This paper estimates a height production function using data from a randomized nutrition intervention conducted in rural Guatemala from 1969 to 1977. Using the experimental intervention as an instrument, the IV estimates of the effect of calories on height are an order of magnitude larger than the OLS estimates. Information from a unique measurement error process in the calorie data, counterfactuals results from the estimated model and external evidence from migration studies suggest that IV is not identifying a policy relevant average marginal impact of calories on height. The preferred, attenuation bias corrected OLS estimates from the height production function suggest that, averaging over ages, a 100 calorie increase in average daily calorie intake over the course of a year would increase height by 0.06 cm. Counterfactuals from the model imply that calories gaps in early childhood can explain at most 16% of the height gap between Guatemalan children and the US born children of Guatemalan immigrants.

Parental Resources, Schooling Achievements, and Gender Schooling Gaps: Evidence of Change over 25 years in Rural Guatemala

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.

Disability and self-rated health among older women and men in rural Guatemala: the role of obesity and chronic conditions

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.

Greater years of maternal schooling and higher scores on academic achievement tests are independently associated with improved management of child diarrhea by rural Guatemalan mothers

Appropriate home management can alleviate many of the consequences of diarrhea including malnutrition, impaired development, growth faltering, and mortality. Maternal cognitive ability, years of schooling, and acquired academic skills are hypothesized to improve child health by improving maternal child care practices, such as illness management. Using information collected longitudinally in 1996-1999 from 466 rural Guatemalan women with children <36 months, we examined the independent associations between maternal years of schooling, academic skills, and scores on the Raven's Progressive Matrices and an illness management index (IMI). Women scoring in the lowest and middle tertiles of academic skills scored lower on the IMI compared to women in the highest tertile (-0.24 [95% CI: -0.54, 0.07]; -0.30 [95% CI: -0.54, -0.06], respectively) independent of sociodemographic factors, schooling, and Raven's scores. Among mothers with less than 1 year of schooling, scoring in the lowest tertile on the Raven's Progressive Matrices compared to the highest was significantly associated with scoring one point lower on the IMI (-1.18 [95% CI: -2.20, -0.17]). Greater academic skills were independently associated with maternal care during episodes of infant diarrhea. Schooling of young girls and/or community based programs that provide women with academic skills such as literacy, numeracy and knowledge could potentially improve mothers' care giving practices.

Maternal supplementation differentially affects the mother and newborn

Although studying the effect of supplementation on maternal health or the outcome of pregnancy was not a primary goal of the Institute of Nutrition of Central America and Panama Oriente Longitudinal Study, many important findings in these areas were produced. As part of the study, a food supplementation program was implemented. Two villages received Atole, a gruel containing protein and energy, and 2 matched villages received a refreshing, low-energy drink containing no protein. Both drinks contained micronutrients. Some women did not choose to consume the supplements and those who did consumed widely varying amounts. More volume of Fresco was consumed than Atole. The energy in the supplements improved birthweight, with no apparent additional benefit from protein or micronutrients. Researchers identified several groups of women who benefited from supplementation more than others by having babies with higher birthweights, including those with poorer current nutritional status and those who consumed high amounts of the supplement continuously from one pregnancy to the next. Results from the study provided an early indication that supplementation might increase the duration of gestation and, thus, reduce preterm birth. On the other hand, maternal supplementation did not substantially alter the duration of postpartum amenorrhea once concurrent infant supplementation was taken into account. Finally, findings from this study provided evidence of a biological trade-off between maintenance of maternal nutritional status and increasing fetal size that was responsive to both current maternal nutritional status and supplement intake but not to the mother's nutritional status earlier in life.

Probability, plausibility, and adequacy evaluations of the Oriente Study demonstrate that supplementation improved child growth

This article presents evidence that the high-nutrient supplement in the Oriente study (Atole) improved child growth. The evidence is presented at 4 levels. There was a causal effect of the intervention on child length, as assessed by probability analyses of the randomized, controlled trial (P < 0.05). The plausibility analyses, which included an examination of wasting, showed that the nutritional impact was due to the Atole, especially in those who were <3 y old and who suffered from diarrhea. The adequacy analyses revealed excellent biological efficacy of the Atole at the individual level. At the level of the whole population, the efficacy of impact was much less, because many children did not participate fully in the supplementation program. The external validity of the biological impact is likely to be good for populations with similar diets and medical care.

Maternal years of schooling but not academic skills is independently associated with infant-feeding practices in a cohort of rural Guatemalan women

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.

A simple index to measure hygiene behaviours

BACKGROUND

Spot checks are becoming a popular method to assess hygiene behaviours; however, little is known about their repeatability or predictability. We evaluated the within-household repeatability of hygiene indices created from spot checks and their ability to predict incidence of diarrhoea in young Guatemalan children.

METHODS

We observed hygiene behaviours in 588 households in four rural Guatemalan communities over 36 months. Four indices related to drinking water (DWI; score = 0-3), food (FI; score = 0-3), personal hygiene (PHI; score = 0-3), and domestic household hygiene (DHI; score = 0-6) and one summary hygiene index (SHI; range 0-15) were created. Morbidity of 694 children aged birth to 36 months living in the study households was assessed using biweekly recall. Intraclass correlation coefficients were calculated to assess within-household repeatability; the generalized estimating equations approach was employed to analyse diarrhoea morbidity.

RESULTS

Households were observed a mean of 22.1 +/- 11.2 times. All indices decreased with duration of follow-up (SHI = -0.67 +/- 0.05 points/year; WI = -0.04 +/- 0.01; FI = -0.07 +/- 0.01; PHI = -0.21 +/- 0.01; DHI = -0.37 +/- 0.02; all P < 0.05). Intraclass correlations were low to moderate (SHI = 0.35-0.51; DWI = 0.17-0.21; FI = 0.16-0.18; PHI = 0.27-0.32; DHI = 0.27-0.38). Six separate spot checks would be needed to estimate a household's underlying level of hygiene within 20%. SHI and PHI scores were inversely associated with diarrhoea morbidity (both P < 0.05).

CONCLUSIONS

Hygiene indices created using spot checks can be a rapid and efficient method for assessing hygiene and useful for predicting diarrhoea morbidity in young children. Multiple measures are required to accurately estimate the true hygiene pattern of a household.

Household expenditures and wealth among young Guatemalan adults

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.

Maternal and childhood nutrition and later blood pressure levels in young Guatemalan adults

BACKGROUND

Low birth weight and subsequent rapid child growth are associated with later blood pressure levels. The role of maternal and child nutrition in this association remains unclear.

METHODS

We studied 450 men and women (ages 21-29 years) born during a randomized trial of protein-energy supplementation (Atole) vs low energy/no protein supplementation (Fresco) in pregnancy and early childhood in four rural Guatemalan villages from 1969 to 1977.

RESULTS

Protein-energy supplementation was not associated with differences in blood pressure in adulthood (diastolic blood pressure (DBP): beta = 0.69 mm Hg, 95% confidence internal (CI) (20.82-2.19); P = 0.37; systolic blood pressure (SBP): beta = 0.17 mm Hg, 95% CI (21.68-2.02); P = 0.86). Within the Atole group, maternal height was associated with later SBP (0.22 mm Hg/cm, 95% CI (20.002-0.45); P = 0.05). No other associations between maternal nutritional status, birth size, child growth, or supplement intake were observed for adult blood pressure.

CONCLUSIONS

Our data do not support the role of maternal nutrition during pregnancy, birth size, or early child growth in programming adult blood pressure. Likewise, we found no effect of protein-energy supplementation in pregnancy or in early childhood on blood pressure in young adults.

Maternal and child nutritional supplementation are inversely associated with fasting plasma glucose concentration in young Guatemalan adults

Cardiovascular disease and diabetes may be programmed early in life by abnormal development associated with undernutrition. We investigated whether maternal nutritional status (MNS; height, pregnancy weight gain, nonpregnant BMI, and prenatal supplementation) or childhood nutritional status (CNS; birth weight, length, ponderal index, height-for-age Z-score at 24 mo, and supplementation from 0 to 24 mo) were related to fasting plasma glucose levels in rural-born Guatemalan adults. We studied 209 men and 220 women (mean age 24.4 y) who were involved in a randomized trial of nutritional supplementation of their mothers during pregnancy and during their early childhoods, conducted from 1969 to 1977. In 2 villages, residents were offered Atole (3.8 MJ and 64 g protein/L); 2 other villages were offered Fresco (1.4 MJ/L, no protein). No associations were observed between anthropometric measures of MNS or CNS and fasting plasma glucose levels. In subgroup analyses, inverse associations (all P < 0.15) with birth size were found among women born to fatter mothers, women with low supplement intake, men born to short mothers, and men more severely stunted at 24 mo. Prenatal supplementation was inversely associated with fasting plasma glucose among women [-0.40 +/- 0.17 mmol/(L. MJ. d), P = 0.02]. Among men, postnatal intake of supplementation of 0.10 to 0.20 MJ/d was associated with up to a 0.56 mmol/L reduction in fasting plasma glucose (P = 0.03), but intake in excess of 0.20 MJ/d provided no added benefit. Among women, the benefit of postnatal supplementation was restricted to those born thin (test for interaction P = 0.10). Improving the nutritional status of undernourished women and children may have positive long-term consequences.

Longitudinal analysis of deciduous tooth emergence: III. Sexual dimorphism in Bangladeshi, Guatemalan, Japanese, and Javanese children

Previous studies, mostly in European populations, found sex differences in the pattern of deciduous tooth emergence. Most studies find that the anterior dentition in males is precocial relative to the female dentition, and the pattern reverses so that females lead males in the emergence of the posterior deciduous dentition. Less is known about sex differences in the dental development and emergence of non-European populations. Here we examine the pattern of sex differences in deciduous tooth emergence in Japanese, Javanese, Guatemalan, and Bangladeshi children. The data come from four longitudinal or mixed longitudinal studies using similar study protocols. Survival analysis was used to estimate parameters of a log-normal distribution of emergence for each of the 10 teeth of the left dentition, and sexual dimorphism was assessed by sex-specific differences in mean emergence times and by Bennett's index. The results support the pattern of developmental cross-over observed in other populations. We conclude that there is little evidence to support the hypothesis of Tanguay et al. ([1984] J. Dent. Res. 63:65-68) that ethnic factors mediate sex differences in the emergence of deciduous teeth.

Cardiovascular disease risk factors are related to adult adiposity but not birth weight in young guatemalan adults

Fetal undernutrition has been hypothesized to program inappropriate metabolic responses to nutritional abundance in later life. Most studies have been conducted in industrialized countries. We studied the relationship between birth weight and risk factors for cardiovascular disease (CVD) among 187 men and 198 women age 20-29 y (mean age 24 y) who had participated in a longitudinal study conducted in Guatemala between 1969 and 1977. In women, birth weight was positively associated with adult body mass index (BMI; P < 0.01), systolic (P < 0.001) and diastolic blood pressure (P < 0.05), but not with glucose or any lipid measure. In men, birth weight was not associated with adult BMI, blood pressure or glucose, and was weakly and inversely related to total cholesterol and LDL cholesterol (test for trend: P = 0.06 and P = 0.09, respectively). Adult BMI was associated with increased prevalence of CVD risk factors in both men and women. Our data offer no support for the fetal programming of cardiovascular disease risk hypothesis in young adult women, and weak support in young adult men. Overweight in adults is a strong determinant of variance in CVD risk factor prevalence.

Rural-to-urban migration and cardiovascular disease risk factors in young Guatemalan adults

BACKGROUND

Migration to cities may increase cardiovascular disease risk factors in developing countries. We examined rural and urban individuals who were born in the same villages and shared similar childhood experiences.

METHODS

Blood lipids and glucose, blood pressure, anthropometry, body composition, physical activity, and food, tobacco and alcohol consumption were examined in 161 men and 193 women, 19-29 years old, living in their village of birth (76 commuted to work in Guatemala City), and in 76 men and 43 women living in the city.

RESULTS

Rural and urban women had similar prevalence of overweight (28%), elevated body fat (29.8 +/- 6.1%) and low physical activity (83%). Compared to rural men, more urban men were sedentary (79 versus 27%), and they had higher body fat (15.3 +/- 5.3% versus 13.3 +/- 5.7%), serum cholesterol (4.27 +/- 0.75 versus 3.90 +/- 0.70 mmol/l [165 +/- 29 versus 151 +/- 27 mg/dl]), low density lipoprotein [LDL]-cholesterol (2.66 +/- 0.72 versus 2.30 +/- 0.62 mmol/l [103 +/- 28 versus 89 +/- 24 mg/dl]) and total cholesterol/high density lipoprotein [HDL]-cholesterol ratio (4.6 +/- 1.0 versus 4.1 +/- 0.9). Commuters showed intermediate values. Women had higher serum cholesterol (4.43 +/- 0.80 mmol/l [171 +/- 31 mg/dl]) than men in rural and urban areas. Urban residents ate/drank more saturated fats, red meat and sweetened beverages, and less legumes.

CONCLUSIONS

High proportions of young Guatemalan women were overweight and sedentary. Migration to a city increased sedentarism and undesirable eating habits among men and women; men became fatter and their lipid profile worsened. Public health actions must address the prevention of emerging chronic diseases in countries still burdened by undernutrition and infections.