Dietary Patterns and Cardio-metabolic Risk in a Population of Guatemalan Young Adults

Dietary, socioeconomic, and maize handling practices associated with aflatoxin and fumonisin exposure among women tortilla makers in 5 departments in Guatemala

Previous research has demonstrated human exposure to mycotoxins among Guatemalans, with high levels of mycotoxins being found in blood and urine samples as well as in maize for human consumption. Mishandling of crops such as maize during pre- and post-harvest has been associated with mycotoxin contamination. The overarching goal of this study was to identify risk factors for aflatoxin and fumonisin exposure in Guatemala. A cross-sectional survey of 141 women tortilla makers was conducted in the departments of Guatemala, Sololá, Suchitepéquez, Izabal, and Zacapa in February 2022. Maize and tortilla samples were collected and analyzed for aflatoxin B1 (AFB1) and fumonisin B1, B2, and B3 contamination (FB1, FB2, FB3). Urine samples were collected and analyzed for urinary FB1 (uFB1) contamination. A questionnaire was administered to collect data on sociodemographic characteristics, dietary intake of maize-based foods the week prior to the study, and maize handling practices. Descriptive statistics were used to describe common maize handling practices. A univariable analysis was conducted to identify predictors of low/high AFB1, total fumonisins, and uFB1. Multivariable logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). During tortilla processing, a reduction in the AFB1 and total fumonisin levels was observed. The presence of AFB1 in maize was associated with department and mean total fumonisin level in maize (OR: 1.705, 95% CI: 1.113-2.613). The department where the tortilleria was located was significantly associated with the presence of fumonisins in tortillas. Increased consumption of Tortrix was significantly associated with the presence of FB1 in urine (OR: 1.652, 95% CI: 1.072-2.546). Results of this study can be used in the development and implementation of supply chain management practices that mitigate mycotoxin production, reduce food waste and economic loss, and promote food security.

Metabolic syndrome in people with HIV from Guatemala: analysis of components and risk factors

BACKGROUND

People with HIV (PWH) in Latin America are at a greater risk of developing comorbidities due to the increasing burden of obesity and metabolic syndrome in the region. We explored the associations between social, cardiovascular and HIV-related risk factors with metabolic syndrome in PWH from Guatemala.

METHODS

Cross-sectional study analyzing demographic, clinical and laboratory data from PWH. Metabolic syndrome diagnosis and components are defined by the harmonized Joint Scientific Statement criteria. Data were collected from July 2019 to March 2020 and analyzed using correlations and logistic regression.

RESULTS

Median age was 39 years [IQR 31-48], 56.8% of participants were male and 31.5% (n = 266, 95% CI 0.28-0.34) had metabolic syndrome. Age (adjusted odds ratio (aOR): 1.03, 95% CI 1.02-1.05, p <0.001), urban dweller (aOR: 1.48, 95% CI 1.00-2.18, p = 0.049), low physical activity (aOR: 1.45, 95% CI 1.01-2.08, p = 0.046), hyperuricemia (aOR: 3.31, 95% CI 1.93-5.67, p <0.001), current CD4⁺ T cell count < 200 cells/mm³ (aOR: 1.96, 95% CI 1.19-3.23, p = 0.009), 6 months of efavirenz (aOR: 1.89, 95% CI 1.29-2.77, p = 0.001), and obesity (aOR: 37.0, 95% CI 7.70-178.2, p < 0.001) were independently associated with metabolic syndrome.

CONCLUSIONS

Prevalence of metabolic syndrome in this study was high and driven mainly by social and cardiovascular risk factors such as age, urban dwelling, obesity, hyperuricemia and low physical activity. Efavirenz use and CD4 count were the only HIV-related factors associated with metabolic syndrome.

Age at childbirth and change in BMI across the life-course: evidence from the INCAP Longitudinal Study

Background

Parity has been associated with both short- and long-term weight gain in women. However, it is not clear if timing of parity across the reproductive age has different associations with BMI.

Methods

To prospectively assess the association between age at childbirth and maternal change in BMI, we analyzed data from the ongoing INCAP Longitudinal Study, which started in 1969 in four villages in Guatemala. Cohort women (n=778) provided information on reproductive history and anthropometric measures were measured in 1988-89 (adolescence, 15 to 25y), 2002-04 (early adulthood, 26 to 36y) and 2015-17 (mid adulthood, 37 to 55y). We evaluated the associations of number of live births in the period preceding each study wave (1969-77 to 1988-89, 1988-89 to 2002-04 and 2002-04 to 2015-17) with BMI change in the same period using multivariable linear regression models.

Results

Number of live births between 1988 and 89 and 2002-04 was positively associated with increased BMI, while there was not an association between number of live births and BMI in the other intervals. Women who had one, two, or three or more children between 1988 and 89 and 2002-04 had 0.90 (kg/m², 95% CI: -0.55, 2.35), 2.39 (kg/m², 95% CI: 1.09, 3.70) and 2.54 (kg/m², 95% CI: 1.26, 3.82) higher BMI, respectively, than women who did not give birth in the same period.

Conclusions

Our findings suggest that women who had three or more children during early adulthood gained more weight compared to women who had no children in the same period. In contrast, women who had children earlier or later in their reproductive lives did not gain additional weight compared to those who did not have children during that period. Childbirth may have different associations with BMI based on the mother’s age.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04485-6.

Dietary and socioeconomic risk factors for fumonisin exposure among women of reproductive age in 18 municipalities in Guatemala from 2013 to 2014

Fumonisin exposure is common in populations where maize is a dietary staple, such as in Guatemala, and has been associated with negative health outcomes including neural tube defects. The objective of this study was to estimate fumonisin B1 (FB1) exposure among Guatemalan reproductive-age women and develop a better understanding of the dietary and sociodemographic risk factors for exposure. A cross-sectional study in 18 municipalities in Guatemala was conducted. Midwives and study nurses enrolled consenting women and collected individual and household demographic and socioeconomic data. A food frequency questionnaire was administered to estimate quantity and types of food products consumed. A urine sample was collected and urinary fumonisin B1 (uFB1) concentration was measured. A univariable analysis was conducted to identify predictors of low/high uFB1. Multivariable logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). In total, 775 women had analyzable urine samples. Higher uFB1 levels were associated with speaking Mayan (OR = 2.33, 95% CI:1.44-3.77), less than high school education (OR = 1.61, 95% CI:1.12-2.30), increasing dietary proportion of maize-based foods (OR = 1.02, 95% CI:1.01-1.03), and consumption of tostadas (fried tortillas) (OR = 1.11, 95% CI:1.02-1.22). Lower uFB1 levels were associated with consumption of highly processed maize-based foods (OR = 0.93, 95% CI:0.87-0.99). Tortillas were the most frequently consumed maize-based food among study participants and significantly associated with high uFB1 exposure in the univariable but not multivariable analysis. Consumption of >4,750 grams/week of maize-based foods, >5,184 g/week of locally produced maize-based foods, and >110 servings/week of tortillas were also significantly associated with high uFB1 exposure in univariable analysis. Populations with low socioeconomic status/education levels and high consumption of maize-based foods had higher fumonisin exposure. Interventions aimed at reducing the risk of exposure to mycotoxins through maize in Guatemala, including the increased consumption of non-maize-based foods, should be further explored.

Maternal diet patterns during early pregnancy in relation to neonatal outcomes

BACKGROUND

Research has established that maternal diet influences fetal growth and preterm birth, but most studies only evaluate single nutrients. Relations between dietary patterns and neonatal outcomes are understudied.

OBJECTIVE

We evaluated associations of neonatal outcomes with maternal diet patterns derived using 3 a priori diet scores [Alternative Healthy Eating Index-2010 (AHEI-2010), alternate Mediterranean diet score (aMed), and Dietary Approaches to Stop Hypertension (DASH)] as well as principal components analysis (PCA).

METHODS

We studied 1948 women from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies-Singletons, a racially diverse multisite cohort of pregnant women in the USA (2009-2013). Diet in the past 3 mo was assessed using a self-administered FFQ at 8-13 weeks of gestation. Birthweight was abstracted from medical records and neonatal anthropometry measured postdelivery using standardized protocols.

RESULTS

All 3 a priori scores were significantly associated with increased birthweight, and aMed was also associated with reduced odds of low birthweight [quartile 4 versus 1: ORadj = 0.42; 95% CI: 0.18, 1.00 (P-trend = 0.02)]. Greater aMed and DASH scores were significantly associated with increased length [aMed: quartile 4 versus 1: 0.54 cm; 95% CI: 0.10, 0.99 (P-trend = 0.006); DASH: quartile 4 versus 1: 0.62 cm; 95% CI: 0.25, 0.99 (P-trend = 0.006)] and upper arm length. Neither diet pattern derived from PCA was significantly associated with birthweight.

CONCLUSION

Among mostly low-risk pregnant women, pre- and early pregnancy healthful diet quality indices, particularly the aMed score, were associated with larger neonatal size across the entire birthweight distribution. In the absence of generally accepted pregnancy-specific diet quality scores, these results provide evidence for an association between maternal diet patterns and neonatal outcomes.

Overweight and Obesity, Cardiometabolic Health, and Body Composition: Findings From the Follow-Up Studies of the INCAP Longitudinal Study

BACKGROUND

There has been increased interest in the hypothesis that undernutrition in early life predisposes to cardiometabolic disease risk in adulthood. The Institute of Nutrition of Central America and Panama Longitudinal Study is able to address one critical aspect of this field, specifically whether improvements in nutrition can prevent this increased risk.

OBJECTIVE

To describe the main findings on obesity and body composition across 5 waves of field work (1988-1989, 1991-1994, 1998-1999, 2002-2004, and 2015-2017) and on cardiometabolic health across 3 waves (1998-1999, 2002-2004, and 2015-2017).

RESULTS

Body weight and body fat increased considerably in adulthood, especially among women with sedentary occupations. Adiposity and weight in adulthood were strongly predicted by weight gain after the first 1000 days of life. On the other hand, exposure to improved nutrition in early life reduced diabetes risk by approximately 50% but increased the risk of overweight and obesity.

CONCLUSIONS

Future research will aid in clarifying the underlying mechanisms that drive the opposite associations among diabetes and obesity with early-life nutrition.

Can Central America and the Dominican Republic Overcome Malnutrition in All Its Forms?

Malnutrition impairs many forms of human development. In order to tackle nutritional deficiencies and excesses, the science of evidence-based nutrition needs rapid transformations to scale up pro-poor and sustainable actions. The aims of this article are to briefly outline the nutritional challenges faced in Central America and the Dominican Republic, highlight new evidence produced by the Institute of Nutrition of Central America and Panama during the last decade, and foster the implementation of feasible solutions in limited-resourced settings.

Cross-country comparison of dietary patterns and overweight and obesity among adult women in urban Sub-Saharan Africa

OBJECTIVE

To derive dietary patterns (DP) among women of reproductive age (WRA) and older women in urban Sub-Saharan Africa (SSA), and to examine their association with body mass index (BMI), overweight and obesity.

DESIGN

We used principal component analysis to derive DP. Their association with BMI, overweight and obesity was assessed using linear and multinomial logistic regression models controlling for age, marital status, education and wealth.

SETTING

Cross-sectional data from prospective studies in Accra, Ghana (2008-2009), Dar es Salaam, Tanzania (2014) and Lilongwe and Kasungu, Malawi (2017-2018) were used.

PARTICIPANTS

We compared WRA in Ghana (18-54 years, n 1762) and Malawi (19-48 years, n 137), and older women in Ghana (≥55 years, n 514) and Tanzania (≥50 years, n 134).

RESULTS

Among WRA, protein and healthy DP were identified in both Ghana and Malawi. In Ghana, the protein DP was associated with higher odds of overweight or obesity (adjusted OR 1·82, 95 % CI 1·27, 2·60 for quintile 2). Among older women, three DP were identified in Ghana (cereal, protein and healthy) and two DP in Tanzania (protein and healthy). The protein DP was associated with higher BMI in Ghana (adjusted mean difference 2·83, 95 % CI 0·95, 4·71 for quartile 3).

CONCLUSIONS

Higher quintiles of the protein DP were associated with higher BMI and odds of overweight or obesity among women in urban Ghana, but not in Malawi or Tanzania. Further research is needed to understand how DP influence overweight and obesity among adult women in urban SSA.

High prevalence of non-alcoholic fatty liver disease and metabolic risk factors in Guatemala: A population-based study

BACKGROUND

There are no data on the prevalence of non-alcoholic fatty liver disease (NAFLD) in general population samples in Guatemala or in other Central American countries. The prevalence and distribution of NAFLD and its associated risk factors were evaluated in a population-based sample of adults in Guatemala.

METHODS

Cross-sectional study of 411 men and women 40 years of age or older residing in urban and rural areas of Guatemala. Metabolic outcomes included obesity, central obesity, hypercholesterolemia, diabetes, and metabolic syndrome (MetS). Liver disease outcomes included elevated liver enzymes, elevated Fatty Liver Index (FLI), and elevated FIB-4 score.

RESULTS

The overall prevalence of obesity, central obesity, diabetes, and MetS were 30.9, 74.3, 21.6, and 64.2%, respectively. The fully-adjusted prevalence ratios (95% CI) for obesity, central obesity, diabetes, and MetS comparing women to men were 2.83 (1.86-4.30), 1.72 (1.46-2.02), 1.18 (1.03-1.34), and 1.87 (1.53-2.29), respectively. The overall prevalence of elevated liver enzymes (ALT or AST), elevated FLI, and elevated FIB-4 scores were 38.4, 60.1, and 4.1%, respectively. The fully-adjusted prevalence ratios (95% CI) for elevated liver enzymes (either ALT or AST) and elevated FLI score comparing women to men were 2.99 (1.84-4.86) and 1.47 (1.18-1.84), respectively.

CONCLUSIONS

The prevalence of metabolic abnormalities and liver outcomes in this general population study was very high. The prevalence of metabolic and liver abnormalities was particularly high among women, an observation that could explain the atypical 1:1 male to female ratio of liver cancer in Guatemala.