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Villatoro-Santos CR, Ramirez-Zea M, Villamor E. Urinary sodium, iodine, and volume in relation to metabolic syndrome in Mesoamerican children and their parents. Nutr Metab Cardiovasc Dis 2022; 32:1774-1783. [PMID: 35637087 DOI: 10.1016/j.numecd.2022.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 04/12/2022] [Accepted: 04/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS The roles of sodium or iodine intake on the metabolic syndrome (MetS) etiology remain controversial. We evaluated the associations of 24 h urinary sodium and iodine with MetS among Mesoamerican children and their adult parents. METHODS AND RESULTS We conducted a cross-sectional study among 217 school-age children and 478 parents from 9 Mesoamerican cities. Exposures were high 24 h urinary sodium excretion and concentration (>2000 mg/d or mg/L, respectively) and high 24 h urinary iodine excretion and concentration (≥300 μg/d or μg/L, respectively). In children, the outcome was a standardized metabolic score from five criteria analogous to the Adult Treatment Panel (ATP) III criteria. In adults, MetS was defined according to the ATP III criteria. We estimated adjusted mean differences in the metabolic risk score and adjusted prevalence ratios of MetS between exposure categories using multivariable regression. In children, high sodium concentration was associated with a 0.10 units (43% of a SD) higher score (P = 0.001) and high iodine concentration was related to a 0.09 units (39% of a SD) higher score (P = 0.009). Unexpectedly, high 24 h urinary volume was associated with a lower metabolic score. In adults, high 24 h sodium excretion was related to hypertension and high iodine concentration was related to increased MetS prevalence. CONCLUSION High sodium and iodine concentrations, but not 24 h iodine excretion, are significantly associated with MetS in children, whereas high 24 h urinary volume is related to a decreased metabolic score. In adults, high iodine concentration tends to be related to increased MetS prevalence, but not 24 h iodine excretion.
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Affiliation(s)
- C R Villatoro-Santos
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - M Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - E Villamor
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
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Rivera-Andrade A, Kroker-Lobos MF, Lazo M, Freedman ND, Smith JW, Torres O, McGlynn KA, Groopman JD, Guallar E, Ramirez-Zea M. High prevalence of non-alcoholic fatty liver disease and metabolic risk factors in Guatemala: A population-based study. Nutr Metab Cardiovasc Dis 2019; 29:191-200. [PMID: 30573307 PMCID: PMC6461713 DOI: 10.1016/j.numecd.2018.10.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/30/2018] [Accepted: 10/22/2018] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- A Rivera-Andrade
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - M F Kroker-Lobos
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - M Lazo
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - N D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD 20892, USA
| | - J W Smith
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - O Torres
- Laboratorio de Diagnóstico Molecular, Guatemala City, Guatemala
| | - K A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Rockville, MD 20892, USA
| | - J D Groopman
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - E Guallar
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - M Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
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Corvalán C, Garmendia ML, Jones-Smith J, Lutter CK, Miranda JJ, Pedraza LS, Popkin BM, Ramirez-Zea M, Salvo D, Stein AD. Nutrition status of children in Latin America. Obes Rev 2017; 18 Suppl 2:7-18. [PMID: 28741907 PMCID: PMC5601284 DOI: 10.1111/obr.12571] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/03/2017] [Indexed: 12/30/2022]
Abstract
The prevalence of overweight and obesity is rapidly increasing among Latin American children, posing challenges for current healthcare systems and increasing the risk for a wide range of diseases. To understand the factors contributing to childhood obesity in Latin America, this paper reviews the current nutrition status and physical activity situation, the disparities between and within countries and the potential challenges for ensuring adequate nutrition and physical activity. Across the region, children face a dual burden of undernutrition and excess weight. While efforts to address undernutrition have made marked improvements, childhood obesity is on the rise as a result of diets that favour energy-dense, nutrient-poor foods and the adoption of a sedentary lifestyle. Over the last decade, changes in socioeconomic conditions, urbanization, retail foods and public transportation have all contributed to childhood obesity in the region. Additional research and research capacity are needed to address this growing epidemic, particularly with respect to designing, implementing and evaluating the impact of evidence-based obesity prevention interventions.
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Affiliation(s)
- C Corvalán
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - M L Garmendia
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - J Jones-Smith
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | | | - J J Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - L S Pedraza
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - B M Popkin
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala
| | - D Salvo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico.,Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston, School of Public Health, Austin Campus, Austin, TX, USA
| | - A D Stein
- Hubert Department of Global Health of the Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Barceló A, Gregg EW, Wong-McClure R, Meiners M, Ramirez-Zea M, Segovia J. Total adult cardiovascular risk in Central America. Rev Panam Salud Publica 2015; 38:464-471. [PMID: 27440094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 08/04/2015] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVE To evaluate prevalence of cardiovascular risk among adults 40 years and older using population-based samples from six Central American countries. METHODS Risk factors were derived from a multi-national cross-sectional survey implemented in 2003-2006, which included a sample of 4 202 participants aged 40 years and older. Charts produced by the World Health Organization and the International Society of Hypertension for the Region of the Americas sub-region B were used to predict risk on the basis of factors including age, sex, blood pressure, total serum cholesterol, smoking status, and diabetes status. RESULTS Overall, 85.9% of the population was classified as having < 10% risk for cardiovascular events during the following ten years. The likelihood of being in this risk group decreased with age in both males and females. Four percent of respondents were identified as having > 20% risk. More than 75% of those with a 30-40% risk had previously been identified by health services, and an additional 23% were identified during the study, suggesting they could be diagnosed by opportunistic screening for diabetes, hypertension and hypercholesterolemia. Results of bivariate analysis showed that respondents who were male, older, obese and/or less educated had higher risk for cardiovascular events, but a multivariate analysis including education indicated highest risks for older, obese, and less educated females. CONCLUSIONS Measuring cardiovascular disease risk identifies most cases of (or at risk for) diabetes, hypertension and hypercholesterolemia among adults 40 years and older. This strategy can facilitate implementation of control programs and decrease disabilities and premature mortality.
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Affiliation(s)
- A Barceló
- Department of Chronic Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America,
| | - E W Gregg
- Epidemiology and Statistics Branch, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
| | - R Wong-McClure
- Office of Epidemiology and Surveillance, Caja Costarricense de Seguro Social, San José, Costa Rica
| | - M Meiners
- Faculdade de Ceilândia, Universidade de Brasília
| | - M Ramirez-Zea
- Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - J Segovia
- Department of Chronic Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America,
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Mejicano A, Fort M, Ramirez-Zea M, Mendoza C, Martinez H. Building research capacity in chronic disease prevention in Mesoamerica:
Progress and lessons learned. Ann Glob Health 2014. [DOI: 10.1016/j.aogh.2014.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Aleman-Mateo H, Rush E, Esparza-Romero J, Ferriolli E, Ramirez-Zea M, Bour A, Yuchingtat G, Ndour R, Mokhtar N, Valencia ME, Schoeller DA. Prediction of fat-free mass by bioelectrical impedance analysis in older adults from developing countries: a cross-validation study using the deuterium dilution method. J Nutr Health Aging 2010; 14:418-26. [PMID: 20617282 DOI: 10.1007/s12603-010-0031-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Several limitations of published bioelectrical impedance analysis (BIA) equations have been reported. The aims were to develop in a multiethnic, elderly population a new prediction equation and cross-validate it along with some published BIA equations for estimating fat-free mass using deuterium oxide dilution as the reference method. DESIGN AND SETTING Cross-sectional study of elderly from five developing countries. METHODS Total body water (TBW) measured by deuterium dilution was used to determine fat-free mass (FFM) in 383 subjects. Anthropometric and BIA variables were also measured. Only 377 subjects were included for the analysis, randomly divided into development and cross-validation groups after stratified by gender. Stepwise model selection was used to generate the model and Bland Altman analysis was used to test agreement. RESULTS FFM = 2.95 - 3.89 (Gender) + 0.514 (Ht2/Z) + 0.090 (Waist) + 0.156 (Body weight). The model fit parameters were an R2, total F-Ratio, and the SEE of 0.88, 314.3, and 3.3, respectively. None of the published BIA equations met the criteria for agreement. The new BIA equation underestimated FFM by just 0.3 kg in the cross-validation sample. The mean of the difference between FFM by TBW and the new BIA equation were not significantly different; 95% of the differences were between the limits of agreement of -6.3 to 6.9 kg of FFM. There was no significant association between the mean of the differences and their averages (r= 0.008 and p= 0.2). CONCLUSIONS This new BIA equation offers a valid option compared with some of the current published BIA equations to estimate FFM in elderly subjects from five developing countries.
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Affiliation(s)
- H Aleman-Mateo
- Departamento de Nutricion y Metabolismo. Coordinacion de Nutricion. Centro de Investigacion en Alimentacion y Desarrollo, A.C. Carretera a La Victoria km. 0.6 Hermosillo, Sonora. Apdo. Postal 1735. C.P. 83000.
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Aburto NJ, Ramirez-Zea M, Neufeld LM, Flores-Ayala R. The effect of nutritional supplementation on physical activity and exploratory behavior of Mexican infants aged 8–12 months. Eur J Clin Nutr 2010; 64:644-51. [DOI: 10.1038/ejcn.2010.52] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Corvalán C, Gregory CO, Ramirez-Zea M, Martorell R, Stein AD. Size at birth, infant, early and later childhood growth and adult body composition: a prospective study in a stunted population. Int J Epidemiol 2007; 36:550-7. [PMID: 17376801 DOI: 10.1093/ije/dym010] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pre-natal and post-natal growth are associated with adult body composition, but the relative importance of growth in different periods of childhood is still unclear, particularly in stunted populations. METHODS We studied 358 women and 352 men measured as children in 1969-77 in four villages in Guatemala, and re-measured as adults in 2002-04 (mean age 32.7 years). We determined the associations of body mass index (BMI) and length at birth, and changes in BMI and length during infancy (0-1.0 year) and early (1.0-3.0 years) and later (3.0-7.0 years) childhood, with adult BMI ((a)BMI), percentage of body fat ((a)PBF), abdominal circumference ((a)AC) and fat-free mass ((a)FFM). RESULTS Prevalence of stunting was high (64% at 3 years; HAZ < -2SD). Obesity (WHZ > 2SD) prevalence in childhood was <2%, while overweight prevalence in adulthood was 52%. BMI at birth was positively associated with (a)BMI and (a)FFM while length at birth was positively associated with (a)AC and (a)FFM. Increased BMI in infancy and later childhood were positively associated with all four adult body composition measures; associations in later childhood with fatness and abdominal fatness were stronger than those with (a)FFM. Change in length during infancy and early childhood was positively associated with all four adult body composition outcomes; the associations with (a)FFM were stronger than those with fat mass. CONCLUSIONS Increases in BMI between 3.0 and 7.0 years had stronger associations with adult fat mass and abdominal fat than with (a)FFM; increases in length prior to age 3.0 years were most strongly associated with increases in (a)FFM.
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Affiliation(s)
- C Corvalán
- Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Emory University, 540 Asbury Circle, Atlanta, GA 30322, USA
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