Institute of Nutrition of Central America and Panama

Zona, Guatemala

Institute of Nutrition of Central America and Panama

Zona, Guatemala
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DiGirolamo A.M.,Harvard University | DiGirolamo A.M.,Emory University | Ramirez-Zea M.,Institute of Nutrition of Central America and Panama | Wang M.,Emory University | And 8 more authors.
American Journal of Clinical Nutrition | Year: 2010

Background: Rates of mental illness in children are increasing throughout the world. Observational studies of depression, anxiety, and attention-deficit hyperactivity disorder suggest that zinc is an alternative treatment. Objective: We examined the effect of zinc supplementation on the mental health of school-age children in Guatemala. Design: From January to October 2006, we conducted a 6-mo randomized, double-blind, controlled trial comparing zinc supplementation (10 mg ZnO/d for 5 d/wk) with a placebo (10 mg glucose) in 674 Guatemalan children in grades 1-4. Outcome measures included internalizing (ie, depression and anxiety) and externalizing (ie, hyperactivity and conduct disorder) problem behaviors, positive behaviors (ie, socialization and leadership), and serum zinc concentrations. Results: Zinc and placebo groups did not differ significantly in any behavioral measures at baseline or at follow-up. At baseline, 21.4% of children had serum zinc concentrations <65 μg/dL. At follow-up, both groups improved significantly, and zinc concentrations were higher in the zinc group. Increases in serum zinc concentrations were inversely associated with decreases in depressive symptoms (estimate: -0.01 points per μg Zn/dL; P = 0.01), anxiety (estimate: -0.012 points per μg Zn/dL; P = 0.02), internalizing symptoms (estimate: -0.021 points per μg Zn/dL; P = 0.02), and social skills (estimate: -0.019 points per μg Zn/dL; P = 0.01) in adjusted models that were controlled for child age, sex, socioeconomic status, household, and treatment group. Conclusions: Six months of zinc supplementation did not induce differences in mental health outcomes between zinc and placebo groups. However, increases in serum zinc concentrations were associated with decreases in internalizing symptoms (ie, depression and anxiety) in a community-based sample of children at risk of zinc deficiency. This trial was registered at clinicaltrials.gov as NCT00283660. © 2010 American Society for Nutrition.


Aburto N.J.,Centers for Disease Control and Prevention | Aburto N.J.,National Health Research Institute | Ramirez-Zea M.,Institute of Nutrition of Central America and Panama | Neufeld L.M.,National Health Research Institute | Flores-Ayala R.,Centers for Disease Control and Prevention
European Journal of Clinical Nutrition | Year: 2010

Background/Objectives: Physical activity and exploration in infancy affect physical and cognitive development. Nutritional supplementation improves activity in severely malnourished infants, but the evidence in mild-to-moderately malnourished and nutritionally at-risk infants is equivocal. We tested the effect of multiple-micronutrient supplementation on physical activity and exploration in Mexican infants. Subjects/Methods: Using a quasi experimental design, we analyzed data from a supplementation study that lacked a placebo-control group. We compared infants between 8 and 12 months measured at baseline who had received no supplementation (comparison group, n=78), with infants 8-12 months measured after 4 months of daily supplementation (treatment group, n=109). The treatment consisted of three supplement types: micronutrient powder, syrup (each containing only micronutrients) and a milk-based, fortified-food supplement (FFS; containing micronutrients and macronutrients). We formed the micronutrient-only group (MM) by combining the micronutrient powder and syrup groups. We measured activity and exploration by direct observation and used cluster analysis to form and characterize activity and exploration clusters. We performed logistic regression with activity or exploration cluster as the outcome variable and treatment versus comparison and MM or FFS versus comparison as the predictor variables. Results: Treatment versus comparison increased the odds of being in the high activity (odds ratio (OR)=2.35, P<0.05) and high exploration (OR=1.87, P<0.05) cluster. MM increased the odds of being in the high activity (OR=2.64, P<0.05) cluster and FFS increased the odds (OR=3.16, P<0.05) of being in the high exploration cluster. Conclusions: Nutritional supplementation benefited activity and exploration in this sample of Mexican infants. © 2010 Macmillan Publishers Limited All rights reserved.


Hoddinott J.,International Food Policy Research Institute | Behrman J.R.,University of Pennsylvania | Maluccio J.A.,Middlebury College | Melgar P.,Institute of Nutrition of Central America and Panama | And 5 more authors.
American Journal of Clinical Nutrition | Year: 2013

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. © 2013 American Society for Nutrition.


Ramirez-Zea M.,Institute of Nutrition of Central America and Panama | Melgar P.,Institute of Nutrition of Central America and Panama | Rivera J.A.,Institute of Nutrition of Central America and Panama
Journal of Nutrition | Year: 2010

Our purpose in this article is to describe the objectives, design, overall coverage, and main domains of data collection of the Institute of Nutrition of Central America and Panama Oriente Longitudinal Study and subsequent follow-up studies. This supplementary feeding trial targeted to pregnant and lactating women and children from birth to 7 y of age, conducted in 4 rural Guatemalan villages (1969-77) with a series of follow-up studies (1988-2007), is one of the richest sources of information on the effects of nutrition, growth, development, and human capital in the developing world, with outstanding data from gestation to adult age and 40 y of follow-up. Its results have influenced nutrition knowledge and policy with over 300 scientific publications. We present brief descriptions of preliminary studies that were critical for the success of the trial and the design and methods used during the trial and in the follow-up studies, in chronological order. © 2010 American Society for Nutrition.


Norris S.A.,University of Witwatersrand | Osmond C.,University of Southampton | Gigante D.,Federal University of Pelotas | Kuzawa C.W.,Northwestern University | And 18 more authors.
Diabetes Care | Year: 2012

OBJECTIVE: We examined associations of birth weight and weight gain in infancy and early childhood with type 2 diabetes (DM) risk in five cohorts from low- and middle-income countries. RESEARCH DESIGN AND METHODS: Participants were 6,511 young adults from Brazil, Guatemala, India, the Philippines, and South Africa. Exposures were weight at birth, at 24 and 48 months, and adult weight, and conditional weight gain (CWG, deviation from expected weight gain) between these ages. Outcomes were adult fasting glucose, impaired fasting glucose or DM (IFG/DM), and insulin resistance homeostasis model assessment (IR-HOMA, three cohorts). RESULTS: Birth weight was inversely associated with adult glucose and risk of IFG/DM (odds ratio 0.91[95% CI 0.84-0.99] per SD). Weight at 24 and 48 months and CWG 0-24 and 24-48 months were unrelated to glucose and IFG/DM; however, CWG 48 months-adulthood was positively related to IFG/DM (1.32 [1.22-1.43] per SD). After adjusting for adult waist circumference, birth weight, weight at 24 and 48 months and CWG 0-24 months were inversely associated with glucose and IFG/DM. Birth weight was unrelated to IR-HOMA, whereas greater CWG at 0-24 and 24-48 months and 48 months-adulthood predicted higher IR-HOMA (all P < 0.001). After adjusting for adult waist circumference, birth weight was inversely related to IR-HOMA. CONCLUSIONS: Lower birth weight and accelerated weight gain after 48 months are risk factors for adult glucose intolerance. Accelerated weight gain between 0 and 24 months did not predict glucose intolerance but did predict higher insulin resistance. © 2012 by the American Diabetes Association.


Ventres W.B.,Oregon Health And Science University | Fort M.P.,Institute of Nutrition of Central America and Panama
BMC international health and human rights | Year: 2014

BACKGROUND: There is a growing understanding of the role social determinants such as poverty, gender discrimination, racial prejudice, and economic inequality play on health and illness. While these determinants and effects may be challenging to identify in parts of high-income countries, they are patently obvious in many other areas of the world. How we react to these determinants and effects depends on what historical, cultural, ideological, and psychological characteristics we bring to our encounters with inequity, as well as how our feelings and thoughts inform our values and actions.DISCUSSION: To address these issues, we share a series of questions we have asked ourselves-United States' citizens with experience living and working in Central America-in relation to our encounters with inequity. We offer a conceptual framework for contemplating responses in hopes of promoting among educators and practitioners in medicine and public health an engaged awareness of how our every day work either perpetuates or breaks down barriers of social difference. We review key moments in our own experiences as global health practitioners to provide context for these questions. Introspective reflection can help professionals in global medicine and public health recognize the dynamic roles that they play in the world. Such reflection can bring us closer to appreciating the forces that have worked both for and in opposition to global health, human rights, and well-being. It can help us recognize how place, time, environment, and context form the social determination of health. It is from this holistic perspective of social relations that we can work to effect fair, equitable, and protective environments as they relate to global medicine and public health.


Martorell R.,Emory University | Melgar P.,Institute of Nutrition of Central America and Panama | Maluccio J.A.,Middlebury College | Stein A.D.,Emory University | Rivera J.A.,Instituto Nacional Of Salud Publica
Journal of Nutrition | Year: 2010

This article reviews key findings about the long-term impact of a nutrition intervention carried out by the Institute of Nutrition of Central America and Panama from 1969 to 1977. Results fromfollow-up studies in 1988-89 and 2002-04 show substantial impact on adult human capital and economic productivity. The 1988-89 study showed that adult body size and work capacity increased for those provided improved nutrition through age 3 y, whereas the 2002-04 follow-up showed that schooling was increased for women and reading comprehension and intelligence increased in both men and women. Participants were 26-42 y of age at the time of the 2002-04 follow-up, facilitating the assessment of economic productivity. Wages of men increased by 46% in those provided with improved nutrition through age 2 y. Findings for cardiovascular disease risk factors were heterogeneous; however, they suggest that improved nutrition in early life is unlikely to increase cardiovascular disease risk later in life and may indeed lower risk. In conclusion, the substantial improvement in adult human capital and economic productivity resulting from the nutrition intervention provides a powerful argument for promoting improvements in nutrition in pregnant women and young children. © 2010 American Society for Nutrition.


Gaziano T.A.,Brigham and Women's Hospital | Abrahams-Gessel S.,Center for Health Decision Science | Denman C.A.,Colegio de Mexico | Montano C.M.,Institute of Nutrition of Central America and Panama | And 3 more authors.
The Lancet Global Health | Year: 2015

BACKGROUND: Cardiovascular disease contributes substantially to the non-communicable disease (NCD) burden in low-income and middle-income countries, which also often have substantial health personnel shortages. In this observational study we investigated whether community health workers could do community-based screenings to predict cardiovascular disease risk as effectively as could physicians or nurses, with a simple, non-invasive risk prediction indicator in low-income and middle-income countries. METHODS: This observation study was done in Bangladesh, Guatemala, Mexico, and South Africa. Each site recruited at least ten to 15 community health workers based on usual site-specific norms for required levels of education and language competency. Community health workers had to reside in the community where the screenings were done and had to be fluent in that community's predominant language. These workers were trained to calculate an absolute cardiovascular disease risk score with a previously validated simple, non-invasive screening indicator. Community health workers who successfully finished the training screened community residents aged 35-74 years without a previous diagnosis of hypertension, diabetes, or heart disease. Health professionals independently generated a second risk score with the same instrument and the two sets of scores were compared for agreement. The primary endpoint of this study was the level of direct agreement between risk scores assigned by the community health workers and the health professionals. FINDINGS: Of 68 community health worker trainees recruited between June 4, 2012, and Feb 8, 2013, 42 were deemed qualified to do fieldwork (15 in Bangladesh, eight in Guatemala, nine in Mexico, and ten in South Africa). Across all sites, 4383 community members were approached for participation and 4049 completed screening. The mean level of agreement between the two sets of risk scores was 96·8% (weighted κ=0·948, 95% CI 0·936-0·961) and community health workers showed that 263 (6%) of 4049 people had a 5-year cardiovascular disease risk of greater than 20%. INTERPRETATION: Health workers without formal professional training can be adequately trained to effectively screen for, and identify, people at high risk of cardiovascular disease. Using community health workers for this screening would free up trained health professionals in low-resource settings to do tasks that need high levels of formal, professional training. FUNDING: US National Heart, Lung, and Blood Institute and National Institutes of Health, UnitedHealth Chronic Disease Initiative. © 2015 Gaziano et al. Open Access article published under the terms of CC BY-NC-ND 4.0. Published by Elsevier Ltd. All rights reserved.


Adair L.S.,University of North Carolina at Chapel Hill | Fall C.H.D.,University of Southampton | Osmond C.,University of Southampton | Stein A.D.,Emory University | And 9 more authors.
The Lancet | Year: 2013

Background Fast weight gain and linear growth in children in low-income and middle-income countries are associated with enhanced survival and improved cognitive development, but might increase risk of obesity and related adult cardiometabolic diseases. We investigated how linear growth and relative weight gain during infancy and childhood are related to health and human capital outcomes in young adults. Methods We used data from five prospective birth cohort studies from Brazil, Guatemala, India, the Philippines, and South Africa. We investigated body-mass index, systolic and diastolic blood pressure, plasma glucose concentration, height, years of attained schooling, and related categorical indicators of adverse outcomes in young adults. With linear and logistic regression models, we assessed how these outcomes relate to birthweight and to statistically independent measures representing linear growth and weight gain independent of linear growth (relative weight gain) in three age periods: 0-2 years, 2 years to mid-childhood, and mid-childhood to adulthood. Findings We obtained data for 8362 participants who had at least one adult outcome of interest. A higher birthweight was consistently associated with an adult body-mass index of greater than 25 kg/m2 (odds ratio 1·28, 95% CI 1·21-1·35) and a reduced likelihood of short adult stature (0·49, 0·44-0·54) and of not completing secondary school (0·82, 0·78-0·87). Faster linear growth was strongly associated with a reduced risk of short adult stature (age 2 years: 0·23, 0·20-0·52; mid-childhood: 0·39, 0·36-0·43) and of not completing secondary school (age 2 years: 0·74, 0·67-0·78; mid-childhood: 0·87, 0·83-0·92), but did raise the likelihood of overweight (age 2 years: 1·24, 1·17-1·31; mid-childhood: 1·12, 1·06-1·18) and elevated blood pressure (age 2 years: 1·12, 1·06-1·19; mid-childhood: 1·07, 1·01-1·13). Faster relative weight gain was associated with an increased risk of adult overweight (age 2 years: 1·51, 1·43-1·60; mid-childhood: 1·76, 1·69-1·91) and elevated blood pressure (age 2 years: 1·07, 1·01-1·13; mid-childhood: 1·22, 1·15-1·30). Linear growth and relative weight gain were not associated with dysglycaemia, but a higher birthweight was associated with decreased risk of the disorder (0·89, 0·81-0·98). Interpretation Interventions in countries of low and middle income to increase birthweight and linear growth during the first 2 years of life are likely to result in substantial gains in height and schooling and give some protection from adult chronic disease risk factors, with few adverse trade-offs. Funding Wellcome Trust and Bill & Melinda Gates Foundation. © 2013 Elsevier Ltd.


DeBoer M.D.,University of Virginia | Chen D.,University of Virginia | Burt D.R.,University of Virginia | Ramirez-Zea M.,Institute of Nutrition of Central America and Panama | And 4 more authors.
Annals of Epidemiology | Year: 2013

Background: Nutritional deficits in early life have been associated with a higher prevalence of the metabolic syndrome (MetS) in adulthood. Early childhood diarrhea contributes to undernutrition and may potentially increase the risk for adult noncommunicable diseases. Our objective was to examine associations between early childhood diarrhea burden and later development of MetS. Methods: We studied individuals who participated in the Institute of Nutrition of Central America and Panama Nutritional Supplementation Longitudinal Study (1969-1977) and were followed up in 2002-2004. We used logistic regression to determine associations of diarrhea burden at ages 0 to 6, 6 to 12, and 12 to 24 months with odds of MetS and elevations in its components as adults. Results: Among 389 adults age 25 to 42 years at follow-up, the prevalence of MetS was 29%. Adjusting for several confounders including adult body mass index (BMI), each absolute 1% increase in diarrhea burden at age 0 to 6 months (but not at other time periods) was associated with increased odds of MetS (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01-1.06). This was attributable primarily to associations with elevated blood pressure (OR, 1.03; 95% CI, 1.00-1.06) and waist circumference (OR, 1.03; 95% CI, 1.00-1.06). Conclusions: Childhood diarrhea burden at 0 to 6 months is associated with MetS in adulthood after controlling for childhood growth parameters and adult BMI. © 2013 Elsevier Inc.

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