Life course associations of height, weight, fatness, grip strength, and all-cause mortality for high socioeconomic status Guatemalans

Objectives: The objective of this study was to investigate the association between physical growth in pre-adult life with five outcomes at age 64-76: weight, body mass index, estimated body fat percentage, hand grip strength and mortality. Methods: Super-Imposition by Translation and Rotation (SITAR) growth curves of 40,484 Guatemalan individuals aged 3-19 years were modelled for the parameters of size, timing and intensity (peak growth velocity, e.g. cm/year) of height, weight, body mass index, and grip strength. Associations between the SITAR parameters and old age outcomes were tested using linear and binary logistic regression for a follow-up sample of high socioeconomic status (SES) Guatemalans, of whom 50 were aged 64-76 years old at re-measurement and 45 died prior to the year 2017. Results: SITAR models explained 69-98% of the variance in each outcome, with height the most precise. Individuals in the follow-up sample who had a higher BMI before age 20 years had higher estimated body fat (B=1.4 CI -0.02-2.8) and BMI (B=1.2, CI 0.2-2.2) at the ages 64-76 years. Those who grew slower in height but faster in weight and BMI before age 20 years, had higher BMI and body fat later in life. Conclusions: These findings highlight the importance of a life course perspective on health and mortality risk. Childhood exposures leading to variation in pre-adult growth may be key to better understanding health and mortality risks in old age

Nutritional interventions for preventing stunting in children (Birth to 59 months) living in urban slums in low-and middle-income countries (LMIC)

© 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Background Nutritional interventions to prevent stunting of infants and young children are most often applied in rural areas in low-and middle-income countries (LMIC). Few interventions are focused on urban slums. The literature needs a systematic assessment, as infants and children living in slums are at high risk of stunting. Urban slums are complex environments in terms of biological, social, and political variables and the outcomes of nutritional interventions need to be assessed in relation to these variables. For the purposes of this review, we followed the UN-Habitat 2004 definitions for low-income informal settlements or slums as lacking one or more indicators of basic services or infrastructure. Objectives To assess the impact of nutritional interventions to reduce stunting in infants and children under five years old in urban slums from LMIC and the effect of nutritional interventions on other nutritional (wasting and underweight) and non-nutritional outcomes (socioeconomic, health and developmental) in addition to stunting. Search methods The review used a sensitive search strategy of electronic databases, bibliographies of articles, conference proceedings, websites, grey literature, and contact with experts and authors published from 1990. We searched 32 databases, in English and non-English languages (MEDLINE, CENTRAL, Web of Science, Ovid MEDLINE, etc). We performed the initial literature search from November 2015 to January 2016, and conducted top up searches in March 2017 and in August 2018. Selection criteria Research designs included randomised (including cluster-randomised) trials, quasi-randomised trials, non-randomised controlled trials, controlled before-and-after studies, pre-and postintervention, interrupted time series (ITS), and historically controlled studies among infants and children from LMIC, from birth to 59 months, living in urban slums. The interventions included were nutrition-specific or maternal education. The primary outcomes were length or height expressed in cm or length-for-age (LFA)/height-for-age (HFA) z-scores, and birth weight in grams or presence/absence of low birth weight (LBW). Data collection and analysis We screened and then retrieved titles and abstracts as full text if potentially eligible for inclusion. Working independently, one review author screened all titles and abstracts and extracted data on the selected population, intervention, comparison, and outcome parameters and two other authors assessed half each. We calculated mean selection difference (MD) and 95% confidence intervals (CI). We performed intervention-level meta-analyses to estimate pooled measures of effect, or narrative synthesis when meta-analyses were not possible. We used P less than 0.05 to assess statistical significance and intervention outcomes were also considered for their biological/ health importance. Where effect sizes were small and statistically insignificant, we concluded there was ’unclear effect’. Main results The systematic review included 15 studies, of which 14 were randomised controlled trials (RCTs). The interventions took place in recognised slums or poor urban or periurban areas. The study locations were mainly Bangladesh, India, and Peru. The participants included 9261 infants and children and 3664 pregnant women. There were no dietary intervention studies. All the studies identified were nutrient supplementation and educational interventions. The interventions included zinc supplementation in pregnant women (three studies), micronutrient or macronutrient supplementation in children (eight studies), nutrition education for pregnant women (two studies), and nutrition systems strengthening targeting children (two studies) intervention. Six interventions were adapted to the urban context and seven targeted household, community, or ’service delivery’ via systems strengthening. The primary review outcomes were available from seven studies for LFA/HFA, four for LBW, and nine for length. The studies had overall high risk of bias for 11 studies and only four RCTs had moderate risk of bias. Overall, the evidence was complex to report, with a wide range of outcome measures reported. Consequently, only eight study findings were reported in meta-analyses and seven in a narrative form. The certainty of evidence was very low to moderate overall. None of the studies reported differential impacts of interventions relevant to equity issues. Zinc supplementation of pregnant women on LBW or length (versus supplementation without zinc or placebo) (three RCTs) There was no evidence of an effect on LBW (MD-36.13 g, 95% CI-83.61 to 11.35), with moderate-certainty evidence, or no evidence of an effect or unclear effect on length with low-to moderate-certainty evidence. Micronutrient or macronutrient supplementation in children (versus no intervention or placebo) (eight RCTs) There was no evidence of an effect or unclear effect of nutrient supplementation of children on HFA for studies in the meta-analysis with low-certainty evidence (MD-0.02, 95% CI-0.06 to 0.02), and inconclusive effect on length for studies reported in a narrative form with very low-to moderate-certainty evidence. Nutrition education for pregnant women (versus standard care or no intervention) (two RCTs) There was a positive impact on LBW of education interventions in pregnant women, with low-certainty evidence (MD 478.44g, 95% CI 423.55 to 533.32). Nutrition systems strengthening interventions targeting children (compared with no intervention, standard care) (one RCT and one controlled before-and-after study) There were inconclusive results on HFA, with very low-to low-certainty evidence, and a positive influence on length at 18 months, with low-certainty evidence. Authors’ conclusions All the nutritional interventions reviewed had the potential to decrease stunting, based on evidence from outside of slum contexts; however, there was no evidence of an effect of the interventions included in this review (very low-to moderate-certainty evidence). Challenges linked to urban slum programming (high mobility, lack of social services, and high loss of follow-up) should be taken into account when nutrition-specific interventions are proposed to address LBW and stunting in such environments. More evidence is needed of the effects of multi-sectorial interventions, combining nutrition-specific and sensitive methods and programmes, as well as the effects of ’up-stream’ practices and policies of governmental, non-governmental organisations, and the business sector on nutrition-related outcomes such as stunting

Nutritional interventions for preventing stunting in children (Birth to 59 months) living in urban slums in low-and middle-income countries (LMIC)

© 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Background Nutritional interventions to prevent stunting of infants and young children are most often applied in rural areas in low-and middle-income countries (LMIC). Few interventions are focused on urban slums. The literature needs a systematic assessment, as infants and children living in slums are at high risk of stunting. Urban slums are complex environments in terms of biological, social, and political variables and the outcomes of nutritional interventions need to be assessed in relation to these variables. For the purposes of this review, we followed the UN-Habitat 2004 definitions for low-income informal settlements or slums as lacking one or more indicators of basic services or infrastructure. Objectives To assess the impact of nutritional interventions to reduce stunting in infants and children under five years old in urban slums from LMIC and the effect of nutritional interventions on other nutritional (wasting and underweight) and non-nutritional outcomes (socioeconomic, health and developmental) in addition to stunting. Search methods The review used a sensitive search strategy of electronic databases, bibliographies of articles, conference proceedings, websites, grey literature, and contact with experts and authors published from 1990. We searched 32 databases, in English and non-English languages (MEDLINE, CENTRAL, Web of Science, Ovid MEDLINE, etc). We performed the initial literature search from November 2015 to January 2016, and conducted top up searches in March 2017 and in August 2018. Selection criteria Research designs included randomised (including cluster-randomised) trials, quasi-randomised trials, non-randomised controlled trials, controlled before-and-after studies, pre-and postintervention, interrupted time series (ITS), and historically controlled studies among infants and children from LMIC, from birth to 59 months, living in urban slums. The interventions included were nutrition-specific or maternal education. The primary outcomes were length or height expressed in cm or length-for-age (LFA)/height-for-age (HFA) z-scores, and birth weight in grams or presence/absence of low birth weight (LBW). Data collection and analysis We screened and then retrieved titles and abstracts as full text if potentially eligible for inclusion. Working independently, one review author screened all titles and abstracts and extracted data on the selected population, intervention, comparison, and outcome parameters and two other authors assessed half each. We calculated mean selection difference (MD) and 95% confidence intervals (CI). We performed intervention-level meta-analyses to estimate pooled measures of effect, or narrative synthesis when meta-analyses were not possible. We used P less than 0.05 to assess statistical significance and intervention outcomes were also considered for their biological/ health importance. Where effect sizes were small and statistically insignificant, we concluded there was ’unclear effect’. Main results The systematic review included 15 studies, of which 14 were randomised controlled trials (RCTs). The interventions took place in recognised slums or poor urban or periurban areas. The study locations were mainly Bangladesh, India, and Peru. The participants included 9261 infants and children and 3664 pregnant women. There were no dietary intervention studies. All the studies identified were nutrient supplementation and educational interventions. The interventions included zinc supplementation in pregnant women (three studies), micronutrient or macronutrient supplementation in children (eight studies), nutrition education for pregnant women (two studies), and nutrition systems strengthening targeting children (two studies) intervention. Six interventions were adapted to the urban context and seven targeted household, community, or ’service delivery’ via systems strengthening. The primary review outcomes were available from seven studies for LFA/HFA, four for LBW, and nine for length. The studies had overall high risk of bias for 11 studies and only four RCTs had moderate risk of bias. Overall, the evidence was complex to report, with a wide range of outcome measures reported. Consequently, only eight study findings were reported in meta-analyses and seven in a narrative form. The certainty of evidence was very low to moderate overall. None of the studies reported differential impacts of interventions relevant to equity issues. Zinc supplementation of pregnant women on LBW or length (versus supplementation without zinc or placebo) (three RCTs) There was no evidence of an effect on LBW (MD-36.13 g, 95% CI-83.61 to 11.35), with moderate-certainty evidence, or no evidence of an effect or unclear effect on length with low-to moderate-certainty evidence. Micronutrient or macronutrient supplementation in children (versus no intervention or placebo) (eight RCTs) There was no evidence of an effect or unclear effect of nutrient supplementation of children on HFA for studies in the meta-analysis with low-certainty evidence (MD-0.02, 95% CI-0.06 to 0.02), and inconclusive effect on length for studies reported in a narrative form with very low-to moderate-certainty evidence. Nutrition education for pregnant women (versus standard care or no intervention) (two RCTs) There was a positive impact on LBW of education interventions in pregnant women, with low-certainty evidence (MD 478.44g, 95% CI 423.55 to 533.32). Nutrition systems strengthening interventions targeting children (compared with no intervention, standard care) (one RCT and one controlled before-and-after study) There were inconclusive results on HFA, with very low-to low-certainty evidence, and a positive influence on length at 18 months, with low-certainty evidence. Authors’ conclusions All the nutritional interventions reviewed had the potential to decrease stunting, based on evidence from outside of slum contexts; however, there was no evidence of an effect of the interventions included in this review (very low-to moderate-certainty evidence). Challenges linked to urban slum programming (high mobility, lack of social services, and high loss of follow-up) should be taken into account when nutrition-specific interventions are proposed to address LBW and stunting in such environments. More evidence is needed of the effects of multi-sectorial interventions, combining nutrition-specific and sensitive methods and programmes, as well as the effects of ’up-stream’ practices and policies of governmental, non-governmental organisations, and the business sector on nutrition-related outcomes such as stunting

Nutritional status of Maya children, their mothers, and their grandmothers residing in the city of Merida, Mexico: revisiting the leg-length hypothesis

Objectives: To test the hypothesis that leg length-relative-to-stature is a more sensitive indicator of nutrition and health than is total height (HT) or sitting height (SH) in a sample of 109 triads of urban Maya children (6.0–8.99 years), their mothers, and maternal grandmothers from Merida, Mexico. Methods: From September 2011 to June 2012, the following factors were obtained from all participants: (1) HT, SH, and leg length (LL); (2) the sitting height ratio (SHR5[SH 3 100]/HT), relative leg length index (RLLI5[LL 3 100]/ height), and percentiles and z-scores of HT, SH, and LL were calculated; and (3) the percentages of stunting for children or very short ZHT for the adults, short ZSH, and short ZLL: HT-for-age, SH-for-age, or LL-for-age below the 5th percentile of the reference were calculated. Correlations were performed to examine the association between z-scores of HT, SH, and LL among three generations. Results: Stunting in children was 11% (short ZLL529%, short ZSH57%). Short ZHT was present in 71% of mothers (short ZLL554%, short ZSH550%) and 90% of grandmothers (short ZLL569%, short ZSH583%). Significant correlations in ZHT, ZSH, and ZLL were found in mother-to-child and grandmother-to-mother, with the strongest correlations for ZLL. Conclusions: These findings support the hypothesis for children and mothers. Based on ZLL, there is evidence that childhood and nutrition have improved somewhat for each younger generation. Persistent environmental adversity during growth resulted in growth deficits for LL and SH for the mothers and grandmothers

Supplementary information files for Inequalities in adiposity trends between 1979 and 1999 in Guatemalan children

© the authors, CC-BY 4.0Supplementary files for article Inequalities in adiposity trends between 1979 and 1999 in Guatemalan childrenBackground: Guatemala suffered from civil war and high levels of inequality and childhood stunting in the second half of the 20th century, but little is known about inequalities in secular trends in adiposity.Objectives: To investigate differences in childhood body mass index (BMI) and skinfold thickness trajectories from 1979 to 1999 between three groups of children: High socioeconomic position (SEP) Ladino, Low SEP Ladino, and Low SEP Indigenous Maya.Methods: The sample comprised 19 346 children aged 7–17 years with 54 638 observations. The outcomes were height, BMI, triceps skinfold thickness (TST), and subscapular skinfold thickness (SST) Z-scores according to the Centers for Disease Control and Prevention (CDC) references. Sex-specific multilevel models were used to estimate and compare mean trajectories from 1979 to 1999 between the three groups.Results: Mean Z-scores were always highest for High SEP Ladino children and lowest for Low SEP Maya children. Despite their very short stature, the Low SEP groups had SST trajectories that were above the 50th centile. The BMI trajectories were relatively flat and within one major centile band of the CDC median, with differences between the three groups that were small (0.2–0.3 Z-scores) and did not attenuate over time. Conversely, the TST Z-score trajectories demonstrated larger positive secular trends (e.g., from −1.25 in 1979 to −0.06 in 1999 for Low SEP Maya boys), with differences between the three groups that were large (0.5–1.2 Z-scores) and did attenuate over time (in boys). Secular trends and between-group difference in the SST Z-score trajectories were less pronounced, but again we found stronger evidence in boys that the estimated inequalities attenuated over time.Conclusions: Secular trends and inequalities in skinfolds differ from those for BMI in Guatemalan children. Differences between groups in skinfolds attenuated over time, at least in boys, but whether this is good news is questionable given the very short stature yet relatively large subscapular skinfolds of the Low SEP groups.</p

Low birthweight prevalence among Spanish women during the economic crisis: differences by parity

Previous studies have demonstrated a negative, significant impact on birthweight associated with the current economic crisis in Spain, which has also been reported for other European countries. Effects by parity are not known. Our aim is to compare the trends in low birthweight (LBW) by parity in Spain from 1996 to 2016. Using the National Vital Statistics data, joinpoint regression analysis was used to identify the time periods of significant changes in the prevalence of LBW by parity. Adjusted relative risk (RR) of LBW by year of birth was calculated in order to confirm that the time trend differences in LBW by parity were independent of possible confounders. The prevalence of LBW among live births to primiparous increased from 5.12% to 6.87% in 2008 and then stabilised at maximum values, while among live births to multiparous LBW increased from 3.96% to a maximum of 5.20% and then significantly reduced. Trends in adjusted RR of LBW by parity confirm that primiparous and multiparous were affected differently by the economic crisis. Older, nulliparous women may have felt more biosocial pressure to reproduce during the economic crisis, compared to women who were already mothers. This biosocial pressure may have increased the risks for LBW.</p

Pre-adult IQ test scores by test used.

Box plot (median, quartiles, minimum, maximum) of IQ test scores by test used (Pinter Cunningham A (N = 22), Pinter Durost A(N = 29), Otis Intermedio (N = 35), Pinter General Intermedio (N = 28), and Otis Superior (N = 34).</p

Correlations of pre-adult IQ tests scores.

Correlations of pre-adult IQ tests scores.</p

Four decades of socioeconomic inequalities and secular changes in the physical growth of Guatemalans [abstract]

Four decades of socioeconomic inequalities and secular changes in the physical growth of Guatemalans [abstract

Correlations of pre-adult IQ scores and later life test scores.

Correlations of pre-adult IQ scores and later life test scores.</p