Cria O. Gregory

Health Perceptions and Demographic Characteristics Associated With Underassessment of Body Weight

Objectives: To describe the relationship between BMI and perceived weight status and to determine how underassessment of weight status is associated with demographic characteristics, self‐reported general health, and perceived health risk in relation to ones body weight.

Use of Supplements with and without Iodine in Women of Childbearing Age in the United States

The iodine status of women of childbearing age in the United States has declined dramatically over the last 25 years (1,2). In fact, using criteria from the World Health Organization, certain subgroups may be classified as iodine deficient (3). Given this dramatic decline in iodine status and the critical role of iodine in fetal neurologic development, in October 2006 the American Thyroid Association recommended iodine supplementation for all pregnant and lactating women in the United States and Canada (4). We were interested in determining the percentage of women of childbearing age in the United States taking supplements and the percentage taking supplements containing iodine. We looked at data from the National Health and Nutrition Examination Survey (NHANES) for the years 2001– 2006. NHANES is a stratified, multistage survey that provides a representative sample of the noninstitutionalized U.S. population (5). Information collected includes the use of any vitamins, minerals, or other dietary supplements within the previous 30 days. Product names are obtained and are compared to a database containing information including vitamin and mineral content. The reported use of any supplement and use of a supplement containing iodine within the previous 30 days is presented in Table 1 for nonpregnant women of childbearing age (15–44 years) and pregnant and lactating women. Less than half of nonpregnant women were taking any supplement compared to three fourths of pregnant women and two thirds of lactating women. Only one fifth of nonpregnant and pregnant women and 15% of lactating women were taking a supplement that contained iodine. Although the prevalence of supplement use was much higher among pregnant and lactating women compared to nonpregnant women, the prevalence of taking a supplement containing iodine was similarly low among all groups. This indicates that a lower percentage of supplements consumed by pregnant and lactating women contained iodine compared to supplements consumed by nonpregnant women (26% and 22%, vs. 47%, respectively). Most of these data were collected prior to the American Thyroid Association’s recommendation of iodine supplementation for pregnant and lactating women and provide a baseline of supplement use containing iodine. Recent evidence suggests an increase in the inclusion of iodine in prenatal supplements since the 2006 recommendation; however, the iodine content of prenatal supplements is not regulated in the United States and the amount of iodine in supplements often differs from the amount listed on the label (6). This situation warrants further monitoring. Although the American Thyroid Association recommendation may have contributed to a change in the formulation of some prenatal vitamins, it is unlikely to have had an impact on the formulation of other supplements. Our results suggest that the majority of women of childbearing age are not consuming supplements containing iodine. Given that the critical period for thyroid hormones in neurologic development occurs before many women may know they are pregnant, it is important to ensure adequate iodine nutrition among all women of childbearing age. In the long term, a carefully planned and monitored iodine fortification program combined with supplement use may be a more effective and equitable approach to assuring adequate iodine nutrition for the entire population.

Diet scores and cardio-metabolic risk factors among Guatemalan young adults

We assessed the association of four diet quality scores with multiple cardio-metabolic outcomes among Guatemalan young adults experiencing the nutrition transition. We obtained cross-sectional dietary, demographic, anthropometric and cardio-metabolic risk factor data from 1220 Guatemalan adults (mean age 32.7 (sd 5.8) years) in 2002-4, and computed a Recommended Food Score (RFS), Not Recommended Food Score (NRFS), Food Variety Score (FVS) and the Dietary Quality Index-International (DQI-I). All four scores were correlated with energy intake (r 0.23-0.49; all P < 0.01), but had varying associations with socio-demographic characteristics, lifestyle factors and nutrient intakes. None of the scores was inversely associated with the metabolic syndrome or its components; rather some were positively associated with risk factors. Among both men and women the DQI-I was positively associated with BMI (kg/m2; beta = 0.10, 95 % CI 0.003, 0.21 (men); beta = 0.07, 95 % CI 0.01, 0.14 (women)) and waist circumference (cm; beta = 0.02, 95 % CI 0.01, 0.03 (men); beta = 0.02, 95 % CI = 0.01, 0.02 (women)). Among men, the RFS was positively associated with TAG (mg/l; beta = 0.11, 95 % CI 0.02, 0.21) and glucose (mg/l; beta = 0.13: 95 % CI 0.03, 0.22). We conclude that indices of diet quality are not consistently associated with chronic disease risk factor prevalence in this population of Guatemalan young adults.

Five-year changes in adiposity and cardio-metabolic risk factors among Guatemalan young adults.

BACKGROUND Rapidly transitioning societies are experiencing dramatic increases in obesity and cardio-metabolic risk; however, few prospective studies from developing countries have quantified these increases or described their joint relationships. METHODS We collected dietary, physical activity, demographic, anthropometric and cardio-metabolic risk factor data from 376 Guatemalan young adults in 1997-98 (aged 20-29 years) and in 2002-04 (aged 25-34 years). RESULTS In total, 42 % of men and 56 % of women experienced weight gain >5 kg in 5 years. Percent body fat (%BF) and waist circumference (WC) increased by 4.2 % points and 5.5 cm among men, and 3.2 % points and 3.4 cm among women, respectively. Five-year increases in both %BF and WC were associated with lower physical activity, urban residence and shorter height among men but not among women (test for heterogeneity P < 0.05 for residence and physical activity). Changes in %BF and WC and concomitant changes in cardio-metabolic risk factors were similar for men and women. In standardised regression, change in %BF was associated with changes in TAG (beta=0.19; 95 % CI 0.08, 0.30), total:HDL cholesterol (beta=0.22; 95 % CI 0.12, 0.33) and systolic (beta=0.22; 95 % CI 0.12, 0.33) and diastolic (beta=0.18; 95 % CI 0.08, 0.28) blood pressure, but not with glucose; associations were similar for WC. CONCLUSIONS Over 5 years this relatively young population of Guatemalan adults experienced rapid increases in multiple measures of adiposity, which were associated with adverse changes in lipid and blood pressure levels.

Activities contributing to energy expenditure among Guatemalan adults.

BackgroundGuatemala has experienced a substantial increase in overweight and obesity in recent years, yet physical activity patterns and consequent energy expenditure are largely unexplored in this population.MethodsTo describe overall physical activity levels (PAL) and activities contributing to daily energy expenditure, we analyzed time spent in daily activities as reported by 985 women and 819 men, living in rural and urban areas of Guatemala in 2002–04.ResultsPhysical activity levels recommended to prevent obesity (PAL ≥ 1.70) differed by residence/occupation among men (agricultural-rural: 77%; nonagricultural-rural: 36%; urban: 24%; P < 0.01), but not women (rural: 2%; urban: 3%; P = 0.5). Median energy expenditure was higher among agricultural-rural men (44 MET*h/d; MET = metabolic equivalent) compared to nonagricultural-rural (37 MET*h/d) and urban men (35 MET*h/d; P < 0.01); energy expenditure was slightly lower among rural compared to urban women (34 MET*h/d vs. 35 MET*h/d; P < 0.01). Occupation was the largest contributor to energy expenditure (19–24 MET*h/d); among women and nonagricultural-rural and urban men this was primarily of a light intensity. Energy expenditure in sedentary activities ranged from 2 MET*h/d among rural women to 6 MET*h/d among agricultural-rural men. Any sports/exercise time was reported by 35% and 5% of men and women, respectively. Nevertheless, the majority of participants believed they were significantly active to stay healthy.ConclusionOverall, energy expenditure was low in the population not dedicated to agricultural occupations; an increased focus on active leisure-time behaviors may be needed to counterbalance reductions in energy expenditure consequent to sedentarization of primary occupations.

Physical activity level, dietary habits, and alcohol and tobacco use among young Guatemalan adults.

Physical activity, diet, and alcohol and tobacco use are all related to the development of obesity, diabetes, coronary heart disease, osteoporosis, and cancer. We examined the distribution of measures of these behaviors in a cohort of individuals born in four villages in Guatemala between 1962 and 1977 and who were 26–41 years old in 2003. Response rates to the instruments averaged 80% of cohort members known to be living in Guatemala. Physical activity levels were moderate, and were lowest among migrants to Guatemala City. Dietary habits reflect early phases of the nutrition transition, with high carbohydrate and moderate fat intakes. Migrants to Guatemala City reported higher intakes of meat and of dairy products, while those remaining in or near the original study villages reported higher consumption of tortillas and of vegetables and fruits. One-third of men reported consuming alcohol and 42% were current smokers. Very few women reported alcohol or tobacco use.

Detection of cardio-metabolic risk by BMI and waist circumference among a population of Guatemalan adults

BACKGROUND BMI and waist circumference (WC) are used to screen for cardio-metabolic risk; however it is unclear how well these indices perform in populations subject to childhood stunting. OBJECTIVES To evaluate BMI and WC as indicators of cardio-metabolic risk and to determine optimal cut-off points among 1,325 Guatemalan adults (44 % stunted: 162 cm men). METHODS Cardio-metabolic risk factors were systolic/diastolic blood pressure 85 mmHg, glucose 5 mmol/l, TAG 7 mmol/l, ratio of total cholesterol to HDL-cholesterol 0, and the presence of two or more and three or more of the preceding risk factors. Receiver operating characteristic (ROC) curve analysis was used. RESULTS Areas under the ROC curve were in the range of 005978 for WC among men and 006472 among women, respectively. Optimal cut-off points for BMI were 242651 kg/m2 stunted; 242656 kg/m2 among women (262769 kg/m2 non-stunted). Optimal cut-off points for WC were 879134 cm stunted; 889333 cm among women (909486 cm non-stunted). CONCLUSION Optimal cut-off points for BMI were slightly higher among women than men with no meaningful differences by stature. Optimal cut-off points for WC were several centimetres lower for stunted compared with non-stunted men, and both were substantially lower than the current recommendations among Western populations. Cut-off points derived from Western populations may not be appropriate for developing countries with a high prevalence of stunting.