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Biomedical subjects

R Martorell

Publications and source records attributed to R Martorell.

At least 19 recordsLinked to original sources
PubMed2006

Country development and the association between parity and overweight.

INTRODUCTION: Parity is associated with overweight and obesity in developed countries and has been related to maternal depletion in poor developing countries. However, the literature from developing countries is limited and may not represent current stages of development. METHODS: We analyzed data from 50 Demographic and Reproductive Health Surveys conducted between 1992 and 2003. We examined the association between parity (proxied by number of live births) and overweight (body mass index (BMI)> or =25 kg/m(2)) in relation to level of country wealth and development. RESULTS: The odds ratio (OR) for overweight comparing women with at least four live births to women with one live birth was >1.0 in 38 of the 50 countries studied. The median OR was >1.0 in all regions studied and highest in North Africa/West Asia, where all countries had OR >1.0. Country wealth and development were both positively associated with the ORs. CONCLUSIONS: The importance of parity as a predictor of overweight increases with national economic development and wealth. Policy implications might include the development and implementation of programs to prevent excessive gestational weight gain and promote postpartum weight loss via dietary change and physical activity, concomitant with exclusive breastfeeding.

Adolescent↗
PubMed2006

Construction of the World Health Organization child growth standards: selection of methods for attained growth curves.

The World Health Organization (WHO), in collaboration with a number of research institutions worldwide, is developing new child growth standards. As part of a broad consultative process for selecting the best statistical methods, WHO convened a group of statisticians and child growth experts to review available methods, develop a strategy for assessing their strengths and weaknesses, and discuss methodological issues likely to be faced in the process of constructing the new growth curves. To select the method(s) to be used, the group proposed a two-stage decision-making process. First, to select a few relevant methods based on a list of set criteria and, second, to compare the methods using available tests or other established procedures. The group reviewed 30 methods for attained growth curves. Using the pre-defined criteria, a few were selected combining five distributions and two smoothing techniques. Because the number of selected methods was considered too large to be fully tested, a preliminary study was recommended to evaluate goodness of fit of the five distributions. Methods based on distributions with poor performance will be eliminated and the remaining methods fully tested and compared.

Body Height↗
PubMed2004

Ultrasound measurement of fetal size in rural Guatemala.

OBJECTIVES: To describe the fetal growth pattern of a population from rural Guatemala and determine when during gestation growth faltering becomes evident. METHODS: Ultrasound examinations were conducted for 319 women. Femur length (FL), biparietal diameter (BPD), abdominal (AC) and head circumference (HC) were compared with reference values. RESULTS: FL and AC were similar to reference values throughout gestation. BPD and HC were below the 50th percentile by 30 weeks' gestation and below the 10th percentile later in gestation. We expected all four dimensions to show marked growth restriction during gestation. Measurement differences may explain the results but would call into question the value of cross-study comparisons. Infants born small for gestational age were small in all measures as early as 15 weeks. CONCLUSIONS: Fetal growth faltering begins in early gestation among infants who were born small. The lack of deviation from reference data for FL and AC requires further clarification.

Anthropometry↗
PubMed2001

Short-term benefits of catch-up growth for small-for-gestational-age infants.

BACKGROUND: Recent studies suggest that small newborns who present rapid postnatal growth may have an increased risk of chronic diseases in adulthood. On the other hand, it is widely assumed that catch-up growth is desirable for low birthweight children, but the literature on this subject is limited. METHODS: Population-based cohort study in southern Brazil, with 3582 children examined at birth, 20 and 42 months of age. Catch-up growth from 0 to 20 months was related to subsequent risks of hospital admissions and mortality. RESULTS: Children who were small-for-gestational-age (SGA) but presented substantial weight gain (> or =0.66 z-score) up to the age of 20 months had 65% fewer subsequent hospital admissions than other SGA children (5.6% versus 16.0%; P < 0.001). Mortality to age 5 years was 75% lower (3 versus 13 per 1000, a non-significant difference based on a small number of deaths) for rapid-growing SGA children compared to the remaining SGA children. Their admission and mortality rates were similar to those observed for children born with an appropriate birthweight for their gestational age (AGA). Similar positive effects of rapid growth were found for AGA children. CONCLUSION: There appear to be definite benefits associated with catch-up growth. Growth promotion efforts for infants who are born small should take into account their possible short- and long-term consequences.

Analysis of Variance↗
PubMed2001

Early nutrition and later adiposity.

The objective was to review whether nutrition during pregnancy and the first 3 y of life predisposes individuals to be fatter as adults. The roles of undernutrition, overnutrition and breastfeeding were considered. The evidence that poor nutrition in early life is a risk factor for increased fatness later in life is inconclusive. Overnutrition, as proxied by high birthweight or gestational diabetes, on the other hand, is associated with subsequent fatness. Two large, well-conducted studies in developed countries suggest that breastfeeding has a protective effect. Nutrition in early life has a demonstrable but small impact on adult obesity.

Adipocytes↗
PubMed2001

Full breast-feeding for at least four months has differential effects on growth before and after six months of age among children in a Mexican community.

This study examines the relationship between breast-feeding and growth from 0 to 6 and 6 to 20 mo among 185 children in a Mexican community. Infants from a previous 6-mo longitudinal study were followed up for additional anthropometric measurements at a mean age of 19.9 mo. Size at 6 mo and at follow-up were modeled as outcomes of whether infants were fully breast-fed (exclusively or predominantly breast-fed) for at least 4 mo, controlling for size at birth and 6 mo, respectively, and potential confounders. From birth to 6 mo, fully breast-fed infants had ponderal index increments of 0.07 units larger (P = 0.04) than comparison infants. There were no differences in weight. For length, an interaction between full breast-feeding and socioeconomic status (SES) was found, with fully breast-fed infants of low SES growing more than comparison infants, whereas the opposite was seen at upper SES levels. From 6 to 20 mo, fully breast-fed infants had weight and length increments of 0.53 cm (P < 0.001) and 0.72 kg (P = 0.01) smaller than those of comparison infants. For ponderal index, an interaction between mother's education and breast-feeding revealed an inverted U-shaped response across levels of education. Additionally, logistic regressions of monthly breast-feeding on lagged measurements revealed that relatively heavier infants had higher odds of being fully breast-fed at 2 and 3 mo. Our findings indicate that the benefits of full breast-feeding on growth may be most pronounced early in life. Further research of unmeasured confounders may explain the association of full breast-feeding with slower growth beyond 6 mo.

Body Weight↗
PubMed2001

Growth in indigenous and nonindigenous Chilean schoolchildren from 3 poverty strata.

OBJECTIVES: This study sought to determine whether the short stature of Mapuche children, an indigenous group in Chile, reflects poverty or genetic heritage and whether the international reference population, derived from studies of US children of mostly European origin, is appropriate for assessing growth failure in indigenous peoples of the Americas. METHODS: The study assessed 768 schoolchildren of Mapuche and non-Mapuche ancestry, aged 6 to 9 years, living under conditions of extreme, medium, and low poverty. RESULTS: Growth retardation was strongly related to poverty in both ethnic groups. Within poverty levels, there were no significant differences in stature between ethnic groups, and in low-poverty areas in Santiago, the capital city, mean stature was only slightly less than in the reference population. CONCLUSIONS: Poverty, not ancestry, explains the short stature of Mapuche children, and use of the international reference to assess growth in this population is appropriate.

Body Height↗
PubMed2001

Determinants of fasting glucose in young Guatemalan adults.

OBJECTIVE: To examine correlates of fasting glucose, a precursor for type 2 diabetes mellitus, in young adults in Guatemala, a country undergoing an epidemiologic transition. DESIGN: Cross-sectional. METHODS: Anthropometric, lifestyle, dietary, serum lipid, and socioeconomic characteristic data were collected on 189 men and 201 women (mean age 24.4 years) born in four villages in Eastern Guatemala. We used linear regression to identify parsimonious predictive models, including 2-way interactions. RESULTS: In men, mean fasting glucose was 87.3 mg/dL (SD 10.2); our model explained 30% of variance. Body mass index (BMI), abdomen-to-hip ratio (AHR), and total cholesterol showed graded positive effects. BMI and AHR interacted (P<.001); men with high BMI and high AHR had the highest fasting glucose levels. No dietary factors independently predicted fasting glucose. In women, mean fasting glucose was 83.9 mg/dL (SD 8.5); 22% of variance was explained by BMI, energy-adjusted fat intake, physical activity, birth village, and current residence (rural/urban). BMI and fasting glucose were positively related. Urban residence interacted with birth village (P=.06) and physical activity (P=.13). CONCLUSIONS: The major conclusion drawn from this study is that increased adiposity, even among lean individuals, is the largest environmental predictor of fasting glucose. Prevention and control of obesity in young adults in transitioning countries are key strategies for the prevention of diabetes.

Adult↗
PubMed2000

Obesity in women from developing countries.

OBJECTIVES: The key objective was to estimate obesity (>/=30 kg/m2) in women 15-49 y from developing countries. A second objective was to study how obesity varies by educational level and by residence in urban and rural areas. A third objective was to investigate how national incomes shape the relationship between obesity and eduction or residence. DESIGN: The analyses use cross-sectional data from nationally representative surveys from developing countries carried out in the last decade. Most of the surveys were Demographic Health Surveys (DHS). Data from a survey from the USA are used for comparison. SETTING: The 39 surveys used come from 38 developing countries and the USA. SUBJECTS: A total of 147,938 non-pregnant women 15-49 y were included in the analyses. RESULTS: The percentage of obese women was 0.1% in South Asia, 2.5% in Sub-Saharan Africa, 9. 6% in Latin America and the Caribbean, 15.4% in Central Eastern Europe/Commonwealth of Independent States (CEE/CIS), 17.2% in the Middle East and North Africa, and 20.7% in the USA. Levels of obesity in countries increased sharply until a gross national product of US$1500 per capita (1992 values) was reached and changed little thereafter. In very poor countries, such as in Sub-Saharan Africa, obesity levels were greatly concentrated among urban and higher educated women. In more developed countries, such as those in Latin America and the CEE/CIS regions, obesity levels were more equally distributed in the general population. CONCLUSIONS: Based on the analyses presented and on a review of the literature, it is concluded that obesity among women is a serious problem in Latin America and the Caribbean, the Middle East and North Africa, and the CEE/CIS region. Obesity is less of a concern in Sub-Saharan Africa, China and South Asia. Obesity levels increased over time in most of the limited number of countries with data, but at varying rates. Rising national incomes in developing countries and increased 'Westernization' will most likely lead to increased levels of obesity in the future. SPONSORSHIP: Financial support was provided by the Food and Nutrition Program of the Pan American Health Organization and by the World Bank.

Adolescent↗
PubMed2000

Overweight and obesity in preschool children from developing countries.

OBJECTIVES: To estimate levels and trends in overweight and obesity in preschool children from developing countries; to study how overweight varies by the educational level of the mother, by urban or rural residence, and by gender; to investigate how these relationships are related to the gross national product (GNP). DESIGN: 71 national nutrition surveys since 1986 from 50 countries were used. SUBJECTS: 150,482 children 12 to 60 months from the most recent survey from each country were the primary sample. MEASUREMENTS: Overweight and obesity were defined as weight-for-height (>1 or >2 s.d., respectively) of the WHO/NCHS reference curves. Stunting was <-2 s.d. of the same reference. Urban was as defined in each of the surveys and higher education was defined as at least one year of secondary schooling or higher. RESULTS: 32 of 50 countries had a prevalence of obesity below 2.3%, the value in the reference population. The prevalences of overweight and obesity were lowest in Asia and in Sub-Saharan Africa. In 17 countries with serial data, no consistent regional trends could be detected. Overweight was more common in urban areas, in children of mothers with higher education, and in girls; these relationships did not differ by GNP but GNP was related negatively to stunting and positively to overweight. CONCLUSIONS: Obesity does not appear to be a public health problem among preschool children in Asia and Sub-Saharan Africa. In a number of countries in Latin America and the Caribbean, the Middle East and North Africa, and the region of Central Eastern Europe/Commonwealth of Independent States, levels are as high as in the United States.

Child Welfare↗
PubMed2000

Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: pooled analysis of randomized controlled trials.

BACKGROUND: Zinc deficiency is prevalent in children in developing countries. Supplemental zinc provides therapeutic benefits in diarrhea. OBJECTIVE: We sought to measure the effect of supplemental zinc given with oral rehydration therapy during recovery from acute or persistent diarrhea. DESIGN: We conducted pooled analyses including all available published and unpublished randomized controlled trials of the effects of supplementary oral zinc in children aged <5 y with acute or persistent diarrhea. We used Cox survival regression analysis to evaluate the overall effect of zinc on continuation of diarrhea and possible differential effects in subgroups divided by sex, age, weight-for-height, and initial plasma zinc concentration. Dichotomous outcomes were analyzed by logistic regression. To assess the effects of excluding studies without original data from the pooled analyses, effect-size was estimated for all studies by using random-effects models. RESULTS: Zinc-supplemented children had a 15% lower probability of continuing diarrhea on a given day (95% CI: 5%, 24%) in the acute-diarrhea trials and a 24% lower probability of continuing diarrhea (95% CI: 9%, 37%) and a 42% lower rate of treatment failure or death (95% CI: 10%, 63%) in the persistent-diarrhea trials. In none of the subgroup analyses were the 2 subgroups of each pair significantly different from each other; however, in persistent diarrhea there tended to be a greater effect in subjects aged <12 mo, who were male, or who had wasting or lower baseline plasma zinc concentrations. CONCLUSION: Zinc supplementation reduces the duration and severity of acute and persistent diarrhea.

Acute Disease↗
PubMed2000

Co-occurrence of nutrition problems in Honduran children.

We used data from the 1996 Honduras National Micronutrient Survey to investigate the co-occurrence of vitamin A deficiency (VAD), anemia and stunting in a representative sample of Honduran children 1-5 y old. Observed frequencies of co-occurrence were compared with frequencies expected by chance in children 12-35.9 mo old (n = 633) and 36-59.9 mo old (n = 610) for the three possible two-way combinations of the problems and the three-way combination. Observed frequencies were greater than expected frequencies for all eight comparisons, and all comparisons except for that of stunting and anemia in younger children were significant. The observed frequency of the three-way co-occurrence was 8.4% compared with an expected co-occurrence of 8.1% in younger children (P: < 0.05) and 4.8% compared with 4.2%, respectively, in older children (P: < 0.001). Although there was statistical evidence for co-occurrence, differences between expected and observed prevalences were small for most comparisons. Our findings suggest that having one or two problems does not appreciably increase the probability of having another. The efficiency of nutrition interventions aimed at these conditions would not be improved by targeting children with any one of the conditions; rather, the three conditions should be treated as virtually independent when designing programs. Replication of this study in other settings is warranted.

Age Distribution↗
PubMed1999

Infant and child growth and fatness and fat distribution in Guatemalan adults.

To examine whether poor growth in utero or young childhood is associated with adult abdominal fatness in a developing country context, the authors analyzed prospectively collected data on 372 female and 161 male Guatemalans measured as children between 1969 and 1977 and remeasured as adults in 1988-1989 (men and women) and 1991-1994 (women only). Childhood stunting (height-for-age z score) was associated with a lower body mass index and percent body fat in men, while no associations were found in women. In both sexes, however, severely stunted children had significantly greater adult abdominal fatness (waist:hip ratio), once overall fatness and confounders were controlled. The adult waist:hip ratio (x100) was increased by 0.65 (95% confidence interval 0.10 to 1.20) in men and 0.29 (95% confidence interval -0.03 to 0.61) in women for each height-for-age z score less at age three. Migration to urban centers was significantly associated with an even greater waist:hip ratio in severely stunted females (p = 0.03). In a subsample of 137 women, short and thin newborns had significantly greater adult abdominal fatness compared with long and thin or short and fat newborns or children who became stunted postnatally. The adult waist:hip ratio (x100) was increased by 1.58 (95% confidence interval 0.35 to 2.81) for each kilogram less birth weight. The authors conclude that, in countries where maternal and child malnutrition exists alongside rapid economic development and urban migration, abdominal obesity and related chronic diseases are likely to increase.

Adult↗
PubMed1999

Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: pooled analysis of randomized controlled trials. Zinc Investigators' Collaborative Group.

OBJECTIVES: This study assessed the effects of zinc supplementation in the prevention of diarrhea and pneumonia with the use of a pooled analysis of randomized controlled trials in children in developing countries. STUDY DESIGN: Trials included were those that provided oral supplements containing at least one half of the United States Recommended Daily Allowance (RDA) of zinc in children <5 years old and evaluated the prevention of serious infectious morbidity through household visits. Analysis included 7 "continuous" trials providing 1 to 2 RDA of elemental zinc 5 to 7 times per week throughout the period of morbidity surveillance and 3 "short-course" trials providing 2 to 4 RDA daily for 2 weeks followed by 2 to 3 months of morbidity surveillance. The effects on diarrhea and pneumonia were analyzed overall and in subgroups defined by age, baseline plasma zinc concentration, nutritional status, and sex. The analysis used random effects hierarchical models to calculate odds ratios (OR) and 95% CIs. RESULTS: For the zinc-supplemented children compared with the control group in the continuous trials, the pooled ORs for diarrheal incidence and prevalence were 0.82 (95% CI 0.72 to 0.93) and 0.75 (95% CI 0.63 to 0.88), respectively. Zinc-supplemented children had an OR of 0.59 (95% CI 0.41 to 0.83) for pneumonia. No significant differences were seen in the effects of the zinc supplement between the subgroups examined for either diarrhea or pneumonia. In the short-course trials the OR for the effects of zinc on diarrheal incidence (OR 0.89, 95% CI 0.62 to 1.28) and prevalence (OR 0.66, 95% CI 0.52 to 0.83) and pneumonia incidence (OR 0.74, 95% CI 0.40 to 1.37) were similar to those in the continuous trials. CONCLUSIONS: Zinc supplementation in children in developing countries is associated with substantial reductions in the rates of diarrhea and pneumonia, the 2 leading causes of death in these settings.

Child↗
PubMed1999

Fatness and body mass index from birth to young adulthood in a rural Guatemalan population.

Body mass index (BMI; wt in kg/ht2 in m) has been proposed as a simple and valid measure for monitoring fatness. Using data from a 25-y longitudinal study of rural Guatemalans, we found that, as children, this population was stunted (mean height-for-age z = -2.6) and had low triceps skinfold thicknesses ( approximately 10% of reference medians), yet had mean BMIs above US reference medians. As young adults, mean BMIs were at the 50th and 20th percentiles for women and men, respectively. BMIs between ages 1 and 5 y were moderately correlated (r = 0.2-0.3) with those in young adulthood. BMI was correlated with subscapular (r = 0.5-0.8) and triceps (r = 0.2-0.7) skinfold thicknesses at all ages and with predicted percentage body fat in adolescence (r = 0.65) and adulthood (r = 0.8). Fatness was highly centralized, with ratios of subscapular to triceps skinfold thicknesses at the 50th-90th percentiles of reference medians at all ages. BMI was a poor indicator of central fat; the correlation between BMI and waist-to-hip ratio in 14-17-y-old males was -0.21). In stunted populations in developing countries, BMI alone should be interpreted with caution. In stunted children, BMIs may be high despite small extremity skinfold thicknesses; BMI alone may overestimate the prevalence of fatness in these children. In adults, measures in addition to BMI may be required to identify centralized adiposity in these populations.

Journal Article↗
PubMed1999

Dietary vitamin A intakes of preschool-age children in South India.

The vitamin A intake of children aged 1-3 y (n = 683) was assessed using a quantitative food-frequency questionnaire in a vitamin A intervention study in South India. Trained field workers interviewed mothers about their children's usual consumption of common sources of vitamin A and collected information on portion sizes using standard cups. Mothers were asked to state the number of months in a year during which specific seasonal foods were available. Information about current breast-feeding was also obtained. Vitamin A intakes from nonbreast milk sources were extremely low at all ages. The median intake of total vitamin A, beta-carotene and retinol was 121, 100 and 21 retinol equivalents (RE), respectively. Maternal education and socioeconomic status (SES) were positively associated with total vitamin A and retinol intakes. Girls had significantly lower intakes than boys even after adjusting for differences in age, maternal education, SES and breast-feeding status. Breast-feeding was common, but declined to 60% by 24 mo and to 15% by 36 mo. Vitamin A intakes from nonbreast milk sources increased with age only for currently breast-fed children, who tended to be of lower SES. After taking into account the potential contribution of breast milk by using published estimates, nonbreast-fed children met only 60% of the Indian recommended dietary allowance (RDA; 250 RE/d), whereas breast-fed children met approximately 90% of the RDA during y 2 of life.

Anthropometry↗
PubMed1999

Early childhood nutrition, education and fertility milestones in Guatemala.

Data on fertility milestones were collected in 1994 and linked to information collected in a trial conducted in eastern Guatemala between 1969 and 1977, to examine whether early childhood nutrition was associated with the timing of fertility milestones. In the original trial, two pairs of villages were randomly allocated to receive either a high energy, high protein supplement (Atole) or a low energy, no-protein supplement (Fresco). Mean age at follow-up was 23.47 y (n = 240). About 62% of women had experienced first birth (median age at first birth = 19.83 y). The median intervals from menarche to first intercourse and from first intercourse to first birth were 5.67 and 0.95 y; they were 1.68 and 0.06 y shorter, respectively, for the Atole group than for the Fresco group. Women who had received Atole in utero and/or during early childhood experienced earlier milestones even after adjusting for socioeconomic status (SES), education and age at the prior event. Median age at first birth was 1.17 y earlier for the Atole group. Better growth during early childhood (not severely stunted) led to earlier milestones (median age at first birth was 1.04 y earlier), primarily among women with illiterate fathers. Completion of primary school significantly delayed fertility milestones; the median age at first birth was 4.27 y later for those who completed primary school compared with those who did not (P < 0.05). In sum, improved nutrition during early childhood results in earlier fertility milestones, but the effects of schooling in delaying fertility milestones are greater in magnitude. Intervention programs that improve early childhood nutrition should be accompanied by investments in education that ensure that girls complete primary school.

Adult↗