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BACKGROUND: Food environment (FE) has been linked to obesity in urban areas, but there is limited information in rural areas, particularly in developing countries, where prevalence of obesity is high. OBJECTIVE: To determine the association between FE and childhood obesity using Geographic Information Systems (GIS). METHODS: A total of 218 (8-10 years) children participated in a cross-sectional study. Weight, height, and body fat were measured. Geolocation of convenience stores (CS) and participants' households was collected, and the amount of processed food (PF) in the stores was measured. The proximity to the nearest CS and the number of CS within a 250-m buffer from each participant's household was calculated using GIS. Linear regression models between obesity measurements and FE were performed. RESULTS: The combined prevalence of overweight and obesity was 32%. A total of 91% of the children had access to a CS within 250 m. On average, 48% of the shelf-space of the CS were occupied with PF. A positive association between the density of CS with body fat % (ß = .145; 95% CI, 0.048-0.241, P = .004), abdominal fat % (ß = .206; 95% CI, 0.048-0.241, P = .003), and body mass index (BMI)-for-age z-score (BMIz; ß = .028; 95% CI, 0.005-0.062, P = .005) was found. Living closer to CS was associated with increases in body fat % (ß = -0.009; 95% CI, -0.017 to -0.001, P = 0.025), abdominal fat % (ß = -0.012; 95% CI, -0.023 to -0.001, P = 0.033), and BMIz (ß = -0.002, 95% CI, -0.004 to -0.001, P = 0.003). CONCLUSION: In a rural community in Mexico, a high density and low proximity to CS is associated with obesity in school-aged children.

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The aim of this study is to provide an overview of the geographical distribution of Ascariasis, Amebiasis and Giardiasis, and to identify specific geographical, socioeconomic and environmental factors that are associated with the incidence of these infections in Mexican children. We made use of publicly available data that was reported by federal organizations in Mexico for the year 2010. The contribution of geographical, socioeconomic and environmental factors to the incidence of infections was assessed by a multivariable regression model using a backwards selection procedure. A. lumbricoides incidence was associated with mean minimum temperature of the state, the state-wide rate of households without access to piped water and toilet, explaining 77% of the incidence of A. lumbricoides infections. Mean minimum precipitation in the state, the rate of households without access to a toilet, piped water and sewage system best explained (73%) the incidence of E. histolytica infections. G. lamblia infections were only explained by the latitude of the state (11%). In addition to the well-known socioeconomic factors contributing to the incidence of A. lumbricoides and E. histolytica we found that temperature and precipitation were associated with higher risk of infection.

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PURPOSE: Obesity and depression are among the leading causes of disability in Mexico, but their association has not been explored yet. The aim of the current study was to investigate the association between obesity and depression in Mexican population. METHODS: We used data from the health and nutrition survey (ENSANUT 2012), which is representative of the Mexican population. Obesity was determined using the body mass index (BMI) and abdominal obesity by measuring waist circumference. Depressive symptoms were reported using the Center for Epidemiological Studies Depression Scale Short-Form (CES-D-SF, scale 0-21). Regression analyses were performed between obesity and depression, adjusting for gender, age, living with a partner, education, and diabetes history. RESULTS: Obese women had 1.28 (95% CI 1.07-1.53) times the odds of having depression in comparison with normal-weight women, whereas no association was found for men (OR 0.94; 95% CI 0.74-1.19). A significant association between BMI and depressive symptoms score (ß = 0.05, 95% CI 0.02-0.07) was present in women, but no association was found for men (ß = - 0.02, 95% CI - 0.05 to 0.00). There was a statistically significant association between waist circumference and depression scores again for women (ß = 0.03, 95% CI 0.01-0.04) but not for men (ß = 0.00, 95% CI - 0.01 to 0.01). No associations were found between abdominal obesity and depression for both genders. No association was found between different obesity severity levels and depression for both genders. CONCLUSION: Obesity was associated with depression in Mexican women, whereas no association was found between obesity and depression in men.

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BACKGROUND: Overweight and obesity are emerging at alarming rates in low income women in many countries. Guatemala has the additional burden of a high prevalence of chronic under-nutrition (stunting) in children. AIM: The purpose of this paper is to explore the dual burden of infant and child (5-23 months) under-nutrition and maternal over-weight and obesity in the Western Highlands of Guatemala. SUBJECTS AND METHODS: Anthropometric measures were collected in 446 mother-infant dyads in a metropolitan population of mixed indigenous (Maya) and non-indigenous descent in the Western Highlands of Guatemala. Children were identified as stunted based on a height for age <-2 below the WHO reference median and maternal overweight/obesity defined as a BMI ≥25. Stunted children with an overweight/obese mother were compared to other children who were not stunted and/or who did not have an overweight/obese mother. RESULTS: The prevalences of stunting (38%) and maternal overweight/obesity (45%) were high, but just 17% of the mother and child pairs were dual burden. The socio-demographic characteristics of stunted children were not influenced by maternal overweight or obesity. CONCLUSION: Policies are needed to address under-nutrition as well as preventing obesity and obesity-related chronic disease risks of stunted children and their mothers.

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OBJECTIVE: To evaluate the impact of periodic selective treatment with 500 mg mebendazole on soil-transmitted helminth (STH) infections in Cuban schoolchildren. METHODS: We followed up a cohort of 268 STH-positive schoolchildren, aged 5-14 years at baseline, at six-month intervals for two years and a final follow-up after three years. Kato-Katz stool examination was used to detect infections with Ascaris lumbricoides, Trichuris trichiura and hookworm. Common risk factors related to STHs were assessed by parental questionnaire. RESULTS: A significant reduction in the number of STH infections was obtained after three years with the highest reduction for T. trichiura (87.8%) and the lowest for hookworm (57.9%). After six months, cure rates (CRs) were 76.9% for A. lumbricoides, 67.4% for T. trichiura and 44.4% for hookworm. After two treatment rounds, more than 75% of all STH-positive children at baseline were cured, but with important differences between STH species (95.2% for A. lumbricoides, 80.5% for T. trichiura and 76.5% for hookworm). At the end of the study, these cumulative CRs were almost 100% for all three STHs. Risk factors for STHs were sex, sanitary disposal and habit of playing in the soil. CONCLUSIONS: Our results indicate that periodic selective treatment with 500 mg mebendazole is effective in reducing the number of STH infections in Cuban schoolchildren. Although important differences were found between helminth species, two rounds of treatment appeared sufficient to obtain substantial reductions.

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BACKGROUND: Children in rural areas experience the interrelated problems of poor growth, anemia and parasitic infections. We investigated the prevalence of and associations between intestinal helminth and protozoan infections, malnutrition and anemia in school-age Venezuelan children. METHODS: This cross-sectional study was conducted in 390 children aged 4-16 years from three rural areas of Venezuela: the Amazon Region, Orinoco Delta and Carabobo State. Stool samples were collected for direct parasitic examinations. Anthropometric indicators of chronic (height-for-age Z score) and acute (weight-for-height and Body Mass Index (BMI)-for-age Z score in respectively children under 5 years of age and children aged 5 years and above) malnutrition were calculated. Multivariate linear and logistic regression models were built to determine factors associated with nutritional status and polyparasitism. RESULTS: Hookworm and Strongyloides stercoralis prevalences were highest in children from the Amazon rainforest (respectively 72% and 18%) while children from the Orinoco Delta and Carabobo State showed higher rates of Ascaris lumbricoides (respectively 28% and 37%) and Trichuris trichiura (40% in both regions). The prevalence of Giardia lamblia infection was not significantly different between regions (average: 18%). Anemia prevalence was highest in the Amazon Region (24%). Hemoglobin levels were significantly decreased in children with a hookworm infection. Malnutrition was present in respectively 84%, 30% and 13% of children from the Amazon Region, Orinoco Delta and Carabobo State. In multivariate analysis including all regions, G. lamblia and helminth infections were significantly and negatively associated with respectively height-for-age and weight-for-height/BMI-for-age Z scores. Furthermore, hemoglobin levels were positively associated with the height-for-age Z score (0.11, 95% CI 0.02 - 0.20). CONCLUSIONS: In rural populations in Venezuela helminthiasis and giardiasis were associated with acute and chronic nutritional status respectively. These data highlight the need for an integrated approach to control transmission of parasites and improve the health status of rural Venezuelan children.

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BACKGROUND: In many cultures, simple herbal infusions, thin gruels, or sweetened water (agüitas in Guatemalan parlance) are given to infants and toddlers. Formative research has shown that the use of agüitas in early child feeding is deeply embedded in Guatemalan culture. OBJECTIVE: We examined the prevalence and timing of the introduction of agüitas during early life in a low-income population of metropolitan Quetzaltenango in relation to stunting in children. DESIGN: Responses from 456 mothers of children aged 5-23 mo were analyzed by using logistic regression to explore relations between linear growth (stunting), diarrhea, and age at the first introduction of agüitas. RESULTS: A total of 358 of 456 infants (79%) were agüita users independent of sex or ethnicity. Of infants given agüitas, one-fourth of subjects were introduced to agüitas within the first 2.9 wk of age, and one-half of subjects were introduced to agüitas within the first 9 wk of age. Subjects introduced to agüitas before 2.9 wk of age were 1.8 times more likely to be stunted (95% CI: 1.1, 2.8; P = 0.03) irrespective of ethnicity. Children who had ever been given agüitas were twice as likely to have also had diarrhea (OR: 2.1; 95% CI: 1.3, 3.3) and more likely to have needed medical attention for diarrhea (OR: 2.1; 95% CI: 1.1, 4.2), but diarrheal experience was independent of stunting. CONCLUSION: Because of the early introduction of agüitas and the high prevalence of stunting in Guatemala, longitudinal studies are urgently needed to clarify the causal relations. This trial was registered at Nederlands Trial register as NTR3273 for 5-mo-olds and Nederlands Trial register as NTR3292 for infants ≥6 mo.

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BACKGROUND: In developing countries undergoing rapid economic development, the number of dual burden households (i.e. co-existing overweight/obesity and stunting) is increasing. While intestinal parasites are prevalent in these countries, their contribution to dual burden households has so far been neglected. We studied the association between intestinal parasite infection and belonging to a dual burden household in a rural community of Venezuela. METHODS: We examined 225 individuals. A dual burden household was defined as a household with at least one overweight/obese adult (BMI > 25) and at least one stunted child (height -for-age z score <-2). Intestinal parasite (Giardia lamblia and geohelminth) infection was determined by faecal smears. RESULTS: In this community, 47.3% of the individuals were infected with intestinal parasites. Among adults, 65.2% were overweight/obese and 13.8% of the children were stunted. More than one in four households (26.8%) were dual burden households. Being infected with G. lamblia & geohelminths was significantly associated with being in a dual burden household (OR = 4.75, 95% CI: 1.01-22.20, n = 188), indicating a triple burden of disease in this community in Venezuela. CONCLUSION: While the relationship between intestinal parasite infection and stunting has been well established, these results indicate a need to further explore the association of intestinal parasite infection with dual burden households.

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OBJECTIVE: This objective of this study was a methodological analysis of the variety and diversity of dietary items and their different origins offered in institutional menus across four daycare centers serving low-income families in Guatemala City. METHODS: Foods, as served in daycare centers, were used to explore and illustrate the different approaches to evaluating food quality. Foods served at daycare centers were analyzed for variety (number of different items) and diversity (using three food-classification systems). The weight and energy contributions for each meal were reported for animal, plant, mixed, or water; modern versus traditional foods; fortified versus non-fortified foods; and processed versus unprocessed foods. RESULTS: During 5 d of observation, three of the four daycare centers served 100% of the food groups of the current Guatemalan and international classification systems. In addition, the results showed the four daycare centers provided mainly traditional and non-fortified plant-based foods. However, although the traditional foods contributed more by weight, the modern foods contributed more energy. These findings showed that the "modern" foods served at daycare centers are energy dense compared with traditional foods. CONCLUSIONS: These daycare centers contributed to variety and diversity while serving mainly traditional, plant-based foods. Our analysis went beyond the simple existence (mention) of a food as consumed to weight in grams or calories to provide potentially new and useful perspectives for understanding how guidelines for healthful eating patterns can be promoted and assessed, not only in children or in institutions but across all age groups, and settings.

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