Health indicators in double burdened urban Maya children and mothers
2012-08-13T14:14:11Z (GMT) by
Background Middle-income countries are currently undergoing nutrition transition more rapidly than did high income countries. These populations are therefore at high risk of over-nutrition (obesity) and nutrition-related, non-communicable diseases before the elimination of under-nutrition and infectious diseases. Such nutritional double burden is most common in low SES groups of middle-income countries, such as the Maya of Mexico. Long-term poor environmental conditions during early life results in a population with high levels of chronic under-nutrition (stunting), and a consequent predisposition toward overweight/ obesity, and associated health risks later in life. It is important to be able to identify individuals at an increased risk of diseases related to double burden and to determine whether stunting impacts the ability to identify at risk individuals. Aims The overall purpose of this doctoral research was to examine double burden in the urban Maya, a low SES section of the Mexican population which is a current example of a population undergoing significant transition. The specific aims of this thesis were fourfold: 1) To describe the living conditions and population characteristics of the urban Maya of southern Merida in the spring and summer of 2010; 2) to determine whether body mass index (BMI) predicts adiposity indicators in a sample of women and children with a high prevalence of stunting, 3) to determine whether measures of linear growth in women can be predicted by their recalled childhood environment and 4) To determine whether the relationship between objectively estimated free-living energy expenditure and body composition is altered by stunting. Methods Data from interviews, anthropometric measurements and bioelectrical impedance analysis were collected on 58 Maya schoolchildren aged 7-9 years-old and their mothers living in the south of Merida, Mexico. Objective, free-living physical activity monitoring using combined accelerometry and heart rate monitoring of the children was also performed for one week. The interview data was used to describe the living conditions of the south of Merida. Whether stunting status or body proportions influenced the power of BMI to predict adiposity indicators was assessed for the mothers and the children. The mothers recalled early life SES was compared to their current measures of linear growth. The children s objectively estimated energy expenditure was compared to their body composition and measurements of body size. Results The Maya of southern Merida overall had access to clean drinking water and basic health care and have apparently eliminated acute under-nutrition. Yet they remained double burdened with simultaneous stunting and overweight/ obesity. Individual double burden levels were high, with 70% of the mothers were simultaneously stunted and overweight. Family level double burden was also high, with 28% of the families having an overweight mother and a stunted child. The rates of childhood malnutrition varied widely when using different cut-offs. Child stunting rates were between 15.5% and 37.9% when using -2 z-scores of Frisancho s Comprehensive (created using NHANES data) reference versus the 5th percentile of the WHO reference, respectively. Child overweight/ obesity rates were less than 10% when using weight-for-age on both the Comprehensive and WHO reference charts. Child overweight/ obesity as classified using BMI z-scores was between 27.5 to 34.5% using the Comprehensive and WHO reference, respectively, while child overfat was over 80% when using body fat percentage for age reference curves. BMI predicted adiposity indicators in these Maya children, explaining between 33 and 84% of the variance in arm fat index and waist circumference z-score, respectively. BMI was less strongly related to the mothers adiposity indicators, explaining between 19 and 70% of the variance in arm fat area and waist circumference. The relationship between BMI and adiposity indicators was unchanged by stunting or body proportions in either mothers or children. Mothers recalled early life SES was significantly related to but explained little of the variance in her measures of linear growth. Birth decade explained 5% of the variance in stature and the Modernisation index (urban/ rural birth, sugar sweetened beverage consumption, packaged food consumption) explained 5% of the variance in mothers leg length. Birth order, sibling number and consumer durable ownership were also significantly related to linear growth of the mothers. These Maya children had high levels of physical activity, as all exceeded the recommended 60 minutes of moderate-to-vigorous physical activity per day. After controlling for fat free mass, short stature did not predict lower resting energy expenditures in the children. However shorter stature did predict lower levels of activity energy expenditure, particularly in girls. Stunted girls had the lowest activity energy expenditures. Conclusions These urban Maya tend to have access to basic sanitation and services and are at a very high risk for NR-NCDs with the co-existence of chronic under-nutrition (stunting) and overweight/ obesity. The high rates of stunting do not impact the usefulness of BMI to estimate adiposity nor does stunting appear to impact children s energy expenditure. While BMI is useful to predict adiposity in these urban Maya children, it is not recommended for use in the mothers. Interventions to reduce childhood adiposity need to begin very early in life to most effectively reduce adiposity. Research into the low SES groups of middle-income countries, offers insight to what may occur in low-income countries as they advance in the nutrition transition.