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Biomedical subjects

Reynaldo Martorell

Publications and source records attributed to Reynaldo Martorell.

At least 37 records · Page 2Linked to original sources
PubMed2004

Relative importance of birth size and postnatal growth for women's educational achievement.

BACKGROUND: Child undernutrition, commonly measured by growth failure, is associated with functional disadvantages later in life. AIMS: To assess relationships between child growth and women's educational achievement (EA). STUDY DESIGN AND SUBJECTS: Women from four ladino Guatemalan villages were measured as children (1969-1977) and again at ages 20-29 years (1996-1999). The anthropometric measurements analyzed were weight, length, and head circumference (HC) at birth and 2 years and height at adulthood. Sample sizes were 120 at birth, 133 at 2 years, and 145 at adulthood; 108 cases had data at all three points. OUTCOME MEASURES: Women's EA was computed based on five educational tests and was categorized into quintiles. Analysis was based on a proportional odds model. Generalized estimating equations were used to account for sibling clustering. Multiple Stage Least Squares analyses were used to assess the relative importance of birth size and of early (birth to age 2 years) and late postnatal growth (2 years to adulthood). RESULTS: Size at 2 years (HC and length) but no indicator at birth was positively associated with women's EA. Schooling was a strong, positive predictor of women's EA (odds ratio (OR)=13.7, 95% confidence interval (CI) [6.1, 30.6]). Early postnatal growth but not birth size or late postnatal growth was associated with women's EA (OR with 1 standard deviation (S.D.) increment in length=1.5, 95% CI [1.05, 2.2]). CONCLUSIONS: Growth in length and HC from birth to 2 years of age, but not birth size or growth after 2 years, is an important predictor of women's EA.

Adult↗
PubMed2004

Changes in maternal weight from the first to second trimester of pregnancy are associated with fetal growth and infant length at birth.

BACKGROUND: Despite our knowledge of the negative consequences of stunting during early childhood and the important role that maternal nutritional status plays in the development of intrauterine growth retardation, we do not know the extent to which maternal nutritional status influences the growth in length of the fetus or whether a sensitive period for fetal linear growth exists during gestation. OBJECTIVE: Our objective was to explore the relation between maternal weight gain during different stages of pregnancy and linear growth of the fetus. DESIGN: Ultrasound examinations were conducted at 15-24 (x: 17.5) and 28-32 (x: 29.9) wk of gestation in 200 women from 4 rural Guatemalan villages. The associations between maternal weight gain from approximately 10 to 20 and 20 to 30 wk of pregnancy (from the first to the second and from the second to the third trimester, respectively) and fetal linear growth were tested with the use of ordinary least-squares regression. RESULTS: Maternal weight gain from the first to the second trimester was associated with fetal femur and tibia lengths measured at both means of 17 and 30 wk (P < 0.05) and infant length at birth (P < 0.001). Weight gain from the second to the third trimester of pregnancy did not predict fetal linear growth or infant length at birth. CONCLUSIONS: Maternal weight change from the first to the second trimester of pregnancy is strongly associated with fetal growth. Mid-gestation may be a sensitive period for fetal linear growth.

Adult↗
PubMed2004

Multivitamin-mineral supplementation is not as efficacious as is iron supplementation in improving hemoglobin concentrations in nonpregnant anemic women living in Mexico.

BACKGROUND: Iron supplements improve hemoglobin status and reduce anemia due to iron deficiency. It is not known whether multiple micronutrient (MM) supplements are as efficacious as are iron supplements alone in improving hemoglobin concentrations. OBJECTIVE: We conducted a randomized, double-blind community trial in Mexico to compare the efficacy of MM supplements containing iron with that of iron alone in improving hemoglobin concentrations in nonpregnant women. DESIGN: Nonpregnant women (n = 158) were recruited from a semirural community in Mexico and were randomly assigned to receive iron alone (60 mg; Fe group) or MM supplements (vitamins A, B complex, C, D, E, and K and iron, zinc, and magnesium; MM group) 6 d/wk in their home for 12 wk. Hemoglobin concentrations were measured in capillary blood samples at baseline and follow-up. RESULTS: The treatment groups (MM: n = 75; Fe: n = 77) did not differ significantly at recruitment in age, schooling, literacy, or socioeconomic status. There were no significant differences between groups in compliance (median: 97.5%), baseline hemoglobin concentrations, or prevalence of anemia (20%). Losses to follow-up (4%) and mean (+/-SD) changes in hemoglobin (MM group: 6.7 +/- 10.6 g/L; Fe group: 7.1 +/- 13.6 g/L) were not significantly different between groups. However, the change in hemoglobin in anemic subjects was greater in the Fe group than in the MM group (P < 0.05 for interaction), and there was no significant difference in nonanemic subjects. CONCLUSIONS: MM supplements may not be as efficacious as is iron alone in improving the hemoglobin status of anemic women.

Adult↗
PubMed2004

Multimicronutrient interventions but not vitamin a or iron interventions alone improve child growth: results of 3 meta-analyses.

Meta-analyses of randomized controlled intervention trials were conducted to assess the effects of vitamin A, iron, and multimicronutrient interventions on the growth of children < 18 y old. A PubMed database search and other methods identified 14 vitamin A, 21 iron, and 5 multimicronutrient intervention studies that met the design criteria. Weighted mean effect sizes and CI were calculated using a random effects model for changes in height and weight. Tests for homogeneity and stratified analyses by predefined characteristics were conducted. Vitamin A interventions had no significant effect on growth; effect sizes were 0.08 (95% CI: -0.20, 0.36) for height and -0.01 (95% CI: -0.24, 0.22) for weight. Iron interventions also had no significant effect on child growth. Overall effect sizes were 0.09 (95% CI: -0.07, 0.24) for height and 0.13 (95% CI: -0.05, 0.30) for weight. The results were similar across categories of age, duration of intervention, mode and dosage of intervention, and baseline anthropometric status. Iron interventions did result in a significant increase in hemoglobin (Hb) concentrations with an effect size of 1.49 (95% CI: 0.46, 2.51). Multimicronutrient interventions had a positive effect on child growth; the effect sizes were 0.28 (95% CI: 0.16, 0.41) for height and 0.28 (95% CI: -0.07, 0.63) for weight. Interventions limited to only vitamin A or iron did not improve child growth. Multimicronutrient interventions, on the other hand, improved linear and possibly ponderal growth in children.

Africa↗
PubMed2004

Growth and diet quality are associated with the attainment of walking in rural Guatemalan infants.

The attainment of gross motor milestones is an important indicator of motor development in early life; however, little is known about factors affecting gross motor development in children from developing countries. The purpose of this study was to examine the relation of nutritional factors (physical growth and dietary intake) and morbidity during the first year of life to the age of walking without support. Multivariate regression models were used to analyze data collected prospectively between 1991 and 1999 in rural Guatemala. Attainment of children's gross motor milestones was assessed monthly by trained field workers using the 17-milestone Gross Motor Development Scale, morbidity was assessed by biweekly recall, and dietary intakes were measured at 9 and 12 mo of age using repeated 24-h dietary recalls. Median age of walking was 15 mo (range 10-24 mo; n = 174) with no differences by gender. Models were adjusted for birth order, gender, gestational age, maternal age and education, socioeconomic status, and community. Growth in length (-0.57 +/- 0.27 mo length for age Z-score; P = 0.04) and weight (-0.54 +/- 0.19 mo weight for age Z-score, P = 0.005) during the first year of life, rather than size at birth, predicted age of walking. Animal protein intake from complementary foods, while low (mean < 1 g/d) overall, was positively associated with earlier age of walking (P = 0.02). Morbidity during infancy was not associated with age of walking. These findings indicate the importance of prevention of postnatal growth retardation and improvement of diet quality for children's gross motor development.

Birth Order↗
PubMed2004

Maternal and child nutritional supplementation are inversely associated with fasting plasma glucose concentration in young Guatemalan adults.

Cardiovascular disease and diabetes may be programmed early in life by abnormal development associated with undernutrition. We investigated whether maternal nutritional status (MNS; height, pregnancy weight gain, nonpregnant BMI, and prenatal supplementation) or childhood nutritional status (CNS; birth weight, length, ponderal index, height-for-age Z-score at 24 mo, and supplementation from 0 to 24 mo) were related to fasting plasma glucose levels in rural-born Guatemalan adults. We studied 209 men and 220 women (mean age 24.4 y) who were involved in a randomized trial of nutritional supplementation of their mothers during pregnancy and during their early childhoods, conducted from 1969 to 1977. In 2 villages, residents were offered Atole (3.8 MJ and 64 g protein/L); 2 other villages were offered Fresco (1.4 MJ/L, no protein). No associations were observed between anthropometric measures of MNS or CNS and fasting plasma glucose levels. In subgroup analyses, inverse associations (all P < 0.15) with birth size were found among women born to fatter mothers, women with low supplement intake, men born to short mothers, and men more severely stunted at 24 mo. Prenatal supplementation was inversely associated with fasting plasma glucose among women [-0.40 +/- 0.17 mmol/(L. MJ. d), P = 0.02]. Among men, postnatal intake of supplementation of 0.10 to 0.20 MJ/d was associated with up to a 0.56 mmol/L reduction in fasting plasma glucose (P = 0.03), but intake in excess of 0.20 MJ/d provided no added benefit. Among women, the benefit of postnatal supplementation was restricted to those born thin (test for interaction P = 0.10). Improving the nutritional status of undernourished women and children may have positive long-term consequences.

Adult↗
PubMed2004

Multiple micronutrient supplements during pregnancy do not reduce anemia or improve iron status compared to iron-only supplements in Semirural Mexico.

The impact of iron-only supplements (FE) versus multiple micronutrient supplements containing iron (MM) during pregnancy on iron status was assessed in a subsample (n = 453) of women who participated in a randomized double-blind trial in Mexico. Compliance, monitored by observation, was high (>85%). The two groups were similar at recruitment (<13 wk gestation) for various sociodemographic characteristics and for mean hemoglobin (Hb) concentrations and prevalence of anemia (Hb < 110 g/L; 11%). However, mean serum ferritin was higher (P < 0.05) in the MM group (n = 142) compared to the FE group (n = 148) and the prevalence of iron deficiency (serum ferritin < 12 micro g/L) was lower in the MM group (44.4%) compared to the FE group (57.4%). By the third trimester, almost half the women were anemic in both groups, and mean Hb (g/L) was lower for the MM group (104.2; 95% CI: 102.5, 106.0) compared to the FE group (108.1; 95% CI: 106.4, 109.8) after adjusting for baseline serum ferritin. In contrast, there were no differences in Hb concentrations at 1 mo postpartum or in mean ferritin and prevalence of iron deficiency at 32 wk gestation and 1 mo postpartum (90.9 and 45.1% for the MM group; 92.6 and 47.3% for the FE group, respectively). In conclusion, rather than improve Hb or iron status relative to FE-only supplements as hypothesized, MM supplements may have slightly reduced Hb concentrations during pregnancy. Neither supplement was able to meet iron needs as evidenced by dramatic increases in anemia and iron deficiency by the end of pregnancy.

Adult↗
PubMed2004

Measurement and standardization protocols for anthropometry used in the construction of a new international growth reference.

Thorough training, continuous standardization, and close monitoring of the adherence to measurement procedures during data collection are essential for minimizing random error and bias in multicenter studies. Rigorous anthropometry and data collection protocols were used in the WHO Multicentre Growth Reference Study to ensure high data quality. After the initial training and standardization, study teams participated in standardization sessions every two months for a continuous assessment of the precision and accuracy of their measurements. Once a year the teams were restandardized against the WHO lead anthropometrist, who observed their measurement techniques and retrained any deviating observers. Robust and precise equipment was selected and adapted for field use. The anthropometrists worked in pairs, taking measurements independently, and repeating measurements that exceeded preset maximum allowable differences. Ongoing central and local monitoring identified anthropometrists deviating from standard procedures, and immediate corrective action was taken. The procedures described in this paper are a model for research settings.

Anthropometry↗
PubMed2004

Comparison of linear growth patterns in the first three years of life across two generations in Guatemala.

OBJECTIVE: The secular increase in height is assumed to result from long-term improvements in nutritional intakes and reductions in infectious disease burdens. Nutritional supplementation in early life reduces stunting in chronically undernourished populations. It is not known whether these improvements have an impact on the growth of subsequent generations. Our objective was to estimate the intergenerational effect on offspring length of improved nutrition in the mother's early childhood. METHODS: We studied 283 mother-child pairs (mothers born 1969-1977; children born 1996-1999). The mothers had received nutritional supplementation--either atole (enhanced protein-energy) or fresco (moderate energy, no protein), with both containing vitamins and minerals--prenatally and up to age 7 y as part of a community trial conducted in 4 villages in Guatemala. Length was measured on repeated occasions to 36 months of age in both mothers and children. Growth was modeled as a fractional polynomial. RESULTS: Children grew faster than their mothers. Children of mothers who received atole grew faster than children of women who received fresco. In both groups, lengths of individual children were positively correlated with lengths of their own mothers at the same ages. Correlations were generally stronger when the mothers had received atole in early life. CONCLUSION: We have confirmed a secular trend in growth of children in a developing country setting. The rate of child growth reflects, in part, the growth pattern of the mother, including improvements to that pattern resulting from nutritional supplementation.

Child, Preschool↗
PubMed2003

Multiple micronutrient supplementation during pregnancy does not lead to greater infant birth size than does iron-only supplementation: a randomized controlled trial in a semirural community in Mexico.

BACKGROUND: Little is known about the benefits of prenatal multivitamin and mineral supplements in reducing low birth weight. OBJECTIVE: We conducted a randomized, double-blind clinical trial in semirural Mexico to compare the effects of multiple micronutrient (MM) supplements with those of iron supplements during pregnancy on birth size. DESIGN: Pregnant women (n = 873) were recruited before 13 wk of gestation and received supplements 6 d/wk at home, as well as routine antenatal care, until delivery. Both supplements contained 60 mg Fe, but the MM group also received 1-1.5 times the recommended dietary allowances of several micronutrients. RESULTS: At recruitment, the women in the 2 groups were not significantly different in age, parity, economic status, height, or hemoglobin concentration but differed significantly in marital status (4.6% and 2.0% of women in the MM and iron-only groups, respectively, were single mothers) and mean (+/- SD) body mass index (in kg/m(2); 24.6 +/- 4.3 and 23.8 +/- 3.9 in the iron-only and MM groups, respectively). Losses to follow-up (25%) and compliance (95%) did not differ significantly between the groups. In intent-to-treat analyses (MM group: n = 323; iron-only group: n = 322), mean (+/- SD) birth weight (2.981 +/- 0.391 and 2.977 +/- 0.393 kg in the MM and iron-only groups, respectively) and birth length (48.61 +/- 1.82 and 48.66 +/- 1.83 cm in the MM and iron-only groups, respectively) did not differ significantly between the groups. CONCLUSION: These findings suggest that MM supplementation during pregnancy does not lead to greater infant birth size than does iron-only supplementation.

Adult↗
PubMed2003

Associations between prenatal and postnatal growth and adult body size and composition.

BACKGROUND: Adult body size and composition (ABSC) measures are associated with work capacity and productivity, reproductive performance, and chronic disease risk. Growth failure in early childhood may have important long-term consequences through its influence on ABSC. OBJECTIVE: We assessed associations between prenatal and postnatal growth (0-2 y of age) and ABSC. DESIGN: We included 267 singletons from a prospective study carried out between 1969 and 1977 in 4 ladino Guatemalan villages. We used data from that study and from a follow-up study conducted in 1998-1999 (when the subjects were 21-27 y of age) to determine associations of birth weight, length at 15 d of age, ponderal index, and length at 2 y of age with adult height, weight, fat-free mass (FFM), fat mass, percentage of body fat, and waist-to-hip ratio. Multivariate linear regression analyses with mixed models were carried out to account for sibling clustering. Two-stage least-squares analyses were used to separate specific effects of prenatal and postnatal growth. RESULTS: Birth weight, length at 15 d of age, and length at 2 y of age were positively associated with height, weight, and FFM in both sexes (P < 0.05). Prenatal growth and postnatal growth were equally important determinants of height, weight, and FFM. Weak positive associations of postnatal growth with adult fat mass and percentage of body fat were found in both sexes, whereas similar associations for prenatal growth were found in women only. Growth in early childhood was not related to waist-to-hip ratio. CONCLUSIONS: Growth retardation in early childhood was associated with shortness and less FFM in adulthood. Preventing growth failure in utero and preventing growth failure during the first 2 y of life are equally important for ABSC.

Adipose Tissue↗
PubMed2003

Prospective study of protein-energy supplementation early in life and of growth in the subsequent generation in Guatemala.

BACKGROUND: The secular increase in height is assumed to result from long-term improvements in nutritional intakes and reductions in infectious disease burdens. Nutritional supplementation in early life reduces stunting in chronically undernourished populations. It is unknown whether these improvements can be transmitted to subsequent generations. OBJECTIVE: Our objective was to estimate the intergenerational effect on offspring length of improved nutrition in the mother's childhood. DESIGN: We studied 263 children born in 1996-1999 to 231 women who had received nutritional supplementation, ie, atole (high-protein, moderate-energy drink) or fresco (nonprotein, low-energy drink), prenatally and up to age 7 y as part of a community trial in Guatemala between 1969 and 1977. Child length was measured at different times to age 36 mo. RESULTS: Children born to women who received the enhanced supplement were taller (age-adjusted difference: 0.80 cm; 95% CI: 0.16, 1.44 cm) than were children whose mothers received the low-energy supplement. This increment was independent of the children's birth weight or socioeconomic status but was substantially attenuated and no longer significant after adjustment for maternal height (adjusted difference: 0.43 cm; 95% CI: -0.10, 0.96 cm; P > 0.10). The effect of maternal nutritional supplementation was more pronounced in boys than in girls (P for interaction < 0.10) and in children born to women who received supplements at ages 3-7 y than in children born to women who received supplements at ages 0-3 y (P for interaction < 0.01). CONCLUSION: Nutritional supplementation in childhood has positive effects on both the supplemented persons and on the subsequent generation.

Adult↗
PubMed2003

Delayed onset of lactation and risk of ending full breast-feeding early in rural Guatemala.

Mothers of infants (n = 328) born between 1996 and 1999 in four Guatemalan communities were interviewed every 2 wk until 6 mo postpartum (pp) to collect prospective breast-feeding data and assess the association between delayed (>3 d pp) onset of lactation (OL) and the risk of ending full breast-feeding. Cox proportional hazards regression was used to examine the association between delayed OL and the hazard of ending full breast-feeding in the first 6 mo, adjusted for potential confounders and effect modifiers. A significant interaction with community was found (community-specific hazard ratios: HR(A) = 2.87, 95% CI = 1.25, 6.60; HR(B) = 3.43, 95% CI = 1.55, 7.59; HR(C) = 0.26, 95% CI = 0.06, 1.14; HR(D) = 1.11, 95% CI = 0.44, 2.77). Supplementation before OL (preonset supplementation) was associated with delayed OL [odds ratio (OR) = 4.87, 95% CI = 2.29, 10.36] and an increased risk of ending full breast-feeding (HR = 1.49, 95% CI = 1.05, 2.11). In the two communities in which mothers who experienced delayed OL had a significantly greater risk of ending full breast-feeding than did mothers experiencing normal OL, the association between delayed OL and full breast-feeding was mediated in part by preonset supplementation. Further analyses suggest that this was due to delayed OL leading to nonbreast milk feeds, rather than to introduction of supplements delaying OL. We conclude that some mothers who experience delayed OL are less likely to continue full breast-feeding in the first 6 mo and that further research should examine the contextual factors that modify this relationship.

Adult↗
PubMed2003

Effects of early childhood supplementation on the educational achievement of women.

OBJECTIVE: Malnutrition during early childhood has been suggested to cause functional disadvantages in adults, including reduced intelligence and lower educational achievement (EA). We assessed the effects of improved nutrition in early life on the EA of women in 4 rural Guatemalan villages. METHODS: The study sample comprised 130 female singletons exposed to either Atole (53%, 91 kcal and 6.4 g protein/100 mL) or Fresco (47%, 33 kcal/100 mL, no protein) during the prenatal period and the first 2 years of life. EA was assessed at the ages of 22 to 29 years by knowledge, numeracy, and several reading tests. A summary measure of EA was computed based on 5 tests, and outcome variables were categorized into quintiles. Analysis was based on a proportional odds model. Generalized estimating equations were used to account for sibling clustering. RESULTS: Overall, 36.2% of women completed primary school. Women exposed to Atole had better EA than those exposed to Fresco (odds ratio [OR]: 2.8; 95% confidence interval [CI], 1.4, 5.4), with a significant treatment-by-schooling interaction. Atole was not associated with EA (OR: 1.5; 95% CI: 0.7, 3.2) among women who did not complete primary school, whereas among those who completed primary school, Atole was associated with improved EA (OR: 13.7; 95% CI: 3.7, 50.8). CONCLUSIONS: We conclude that better nutrition during early childhood improved adult EA, but only among children who completed primary school.

Adult↗
PubMed2002

Rural-to-urban migration and cardiovascular disease risk factors in young Guatemalan adults.

BACKGROUND: Migration to cities may increase cardiovascular disease risk factors in developing countries. We examined rural and urban individuals who were born in the same villages and shared similar childhood experiences. METHODS: Blood lipids and glucose, blood pressure, anthropometry, body composition, physical activity, and food, tobacco and alcohol consumption were examined in 161 men and 193 women, 19-29 years old, living in their village of birth (76 commuted to work in Guatemala City), and in 76 men and 43 women living in the city. RESULTS: Rural and urban women had similar prevalence of overweight (28%), elevated body fat (29.8 +/- 6.1%) and low physical activity (83%). Compared to rural men, more urban men were sedentary (79 versus 27%), and they had higher body fat (15.3 +/- 5.3% versus 13.3 +/- 5.7%), serum cholesterol (4.27 +/- 0.75 versus 3.90 +/- 0.70 mmol/l [165 +/- 29 versus 151 +/- 27 mg/dl]), low density lipoprotein [LDL]-cholesterol (2.66 +/- 0.72 versus 2.30 +/- 0.62 mmol/l [103 +/- 28 versus 89 +/- 24 mg/dl]) and total cholesterol/high density lipoprotein [HDL]-cholesterol ratio (4.6 +/- 1.0 versus 4.1 +/- 0.9). Commuters showed intermediate values. Women had higher serum cholesterol (4.43 +/- 0.80 mmol/l [171 +/- 31 mg/dl]) than men in rural and urban areas. Urban residents ate/drank more saturated fats, red meat and sweetened beverages, and less legumes. CONCLUSIONS: High proportions of young Guatemalan women were overweight and sedentary. Migration to a city increased sedentarism and undesirable eating habits among men and women; men became fatter and their lipid profile worsened. Public health actions must address the prevention of emerging chronic diseases in countries still burdened by undernutrition and infections.

Adult↗
PubMed2002

Feeding the world in the coming decades requires improvements in investment, technology and institutions.

The world is food secure at the global level, yet nearly 800 million are food insecure. "Business as usual" is not going to bring us close to meeting the Millennium Development Goal of halving the proportion of the population consuming less than the minimum energy requirement. So what has to change? The three papers in this session offer clues in three broad areas: (a) increased investment-by developing and developed countries-in public goods such as agricultural research, education, and clean water, (b) technologies to boost agricultural productivity for the poor and institutions that guide the diffusion and application of technology that need to be developed and (c) national-level institutions and governance structures to be strengthened and held accountable for protecting and respecting human rights, for providing the right types of national-level public goods to those that most need them and for preserving peace and stability.

Africa South of the Sahara↗
PubMed2002

Panel discussion: regional action priorities.

Action priorities for reducing iron deficiency vary across regions. Some regions have limited experience with national programs, such as in the republics of Central Asia, where the focus since independence has been on assessment, advocacy and scaling up of interventions. In more developed regions the priorities are improving established programs and addressing the needs of the remaining subpopulations with high rates of iron deficiency. The etiology of anemia, whether multi-factorial as in Sub-Saharan Africa or mostly due to iron deficiency as in the Middle East and North Africa, is an important factor shaping the choice of strategies. Some interventions are particularly feasible in some settings and are being promoted aggressively, such as flour fortification in Latin America and the Middle East and North Africa, or the fortification of condiments in Asia. The quality of the health infrastructure and resources in general also determine the mix and scale of interventions implemented. A lesson for all regions is that countries in North America and Europe, where diets are varied and abundant and infections nearly absent, generally support multiple strategies that include nutrition education, supplementation and fortification of a variety of staples consumed by toddlers and the general population. Monitoring and evaluation efforts have proven necessary for improving quality and for advocacy.

Anemia, Iron-Deficiency↗