Early Life Nutrition, Adult Diet, and Cardio-metabolic Disease Risk in Rural Guatemala Público

Abstract

Latin America is facing an increasing burden of obesity and cardio-metabolic disease (CMD). The nutrition transition, a shift from whole foods-based traditional diets to diets high in fat, sugar, and processed foods, is thought to contribute to CMD risk. Despite increases in obesity and CMD, there is a persistent burden of childhood undernutrition. People exposed to early life undernutrition might have growth patterns that confer distinct risk for CMD, yet little is known about the long term consequences of early life undernutrition in obesogenic environments.

The first aim of this research was to explore body mass index (BMI) trajectories from infancy through mid-adulthood, early life nutrition, and CMD risk using data from the Institute of Nutrition of Central America and Panama (INCAP) Nutrition Supplementation Trial Longitudinal Cohort. We identified two BMI latent classes in women (low and high) and three in men (low, medium, and high) that separated in infancy and tracked through adulthood, suggesting that early life factors are important in establishing BMI trajectories. Exposure to a nutrition supplement (Atole) from conception to age 2y (i.e. the first 1,000 days) was not associated with BMI latent class trajectory membership. In men only, higher BMI latent class was negatively associated with metabolic syndrome and dysglycemia. BMI trajectory was not associated with most CMD risk factors after controlling for current BMI.

The second aim was to explore adult diet, 12y change in dietary patterns, and CMD risk. While adult diets remained largely reliant on corn tortillas, there was evidence of dietary diversification from 2002-2016 by decreased intake of traditional foods and a mixture of consumption trends for Western foods. In addition to a traditional pattern, our adult dietary pattern analyses suggested the emergence of two Western patterns (meat-based and starch-based) - one of which was associated with increased prevalence of low high density lipoprotein cholesterol (HDL-c) in men. The traditional diet had a differential association with some CMD risk factors by sex.

Our findings highlight the importance of establishing and maintaining healthy BMI throughout the lifecourse, including appropriate growth in early life and preventing excessive weight gain in adulthood. To help mitigate nutrition-related CMD risk, future research should explore approaches to encourage adoption of healthier foods while minimizing the addition of energy-dense, nutrient-poor foods.

Table of Contents

Chapter 1 - Introduction 1

· Specific Aim 1 - Life course BMI trajectories and cardio-metabolic disease risk 4

· Specific Aim 2 - Diet, the nutrition transition, and cardio-metabolic disease risk 5

Chapter 2 - Background 8

· Part I: Obesity in Low- and Middle-Income Countries: Burden, Drivers, and Emerging Challenges 9

- Abstract 10

- Introduction 11

- Distribution and Epidemiology of Obesity in LMICs 11

- Challenges 32

- Conclusion 35

- Summary Points 37

· Part II: Cardio-metabolic Disease, the Dual Burden, and Nutrition Transition in Guatemala 40

- Cardio-metabolic Disease in Guatemala 40

- The Double Burden in Guatemala 42

- The Nutrition Transition in Guatemala 43

- Contributions of this dissertation 47

· Chapter 1 and 2 References 51

Chapter 3 - Overview of cohort and study waves 64

· The INCAP Longitudinal Study, 1969-77 64

· The INCAP Follow-up Study, 1988-89 65

· Cardiovascular Disease Risk Follow-up Study, 1997-99 66

· The Human Capital Study, 2002-04 66

· The Metabolic Study, 2015-17 67

· Chapter 3 References 70

Chapter 4 - Life-Course Body Mass Index Trajectories Are Predicted by Childhood Socioeconomic Status but Not Exposure to Improved Nutrition during the First 1000 Days after Conception in Guatemalan Adults 71

· Abstract 72

· Introduction 74

· Methods 75

- Study population 75

- Data collection and variable specification 76

- Statistical methods 77

· Results 80

· Discussion 81

· Conclusion 86

· Chapter 4 References 87

Chapter 5 - BMI trajectories and markers of CMD risk in rural Guatemalan adults 96

· Abstract 97

· Introduction 99

· Methods 100

- Study Population 100

- BMI Trajectories 102

- Assessment of Anthropometric, Biochemical, and Clinical Measures 103

- Statistical Analyses 106

· Results 107

· Discussion 109

- Strengths and Limitations 113

· Conclusion 114

· Chapter 5 References 115

Chapter 6 - The Nutrition Transition in Rural Guatemala: 12 Year Changes in Adult Diet - 126

· Abstract 127

· Introduction 129

· Methods 130

- Study Population 130

- Assessment of Dietary Intake 131

- Derivation of Dietary Patterns 132

- Assessment of Lifestyle and Socioeconomic Characteristics 133

- Statistical Analyses 134

· Results 134

- Food Groups as a Percentage of Total Caloric Intake 134

- Dietary Patterns 136

· Discussion 138

- Strengths and Limitations 144

- Conclusion 146

· Chapter 6 References 147

Chapter 7 - Dietary patterns and Cardio-metabolic Risk in a Population of Guatemalan Young Adults 162

· Abstract 163

· Introduction 165

· Methods 166

- Study Population 166

- Assessment of Dietary Intake 167

- Derivation of Dietary Patterns 168

- Assessment of Anthropometric, Biochemical, and Clinical Measures 169

- Assessment of Covariates 170

- Statistical Analyses 171

· Results 172

· Discussion 174

- Strengths and Limitations 180

· Conclusion 181

· References for Chapter 7 182

Chapter 8 - Summary, Discussion, and Conclusion 196

· Discussion of Main Findings and Public Health Implications 198

· Cardio-metabolic disease risk 198

· Early life nutrition, life-course BMI trajectories, and cardio-metabolic disease risk 202

· Nutrition transition, adult diet, and cardio-metabolic disease risk 214

· Policy recommendations 228

· Strengths 230

· Limitations 232

· Conclusions 234

· Chapter 8 References 237

Chapter 9 - Supplemental Materials 247

About this Dissertation

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School	Laney Graduate School
Department	Nutrition and Health Sciences
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Health Sciences, General Health Sciences, Epidemiology Health Sciences, Nutrition
Palavra-chave	Dietary patterns 1,000 days Child nutrition Guatemala Latent class growth analysis Cardio-metabolic disease Obesity Developmental origins
Committee Chair / Thesis Advisor	Stein, Aryeh D, Emory University
Committee Members	Martorell, Reynaldo, Emory University Mehta, Neil K., Emory University Ramirez-Zea, Manuel, Institute of Nutrition of Central America and Panama Perrine, Cria, U.S. Centers for Disease Control and Prevention

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