Eduardo Villamor

University of Michigan, Ann Arbor, Michigan, United States

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Publications (139)647.62 Total impact

  • E Villamor · R J Bosch ·

    Annals of Human Biology 11/2015; DOI:10.3109/03014460.2015.1123770 · 1.27 Impact Factor
  • Erica C Jansen · Oscar F Herrán · Eduardo Villamor ·
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    ABSTRACT: Surveillance of age at menarche could provide useful information on the impact of changing environmental conditions on child health. Nevertheless, nationally representative data are exceedingly rare. The aim of this study was to examine trends and sociodemographic correlates of age at menarche of Colombian girls. The study sample included 15,441 girls born between 1992 and 2000 who participated in the Colombian National Nutrition Survey of 2010. We estimated median menarcheal age using Kaplan-Meier time-to-event analyses. Hazard ratios with 95% confidence intervals were estimated with Cox regression models. The median age at menarche was 12.6 years. There was an estimated decline of 0.54 years/decade (P<0.001) over the birth years; this decline was only observed among girls from urban areas, and was more pronounced among girls from wealthier versus poorer families. Child height and BMI, maternal BMI and education, and family wealth were each inversely associated with menarcheal age whereas food insecurity and number of children in the household were positively associated with age at menarche. In conclusion, a negative trend in age at menarche is ongoing in Colombia, especially in groups most likely to benefit from socioeconomic development.
    Economics and human biology 09/2015; 19:138-144. DOI:10.1016/j.ehb.2015.09.001 · 1.90 Impact Factor
  • Ana Baylin · Wei Perng · Mercedes Mora-Plazas · Constanza Marin · Eduardo Villamor ·
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    ABSTRACT: Animal and human adult studies indicate that long-term intake of trans fatty acids (TFAs) may be associated with weight gain. High intake of fast foods and snacks, which are rich in TFAs, is linked to overweight status among school-age children. However, the specific effects of TFAs in this population are unknown. We aimed to examine whether serum TFAs, used as biomarkers of intake, are associated with faster weight gain and linear growth during school years. We quantified TFAs by GLC in serum samples of 668 children aged 5-12 y at the time of recruitment into an ongoing cohort study performed in Bogota (Colombia) since 2006. Serum proportions of trans palmitoleic acid (16:1t), trans oleic acid (18:1t), trans linoleic acid (18:2t), and total TFAs were used as biomarkers of intake. Anthropometric characteristics were measured periodically for a median of 30 mo. Body mass index-for-age z scores (BAZs) and height-for-age z scores (HAZs) were calculated with the use of the WHO reference. We estimated mean change in BAZs and HAZs over follow-up according to quartiles of each TFA at baseline by using mixed-effects regression models with restricted cubic splines. Proportions of trans palmitoleic acid, trans oleic acid, trans linoleic acid, and total TFAs (mean ± SD, % of total serum FAs), were 0.22 ± 0.06, 0.91 ± 0.37, 0.96 ± 0.27, and 2.10 ± 0.59, respectively. Serum TFAs were not associated with changes in BAZs and HAZs after adjusting for sex, baseline age, and socioeconomic status. After subgroup analysis by sex, serum trans palmitoleic acid was positively associated with the estimated change in HAZs from ages 6 to 14 y in boys (with use of the first quartile as the reference, differences in HAZs for trans palmitoleic acid quartiles were 0.73, 0.53, and 0.70, P-trend = 0.03). Proportions of serum TFAs, used as biomarkers of TFA intake, were not associated with weight gain in children aged 6-14 y in low- and middle-income populations in Bogota. The proportion of trans palmitoleic acid was positively associated with linear growth in boys. Longer follow-up and studies in diverse cohorts with wider ranges of TFA intake are warranted. © 2015 American Society for Nutrition.
    Journal of Nutrition 07/2015; 145(9). DOI:10.3945/jn.115.210468 · 3.88 Impact Factor
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    ABSTRACT: Micronutrients are essential to neurocognitive development, yet their role on educational outcomes is unclear. We aimed to examine the associations of micronutrient status biomarkers with risk of grade repetition and rates of school absenteeism in a cohort of school children. We recruited 3156 children aged 5-12 y from public schools in Bogota, Colombia. Circulating ferritin, hemoglobin, zinc, vitamin A, vitamin B-12, erythrocyte folate, and mean corpuscular volume (MCV) were measured in blood samples obtained at the beginning of the year. Absenteeism was recorded weekly during the school year, and grade repetition was determined the next year. Risk ratios for grade repetition and rate ratios for absenteeism were estimated by categories of micronutrient status indicators with use of Poisson regression, adjusting for potential confounders. The risk of grade repetition was 4.9%, and the absenteeism rate was 3.8 d per child-year of observation. Vitamin B-12 deficiency (<148 pmol/L) was associated with an adjusted 2.36-fold greater risk of grade repetition (95% CI: 1.03, 5.41; P = 0.04) compared with plasma concentrations ≥148 pmol/L. Other micronutrients were not related to grade repetition. Vitamin B-12 deficiency was also associated with school absenteeism rates. Compared with children with plasma vitamin B-12 concentrations ≥148 pmol/L, vitamin B-12-deficient children had a 1.89-times higher adjusted rate (95% CI: 1.53, 2.34; P < 0.0001). Anemia was related to a 72% higher rate (95% CI: 48%, 99%; P < 0.0001), whereas every 5-fL difference in MCV was associated with a 7% lower adjusted rate (95% CI: 4%, 10%; P < 0.0001). Vitamin B-12 deficiency was associated with risk of grade repetition and school absenteeism rates in school children from Bogota, Colombia. The effects of correcting vitamin B-12 deficiency on educational outcomes and neurocognitive development of school children need to be determined in intervention studies. © 2015 American Society for Nutrition.
    Journal of Nutrition 05/2015; 145(7). DOI:10.3945/jn.115.211391 · 3.88 Impact Factor
  • Ofra Duchin · Constanza Marin · Mercedes Mora-Plazas · Eduardo Villamor ·
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    ABSTRACT: Parental body image dissatisfaction (BID) is associated with children's weight in cross-sectional studies; however, it is unknown whether BID predicts development of adiposity. The objective of the present study was to investigate the associations between maternal dissatisfaction with her or her child's body and children's BMI trajectories. Longitudinal study. Maternal dissatisfaction (BID) with her and her child's body was calculated based on ratings of Stunkard scales obtained at recruitment, as current minus desired body image. Children's height and weight were measured at baseline and annually for a median of 2·5 years. Mixed-effects models with restricted cubic splines were used to construct sex- and weight-specific BMI-for-age curves according to maternal BID levels. Public primary schools in Bogotá, Colombia. Children (n 1523) aged 5-12 years and their mothers. After multivariable adjustment, heavy boys and thin girls whose mothers desired a thinner child gained an estimated 1·7 kg/m2 more BMI (P=0·04) and 2·4 kg/m2 less BMI (P=0·004), respectively, between the age 6 and 14 years, than children of mothers without BID. Normal-weight boys whose mothers desired a thinner child's body gained an estimated 1·8 kg/m2 less BMI than normal-weight boys of mothers without BID (P=0·02). Maternal BID with herself was positively related to children's BMI gain during follow-up. Maternal BID is associated with child's BMI trajectories in a sex- and weight-specific manner.
    Public Health Nutrition 04/2015; -1:1-6. DOI:10.1017/S1368980015001317 · 2.68 Impact Factor
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    ABSTRACT: Supply of essential n-3 PUFA is limited worldwide. While fish-oil supplementation effectively improves n-3 PUFA status, it may not be a sustainable intervention. The use of α-linolenic acid (ALA)-rich cooking oils in the household may be a suitable alternative but its effect on PUFA status is unclear. We aimed to compare the effect of providing families with soyabean oil, an ALA-rich cooking oil, v. sunflower oil on whole-blood PUFA levels of children aged 11-18 years. In a randomized, masked, parallel trial, we assigned families to receive a one-month supply of either soyabean or sunflower oil. Fatty acid concentrations were quantified in whole-blood samples obtained from the children before and at the end of the intervention. Changes in fatty acids were compared between treatment arms with use of linear regression for repeated measures. Sixty low- and middle-income families. Bogotá, Colombia. Soyabean oil significantly increased ALA concentrations by 0·05 percentage points of total serum fatty acids whereas sunflower oil decreased them by 0·12 percentage points (soyabean v. sunflower oil effect=0·17; 95 % CI 0·11, 0·24). Concentrations of both n-3 and n-6 very-long-chain PUFA, including docosapentaenoic acid, DHA, dihomo-γ-linolenic acid and arachidonic acid, increased significantly in both intervention arms. Levels of oleic acid and palmitic acid decreased, irrespective of oil assignment. Total energy or energy intake from saturated fat did not change. Replacing cooking oils at the household level is an effective intervention to improve essential PUFA status of children.
    Public Health Nutrition 03/2015; -1:1-9. DOI:10.1017/S1368980015000762 · 2.68 Impact Factor
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    ABSTRACT: Long-chain n-3 fatty acid intake in Colombia is low because fish consumption is limited. Vegetable oils with high n-3 fatty acid content are recommended, but their concentrations of trans fats were high in previous studies. Thus, regular monitoring of the fatty acid composition of vegetable oils is required. Our objective was to quantify the fatty acid composition in commercially available oils in Bogota, Colombia and determine if composition changed from 2008 to 2013. Cross-sectional study. We obtained samples of all commercially available oils reported in a survey of low- and middle-income families with a child participating in the Bogota School Children Cohort. Bogota, Colombia. Not applicable. Sunflower oil had the highest trans-fatty acid content (2·18 %). Canola oil had the lowest proportion of trans-fatty acids (0·40 %) and the highest n-3 fatty acid content (9·37 %). In terms of percentage reduction from 2008 to 2013 in 18:1 and 18:2 trans-fatty acids, canola oil had 89 % and 65 % reduction, mixed oils had 44 % and 48 % reduction, and sunflower oil had 25 % and 51 % reduction, respectively. Soyabean oil became widely available in 2013. The content of trans-fatty acids decreased in all oils from 2008 to 2013, suggesting a voluntary reduction by industry. We believe that regular monitoring of the fatty acid composition of oils is warranted.
    Public Health Nutrition 03/2015; -1:1-5. DOI:10.1017/S136898001500049X · 2.68 Impact Factor
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    ABSTRACT: Background: Although many studies have examined health effects of infant feeding, studies on diet quality shortly after the weaning and lactation period are scarce. Objectives: Our aims were to develop and evaluate a diet score that measures overall diet quality in preschool children and to examine the sociodemographic and lifestyle determinants of this score. Methods: On the basis of national and international dietary guidelines for young children, we developed a diet score containing 10 components: intake of vegetables; fruit; bread and cereals; rice, pasta, potatoes, and legumes; dairy; meat and eggs; fish; oils and fats; candy and snacks; and sugar-sweetened beverages. The total score ranged from 0 to 10 on a continuous scale and was standardized to an energy intake of 1200 kcal/d with the residual method. The score was evaluated in 3629 children participating in the Generation R Study, a population-based prospective cohort study. Food consumption was assessed with a food-frequency questionnaire (FFQ) at a median age of 13 mo. Results: The mean +/- SD diet score was 4.1 +/- 1.3. The food-based diet score was positively associated with intakes of many nutrients, including n-3 (omega-3)-31 fatty acids [FAs; 0.25 SD increase 195% CI: 0.22, 0.27) per 1 point increase in the diet score], dietary fiber [0.32 (95% CI: 0.30, 0.34)], and calcium [0.13 (95% CI: 0.11, 0.16)], and was inversely associated with intakes of sugars [-0.28(95% CI: -0.31, -0.26)] and saturated fat [-0.03 (95% CI: -0.05, -0.01)]. A higher diet score was associated with several health-conscious behaviors, such as maternal folic acid supplement use during pregnancy, no smoking during pregnancy, and children watching less television. Conclusion: We developed a novel food-based diet score for preschool children that could be applied in future studies to compare diet quality in early childhood and to investigate associations between diet in early childhood and growth, health, and development.
    Journal of Nutrition 02/2015; DOI:10.3945/jn.114.199349 · 3.88 Impact Factor
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    ABSTRACT: To investigate associations between maternal overweight and obesity and infant mortality outcomes, including cause-specific mortality. Population based cohort study. 1 857 822 live single births in Sweden 1992-2010. Associations between maternal body mass index (BMI) in early pregnancy and risks of infant, neonatal, and postneonatal mortality, overall and stratified by gestational length and by causes of infant death. Odds ratios were adjusted for maternal age, parity, smoking, education, height, country of birth, and year of delivery. Infant mortality rates increased from 2.4/1000 among normal weight women (BMI 18.5-24.9) to 5.8/1000 among women with obesity grade 3 (BMI ≥40.0). Compared with normal weight, overweight (BMI 25.0-29.9) and obesity grade 1 (BMI 30.0-34.9) were associated with modestly increased risks of infant mortality (adjusted odds ratios 1.25 (95% confidence interval 1.16 to 1.35) and 1.37 (1.22 to 1.53), respectively), and obesity grade 2 (BMI 35.0-39.9) and grade 3 were associated with more than doubled risks (adjusted odds ratios 2.11 (1.79 to 2.49) and 2.44 (1.88 to 3.17)). In analyses stratified by preterm and term births, maternal BMI was related to risks of infant mortality primarily in term births (≥37 weeks), where risks of deaths due to birth asphyxia and other neonatal morbidities increased with maternal overweight and obesity. Obesity grade 2-3 was also associated with increased infant mortality due to congenital anomalies and sudden infant death syndrome. Maternal overweight and obesity are associated with increased risks of infant mortality due to increased mortality risk in term births and an increased prevalence of preterm births. Maternal overweight and obesity may be an important preventable risk factor for infant mortality in many countries. © Johansson et al 2014.
    BMJ Clinical Research 12/2014; 349(dec02 6):g6572. DOI:10.1136/bmj.g6572 · 14.09 Impact Factor
  • Eduardo Villamor · Ronald J Bosch ·
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    ABSTRACT: Abstract Background: Anthropometric studies often include replicates of each measurement to decrease error. The optimal method to combine these measurements is uncertain. Aim: To identify the optimal method to combine replicate measures for analysis. Methods: The authors carried out 10 000 Monte Carlo simulations to explore the effect of six approaches to combine replicate measurements in a hypothetical two-group intervention study (n = 100 per arm) in which the outcome, infant length at age 1 year, was measured two or three times. One group had a true value with a normal distribution N (mean = 76, SD = 2.4 cm). Statistical power was estimated to detect a 1 cm difference between the groups, based on a t-test. Results: Under a realistic scenario with a measurement error distribution N (0, 0.8), highest power was reached by use of the mean and the median of pairwise averages. However, when a portion of the data (≥2%) were contaminated by greater error (e.g. due to data entry), the median of three measurements outperformed all other methods while the mean had the lowest performance. Conclusion: Obtaining three rather than two measures and using the median of the three replicates is a safe and robust approach to combine participants' raw data values for use in subsequent analyses.
    Annals of Human Biology 11/2014; 42(5):1-4. DOI:10.3109/03014460.2014.969488 · 1.27 Impact Factor
  • W Perng · E Villamor · M Mora-Plazas · C Marin · A Baylin ·
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    ABSTRACT: Background/objectives: Studies in adults indicate that dietary polyunsaturated fatty acid (PUFA) composition may play a role in development of adiposity. Because adipocyte quantity is established between late childhood and early adolescence, understanding the impact of PUFAs on weight gain during the school-age years is crucial to developing effective interventions. Subjects/methods: We quantified N-3 and N-6 PUFAs in serum samples of 668 Colombian schoolchildren aged 5-12 years at the time of recruitment into a cohort study, using gas-liquid chromatography. Serum concentrations of N-3 (alpha-linolenic acid (ALA), eicosapentaenoic acid, docosahexaenoic acid) and N-6 PUFAs (linoleic acid, gamma-linolenic acid, dihomo-gamma-linolenic acid, arachidonic acid) were determined as percentage total fatty acids. Children's anthropometry was measured annually for a median of 30 months. We used mixed-effects models with restricted cubic splines to construct population body mass index-for-age z-score (BAZ) growth curves for age- and sex-specific quartiles of each PUFA. Results: N-3 ALA was inversely related to BAZ gain after adjustment for sex, baseline age and weight status, as well as household socioeconomic level. Estimated BAZ change between 6 and 14 years among children in the highest quartile of ALA compared with those in the lowest quartile was 0.45 (95% confidence interval: 0.07, 0.83) lower (P-trend=0.006). Conclusions: N-3 ALA may be protective against weight gain in school-age children. Whether improvement in PUFA status reduces adiposity in pediatric populations deserves evaluation in randomized trials.
    European Journal of Clinical Nutrition 10/2014; 69(2). DOI:10.1038/ejcn.2014.210 · 2.71 Impact Factor
  • Oscar F Herrán · Julia B Ward · Eduardo Villamor ·
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    ABSTRACT: Objective: Vitamin B-12 deficiency is associated with many adverse health outcomes and is highly prevalent worldwide. The present study assesses the prevalence of vitamin B-12 deficiency and marginal deficiency in Colombian children and women and examines the sociodemographic correlates of serum vitamin B-12 concentrations in these groups. Design: Cross-sectional, nationally representative survey. Setting: Colombia. Subjects: Children <18 years old (n 7243), pregnant women (n 1781), and nonpregnant women 18-49 years old (n 499). Results: The overall prevalence of vitamin B-12 deficiency (serum vitamin B-12 < 148 pmol/l) and marginal deficiency (serum vitamin B-12 = 148-221 pmol/l) was, respectively, 6.6 % (95 % CI 5.2%, 8.3 %) and 22.5 % (95 % CI 21.1%, 23.9 %). Pregnant women had the highest prevalence of deficiency (18.9 %; 95 % CI 16.6%, 21.5 %) compared with non-pregnant adult women (18.5 %; 95 % CI 4.4%, 53.1%) and children (2.8 %; 95 % CI 2.3 % %, 3.3 %). In multivariable analyses among children, mean serum vitamin B-12 was positively associated with female sex (12 pmol/l higher compared with males; P=0.004), secondary or higher education of the household head (12 pmol/l higher compared with primary or less; P= 0.009) and food security (21 pmol/l higher compared with severe food insecurity; P= 0.003). In multivariable analyses among pregnant women, mean serum vitamin B-12 was positively associated with education of the household head and inversely associated with living in the National territories, Eastern or Pacific regions. Conclusions: The prevalence of vitamin B-12 deficiency and marginal deficiency in Colombian women and children is substantial. The burden falls largely on adult women, those with lowest education and those living in the poorest, most rural regions of the country.
    Public Health Nutrition 06/2014; 18(05):1-8. DOI:10.1017/S1368980014001141 · 2.68 Impact Factor
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    ABSTRACT: Objective To identify a body fat percentage (%BF) threshold related to an adverse cardiometabolic profile and its surrogate BMI cut-off point.Design Cross-sectional study.Setting Two public schools in poor urban areas on the outskirts of Guatemala City.Subjects A convenience sample of ninety-three healthy, prepubertal, Ladino children (aged 7-12 years).Results Spearman correlations of cardiometabolic parameters were higher with %BF than with BMI-for-age Z-score. BMI-for-age Z-score and %BF were highly correlated (r=0·84). The %BF threshold that maximized sensitivity and specificity for predicting an adverse cardiometabolic profile (elevated homeostasis model assessment-insulin resistance index and/or total cholesterol:HDL-cholesterol ratio) according to receiver operating characteristic curve analysis was 36 %. The BMI-for-age Z-score cut-off point that maximized the prediction of BF ≥ 36 % by the same procedure was 1·5. The area under the curve (AUC) for %BF and for BMI data showed excellent accuracy to predict an adverse cardiometabolic profile (AUC 0·93 (sd 0·04)) and excess adiposity (AUC 0·95 (sd 0·02)).Conclusions Since BMI standards have limitations in screening for adiposity, specific cut-off points based on ethnic-/sex- and age-specific %BF thresholds are needed to better predict an adverse cardiometabolic profile.
    Public Health Nutrition 06/2014; 18(06):1-8. DOI:10.1017/S1368980014001207 · 2.68 Impact Factor
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    Emily Walton · Henry Oliveros · Eduardo Villamor ·
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    ABSTRACT: Risk factors for progression from acute malaria to multiple organ dysfunction syndrome (MODS) are poorly understood. The MODS is commonly diagnosed with the sequential organ failure assessment (SOFA) scale, but this scale has been understudied in patients with severe malaria. We conducted a cohort study among 426 adult males admitted to hospital with malaria in Bogotá, Colombia. We estimated SOFA scores and relative risks (RRs) for MODS during hospitalization according to patients' characteristics on admission. Risk of MODS was 7.3% over a median 6.0 days in hospital. Baseline hemoglobin was strongly, inversely associated with MODS (adjusted RR for hemoglobin ≤ 8.5 g/dL versus hemoglobin > 11 g/dL = 9.5, 95% confidence interval [CI]: 3.6, 25.3). Plasmodium falciparum malaria and parasitemia were positively associated with MODS. There was a strong interaction between baseline parasitemia and hemoglobin on MODS risk. In conclusion, the use of parasitemia and hemoglobin on admission to identify high-risk patients deserves consideration.
    The American journal of tropical medicine and hygiene 05/2014; 91(1). DOI:10.4269/ajtmh.13-0640 · 2.70 Impact Factor
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    Martina Persson · Stefan Johansson · Eduardo Villamor · Sven Cnattingius ·
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    ABSTRACT: Background: Maternal overweight and obesity increase risks of pregnancy and delivery complications and neonatal mortality, but the mechanisms are unclear. The objective of the study was to investigate associations between maternal body mass index (BMI) in early pregnancy and severe asphyxia-related outcomes in infants delivered at term (≥37 weeks). Methods and findings: A nation-wide Swedish cohort study based on data from the Medical Birth Register included all live singleton term births in Sweden between 1992 and 2010. Logistic regression analyses were used to obtain odds ratios (ORs) with 95% CIs for Apgar scores between 0 and 3 at 5 and 10 minutes, meconium aspiration syndrome, and neonatal seizures, adjusted for maternal height, maternal age, parity, mother's smoking habits, education, country of birth, and year of infant birth. Among 1,764,403 term births, 86% had data on early pregnancy BMI and Apgar scores. There were 1,380 infants who had Apgar score 0-3 at 5 minutes (absolute risk = 0.8 per 1,000) and 894 had Apgar score 0-3 at 10 minutes (absolute risk = 0.5 per 1,000). Compared with infants of mothers with normal BMI (18.5-24.9), the adjusted ORs (95% CI) for Apgar scores 0-3 at 10 minutes were as follows: BMI 25-29.9: 1.32 (1.10-1.58); BMI 30-34.9: 1.57 (1.20-2.07); BMI 35-39.9: 1.80 (1.15-2.82); and BMI ≥40: 3.41 (1.91-6.09). The ORs for Apgar scores 0-3 at 5 minutes, meconium aspiration, and neonatal seizures increased similarly with maternal BMI. A study limitation was lack of data on effects of obstetric interventions and neonatal resuscitation efforts. Conclusion: Risks of severe asphyxia-related outcomes in term infants increase with maternal overweight and obesity. Given the high prevalence of the exposure and the severity of the outcomes studied, the results are of potential public health relevance and should be confirmed in other populations. Prevention of overweight and obesity in women of reproductive age is important to improve perinatal health.
    PLoS Medicine 05/2014; 11(5):e1001648. DOI:10.1371/journal.pmed.1001648 · 14.43 Impact Factor
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    ABSTRACT: Body image dissatisfaction (BID) in school-age children is positively associated with weight status in cross-sectional studies; however, it is uncertain whether BID is a risk factor for the development of adiposity over time. The aim of the present study was to examine the association of BID with changes in BMI in school-age children. Longitudinal study. At recruitment, children were asked to indicate the silhouette that most closely represented their current and desired body shapes using child-adapted Stunkard scales. Baseline BID was calculated as the difference of current minus desired body image. Height and weight were measured at recruitment and then annually for a median of 2·5 years. Sex-specific BMI-for-age curves were estimated by levels of baseline BID, using mixed-effects models with restricted cubic splines. Public primary schools in Bogotá, Colombia. Six hundred and twenty-nine children aged 5-12 years. In multivariable analyses, thin boys who desired to be thinner gained an estimated 5·8 kg/m2 more BMI from age 6 to 14 years than boys without BID (P = 0·0004). Heavy boys who desired to be heavier or thinner gained significantly more BMI than boys without BID (P = 0·003 and P = 0·007, respectively). Thin girls who desired to be heavier or thinner gained significantly less BMI than girls without BID (P = 0·0008 and P = 0·05, respectively), whereas heavy girls who desired to be heavier gained an estimated 4·8 kg/m2 less BMI than girls without BID (P = 0·0006). BID was not related to BMI change in normal-weight children. BID is associated with BMI trajectories of school-age children in a sex- and weight-specific manner.
    Public Health Nutrition 04/2014; 18(2):1-7. DOI:10.1017/S1368980014000366 · 2.68 Impact Factor
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    ABSTRACT: Infection is an important cause of morbidity throughout childhood. Poor micronutrient status is a risk factor for infection-related morbidity in young children, but it is not clear whether these associations persist during school-age years. We examined the relation between blood concentrations of micronutrient status biomarkers and risk of gastrointestinal and respiratory morbidity in a prospective study of 2774 children aged 5-12 y from public schools in Bogotá, Colombia. Retinol, zinc, ferritin, mean corpuscular volume, hemoglobin, erythrocyte folate, and vitamin B-12 concentrations were measured in blood at enrollment into the cohort. Children were followed for 1 academic year for incidence of morbidity, including diarrhea with vomiting, cough with fever, earache or ear discharge with fever, and doctor visits. Compared with adequate vitamin A status (≥30.0 μg/dL), vitamin A deficiency (<10.0 μg/dL) was associated with increased risk of diarrhea with vomiting [unadjusted incidence rate ratio (IRR): 2.17; 95% CI: 0.95, 4.96; P-trend = 0.03] and cough with fever (unadjusted IRR: 2.36; 95% CI: 1.30, 4.31; P-trend = 0.05). After adjustment for several sociodemographic characteristics and hemoglobin concentrations, every 10 μg/dL plasma retinol was associated with 18% fewer days of diarrhea with vomiting (P < 0.001), 10% fewer days of cough with fever (P < 0.001), and 6% fewer doctor visits (P = 0.01). Every 1 g/dL of hemoglobin was related to 17% fewer days with ear infection symptoms (P < 0.001) and 5% fewer doctor visits (P = 0.009) after controlling for sociodemographic factors and retinol concentrations. Zinc, ferritin, mean corpuscular volume, erythrocyte folate, and vitamin B-12 status were not associated with morbidity or doctor visits. Vitamin A and hemoglobin concentrations were inversely related to rates of morbidity in school-age children. Whether vitamin A supplementation reduces the risk or severity of infection in children over 5 y of age needs to be determined.
    Journal of Nutrition 02/2014; 144(4). DOI:10.3945/jn.113.185876 · 3.88 Impact Factor
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    ABSTRACT: Although child undernutrition and stunting has been decreasing worldwide while obesity rates increase, these extreme conditions might coexist in families from low- and middle-income countries. We examined the association between maternal and child anthropometric indicators using a population representative sample. 4,258 non-pregnant women and their children <60 months who participated in the 2006 Brazilian Demographic Health Survey. We compared the distributions of two nutritional indexes of children, height-for-age (HAZ) and body mass index-for age (BAZ) z-scores, by categories of maternal height, body mass index (BMI), and waist circumference (WC). Adjusted mean differences and 95% confidence intervals (95% CI) were estimated from linear regression, taking into account the complex survey design. We also examined the associations of maternal anthropometry with the prevalence of child stunting (HAZ<-2) and overweight/obesity (BAZ>2). HAZ was positively associated with maternal height and WC in a linear fashion. After adjustment, for sociodemographic characteristics, children whose mothers' height was<145 cm had 1.2 lower HAZ than children whose mothers were ≥160 cm tall (p-trend<0.0001). After further adjustment for maternal height and maternal BMI, children of mothers with a waist circumference ≥88 cm had 0.3 higher HAZ than those of mothers with WC<80 cm (p-trend<0.01). Adjusted prevalence ratios and 95% CI for stunting by the categories of maternal height (<145, 145-149, 150-154, 155-159 and ≥160 cm) were, respectively, 2.95 (1.51;5.77), 2.29 (1.33;3.93), 1.09 (0.63;1.87), and 0.89 (0.45;1.77), (p-trend = 0.001). BAZ was positively associated with maternal BMI and WC. We observed a strong, positive association of maternal and child nutritional status. Mothers of low stature had children with lower stature, mothers with central obesity had taller children, and mothers with overall or abdominal obesity had children with higher BAZ.
    PLoS ONE 01/2014; 9(1):e87486. DOI:10.1371/journal.pone.0087486 · 3.23 Impact Factor
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    ABSTRACT: Obesity is highly related to negative reproductive health outcomes, but its relationship with spontaneous abortion and stillbirth remains to be understood, especially in transitioning economies. This study aimed to examine the relationship between obesity and spontaneous abortions and stillbirths in a representative sample of the Brazilian population. Cross-sectional study using secondary data of Brazilian women of reproductive age (15-45 years old) from the National Demographic and Health Survey in 2006. Obesity was measured by body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHR). Logistic regression modeling of the survey data was used to evaluate the relationship between obesity and the study outcomes. The three obesity markers used were found to be strongly and positively associated with spontaneous abortion and stillbirth occurrence. In the adjusted models, there was strong evidence that for each unit increase in BMI (OR = 1.05; 95%CI: 1.02-1.08) and WHR (OR = 1.32; 95%CI: 1.03-1.69), the odds of having a spontaneous abortion was higher. In addition, compared to those of optimal weight, obese women were more likely to have negative outcomes. Maternal age, parity, skin color, educational level and household income were important covariates for adjustment. A sensitivity analysis among women who had only one pregnancy was also performed and showed similar results. Obesity is potentially associated with an increased risk of spontaneous abortion and stillbirth in a representative sample of the Brazilian population. These findings are in accordance with previous studies and thus reinforce the need for obstetric care providers to counsel obese reproductive-age women regarding the risks, complications and importance of weight loss and weight control prior to pregnancy.
    BMC Pregnancy and Childbirth 01/2014; 14(1):5. DOI:10.1186/1471-2393-14-5 · 2.19 Impact Factor
  • Nicole M Kasper · Oscar F Herrán · Eduardo Villamor ·
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    ABSTRACT: Low- and middle-income countries are experiencing rises in the prevalence of adult obesity. Whether these increases disproportionately affect vulnerable subpopulations is unclear because most previous investigations were not nationally representative, were limited to women, or relied on self-reported anthropometric data which are subject to bias. The aim of the present study was to assess changes in the prevalence of obesity from 2005 to 2010 in Colombian adults; overall and by levels of sociodemographic characteristics. Two cross-sectional, nationally representative surveys. Colombia. Men and women 18-64 years old (n 31 105 in 2005; n 81 115 in 2010). The prevalence of obesity (BMI ≥30 kg/m2) was 13·9 % in 2005 and 16·4 % in 2010 (prevalence difference = 2·7 %; 95 % CI 1·9, 3·4 %). In multivariable analyses, obesity was positively associated with female sex, age, wealth, and living in the Pacific or National Territories regions in each year. In 2010, obesity was also associated with living in an urban area. The change in the prevalence of obesity from 2005 to 2010 varied significantly according to wealth; 5·0 % (95 % CI 3·3, 6·7 %) among the poorest and 0·3 % (95 % CI -1·6, 2·2 %) in the wealthiest (P, test for interaction = 0·007), after adjustment. Obesity rates also increased faster in older than younger people (P, test for interaction = 0·01), among people from urban compared with non-urban areas (P, test for interaction = 0·06) and in adults living in the Atlantic region compared with others. Adult obesity prevalence has increased in Colombia and its burden is shifting towards the poor and urban populations.
    Public Health Nutrition 01/2014; 17(11):1-9. DOI:10.1017/S1368980013003418 · 2.68 Impact Factor

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  • 2009-2015
    • University of Michigan
      • • Department of Epidemiology
      • • Department of Environmental Health Sciences
      Ann Arbor, Michigan, United States
    • Tufts University
      Georgia, United States
  • 2014
    • Universidad de La Sabana
      Chía, Cundinamarca, Colombia
  • 2013
    • Karolinska University Hospital
      Tukholma, Stockholm, Sweden
  • 2002-2013
    • Harvard University
      • Department of Nutrition
      Cambridge, Massachusetts, United States
  • 2000-2013
    • Harvard Medical School
      • Division of Nutrition
      Boston, Massachusetts, United States
  • 2011
    • Aarhus University
      • Department of Public Health
      Aarhus, Central Jutland, Denmark
    • Karolinska Institutet
      Solna, Stockholm, Sweden
  • 2006
    • Muhimbili University of Health and Allied Sciences
      • Department of Internal Medicine
      Dar es Salaam, Dar es Salaam Region, Tanzania