Institute Of Nutrition Of Central America And Panama Research Articles

Early Childhood Nutrition and Cognitive Functioning in Childhood and Adolescence.

The Institute of Nutrition of Central America and Panama (INCAP) Longitudinal Study provides a unique opportunity to examine the role of nutrition in cognitive functioning over time, controlling for other sociocultural factors. This article describes results of analyses carried out in the INCAP Longitudinal Study on relationships between early childhood nutritional status and supplementation with concurrent and subsequent cognitive development in childhood and adolescence/young adulthood. Articles were chosen for review that addressed this topic from the original and 1988 follow-up studies; 41 articles were reviewed and key results summarized for relationships between early nutrition and cognition in infancy, early childhood, and adolescence/young adulthood. Overall, results suggest strong relationships between indicators of a child's early nutritional status and motor and cognitive development in infancy and through the preschool years, continuing into adolescence/young adulthood, particularly for males. Nutritional supplementation during gestation through 2 years of age was associated with improvements in motor development and small, but consistent improvements in cognitive development during infancy and preschool years, with similar results of greater magnitude found with cognitive functioning in adolescence and young adulthood. Findings remain strong after controlling for various sociocultural factors (eg, socioeconomic status [SES]) and schooling. Among adolescents, significant interactions were found with SES and years of school attained; differences in performance favored Atole over Fresco children, with greatest differences for participants of low SES and those with higher levels of schooling. Results support the need for programs to address unmet nutritional requirements among at-risk mothers and children and potential beneficial effects for human cognitive development.

History and Design of the INCAP Longitudinal Study (1969-1977) and Its Impact in Early Childhood.

The Institute of Nutrition of Central America and Panama (INCAP) longitudinal study of 1969 to 1977 was a community randomized trial in which 2 pairs of matched villages received either a protein-rich gruel (atole) or a nonprotein, low-energy drink (fresco). Both contained equal amounts of micronutrients by volume. I review the history and design of the study and impact on dietary intakes and physical growth. The design dates from the 1960s when protein was seen as the main dietary deficiency. During the 1970s, emphasis shifted to energy deficiency and this influenced early analyses. Energy from the 2 drinks during pregnancy was associated with improved birthweights and whether protein was also provided along with energy appeared to make no difference. These analyses, observational in nature, were possible because there was substantial overlap in energy intakes from the supplements during pregnancy across village types. In children, analyses initially focused on energy but eventually relied on the original experimental design. Exposure to the atole compared to fresco was associated with improved physical growth at 3 years of age but not from 3 to 7 years. Consumption of the fresco in the first 3 years of life was low such that there was little overlap in energy intakes from the supplements, not allowing for the type of analyses done for pregnancy. Diets in atole villages were greater from 15 to 36 months in protein, energy, and micronutrients, making attribution of impact on growth to a specific nutrient impossible. The atole improved linear growth, arm, and calf circumferences at 3 years but not skinfold thicknesses.

Social and Economic Development and Change in 4 Guatemalan Villages Over a Half Century.

This article describes nearly 50 years of social and economic development and changes that have occurred in the 4 villages of the Institute of Nutrition of Central America and Panama (INCAP) Longitudinal Study (1969-1977). In doing so, it contextualizes the changes in health and nutrition for the study population over that period. Since the start of the INCAP Longitudinal Study, the original 4 villages, like their home country, have undergone tremendous demographic, social, and economic change. Originally rather isolated, road and transportation access for the villages has improved steadily and substantially. The population in the villages has more than doubled. Schooling access and outcomes have also improved substantially, with average grades of schooling tripling and literacy doubling, reaching levels currently on par with national averages. Occupations have also changed over the course of a generation. Early on, subsistence farming and agriculture in general were dominant but are now much less common. Much of this change is associated with declining agricultural markets alongside increased access to nonagricultural jobs near the villages and in the capital. With all these changes have come improvements in living standards. It is within this dynamic context that study participants for the INCAP Longitudinal Study were born and raised and where most now live as adults.

FROM BIRTH TO ADULTHOOD: ANTHROPOMETRIC TRAJECTORIES AND THEIR IMPLICATIONS FOR CHRONIC DISEASES IN GUATEMALA.

The objective of this paper was to study nutritional status and growth, as measured by height and weight, over the life course and their connection with chronic diseases in Guatemala, a country with high levels of child undernutrition and adult overnutrition, using data from the Institute of Nutrition of Central America and Panama (INCAP) Nutrition Trial Cohort study. The study sample comprised a birth cohort of 1570 individuals who had data in the original 1969-1977 survey as well as the 2002-2004 follow-up, allowing for an analysis of the nutritional transition from childhood to adulthood. The associations between childhood and adulthood anthropometrics were analysed, and the links of these with chronic disease indicators were assessed using multiple regression analysis and structural equation modelling. Moving upwards in nutritional status from childhood to adulthood was observed frequently in the study population. Unlike sex and place of residence, early anthropometrics were not generally found to be associated with adult body mass index (BMI). However, direct relationships were found between childhood nutritional status and growth and adulthood high-density lipoprotein (HDL) cholesterol, triglycerides and fasting blood glucose. Furthermore, these relationships were not mediated by BMI. The findings were not sensitive to the metric of childhood anthropometrics, as the use of length-for-age, weight-for-age and weight-for-length all resulted in similar conclusions. These relationships demonstrate the importance of early childhood conditions for later-life outcomes. However, the lack of such relationships for blood pressure suggests that the biological links between childhood anthropometrics and various chronic diseases might vary.

Current practices and strategies to improve the food environment in low‐income schools to reduce non‐communicable risk factors in children in Guatemala City: a qualitative study (1019.21)

Developing countries like Guatemala have recently undergone rapid transitions driven by globalization and development. These have accelerated the increase in prevalence of overweight, obesity and non‐communicable disease risk factors among children. Schools have been identified as effective settings for early intervention and favorable arenas in which to target children’s dietary behaviors, especially through structural approaches. The pilot phase of ¡Pilas!, a school‐based intervention developed by the Institute of Nutrition of Central America and Panama (INCAP), with the support of Johns Hopkins University, sought to improve children’s nutrition but was unsuccessful in its objective to facilitate positive change in school food kiosks (casetas). The aim of this qualitative study is to better understand influencing factors on nutrition within the context of low‐income elementary schools in Guatemala City and to improve the school food environment by identifying strategies targeted at casetas. In‐depth interviews with school principals (n=4) and food vendors (n=4) and focus groups involving interactive activities with children (n=48) were conducted. The current food environment is shaped by school and government regulations and enforcement, products available at casetas, food and/or money brought from home and school provided snack (refacción). Other determinants of dietary behavior include children’s preferences, product pricing, and parental time and concern for nutrition. The degree to which regulations are understood and enforced at each school, as well as evident vendor challenges, are necessary to consider in identifying appropriate intervention level and design. Hopeful strategies to be further piloted include enforcement policies, healthy and creative food preparation, price manipulation and promotions, raffles and games, as well as government and big company involvement.Grant Funding Source: Institute of Nutrition of Central America and Panama (INCAP)

Reynaldo Martorell: driving force in maternal and child nutrition

Reynaldo Martorell: driving force in maternal and child nutrition

Errata

From the December 2009 supplement, Multiple Micronutrient Supplementation During Pregnancy in Developing Country Settings, the following figures should have been published as follows: In, “Multiple micronutrient supplementation during pregnancy in low-income countries: A meta-analysis of effects on stillbirths and on early and late neonatal mortality” by Carine Ronsmans, David J. Fisher, Clive Osmond, Barrie M. Margetts, Caroline H. D. Fall, and the Maternal Micronutrient Supplementation Study Group (MMSSG) Page 552 — Figure 5. Random effects model forest plots for effects of multiple micronutrient supplementation on early neonatal deaths. CI, confidence interval; ES, effect size. In, “Multiple micronutrient supplementation during pregnancy in developing-country settings: Policy and program implications of the results of a meta-analysis” by Roger Shrimpton, Sandra L. Huffman, Elizabeth R. Zehner, Ian Darnton-Hill, and Nita Dalmiya Page 562 — Figure 1. Average adherence to supplementation in the meta-analysis studies In, Special Issue: Research from the Institute of Nutrition of Central America and Panama (INCAP) 1949–1999, Volume 31, Number 1: The introductory article by Nevin S. Scrimshaw entitled “The Origin and Development of INCAP” inadvertently omitted some key words on page 6, second column, first paragraph. It was Fernando Viteri, who after an outstanding research career at INCAP, “… became the head of food and nutrition at PAHO/WHO, Washington and later a full professor at the University of California, Berkeley and Scientist at the Children's Hospital Oakland Research Institute.”

INCAP Studies of Vegetable Proteins for Human Consumption

This article describes the efforts of the Institute of Nutrition of Central America and Panama (INCAP) to develop a relatively low-cost vegetable protein mixture suitable as a complementary food for infants and young children. As it turned out, the resulting product became popular with older children and adults, and its superior nutritional benefits were widely recognized by the population. This effort led to broader studies by INCAP of the nutritional quality of vegetable protein mixtures, including raw materials, processing to convert them into human-grade products, product formulation, and commercialization.

Reflections on the Legacy of INCAP

The second Director of the Institute of Nutrition of Central America and Panama (INCAP) reminisces about the productive program of valuable and practical research at the highest level developed with local personnel in a small and poor developing region. The same was true for the world-class advanced training program that contributed many hundreds of professionals, not only to the region, but to all of Latin America and to other countries. The major contributions of INCAP in its first 25 years are cited along with reasons for its success.

Nutrition, Poverty Alleviation, and Development in Central America and Panama

This paper reviews research with policy relevance for food and nutrition in Central America and similar areas. The research was conducted by the Institute of Nutrition of Central America and Panama (INCAP) during the last three decades of the past millennium (1970-99). Six policy areas were selected for this review: agricultural commercialization and rural development; wage and price policies; human resource development; social safety nets, particularly complementary food programs; multi-sectoral nutrition planning; and food and nutrition monitoring for policy formulation. The contents and major conclusions of the work are described, as well as their public policy implications.

INCAP Studies of Malnutrition and Cognitive Behavior

The Institute of Nutrition of Central America and Panama (INCAP) has made major contributions to the study of the effects of malnutrition on learning. This report summarizes work on the relationship of nutrition to children's learning and development from the 1960's through 1998. The Oriente Longitudinal Study examined the effects of two types of supplementation for mothers and young children on their growth and development (an energy-only drink compared with a protein-energy drink) using a quasi-experimental design. Both drinks were supplemented with micronutrients, and were offered daily. As a result of the research on malnutrition and mental development, researchers could conclude by 1993 that supplementary feeding of infants and young children resulted in significant increases cognitive development and school performance through adolescence. The research also suggested that the pathways that link malnutrition with later development are not only through the neurological system but also operate through changes in child behavior which affect the kinds of care children receive. Other research on learning and development showed that families understood the concept of intelligence, demonstrated the link between micronutrients and cognitive development, and documented the amount of wastage or repetition and drop-out that occurs in Guatemalan schools.

Research from the Institute of Nutrition of Central America and Panama (INCAP) 1949 – 1999

Research from the Institute of Nutrition of Central America and Panama (INCAP) 1949 – 1999

INCAP Studies of Nutrition and Infection

As soon as the Institute of Nutrition of Central America and Panama (INCAP) began to study the poor nutritional status and stunting of children in the rural villages of Central America, it was apparent that infections, particularly diarrheas, were also a serious problem. Studies of kwashiorkor indicated that infections precipitated kwashiorkor and anemia in children who were already malnourished. In the 1940s there was almost no suggestion in the literature of a relation between nutrition and infection. INCAP gradually identified the mechanisms by which any infection worsens nutritional status and demonstrated that infections were more severe and more often fatal in malnourished children and adults. These studies ultimately led to the 1968 World Health Organization (WHO) monograph "Interactions of nutrition and infection" and widespread recognition by public health workers of the importance of this relationship for morbidity and mortality in poorly nourished populations.

History and Early Development of INCAP ,

Nevin Scrimshaw was the founding Director of the Institute of Nutrition of Central America and Panama (INCAP), serving as Director from 1949 to 1961. In this article, he reviews the history of the founding of INCAP, including the role of the Rockefeller and Kellogg Foundations, the Central American governments, and the Pan American Health Organization. The objectives pursued by INCAP in its early years were to assess the nutrition and related health problems of Central America, to carry out research to find practical solutions to these problems, and to provide technical assistance to its member countries to implement solutions. INCAP pursued a strategy of selecting promising Central Americans for advanced education and training in the US who assumed positions of leadership on their return. After this early phase, talented non-Central Americans of diverse origins were brought to INCAP, as well as additional researchers from the region. Growth of INCAP, as reflected in its annual budget and in the physical plant, was rapid and this was accompanied by high scientific productivity. Several field studies were launched that contributed impetus and design elements for the Oriente Longitudinal Study, which is the focus of this supplement.

Introduction: The Development and Legacy of the INCAP Oriente Studies 1969–20091–3

A symposium was organized at the request of the History of Nutrition Research Interest Section of the ASN to update the findings on the long-term effects of the nutrition intervention of the Institute of Nutrition of Central America and Panama (INCAP) Oriente Longitudinal Study (1969–77) since the previous syntheses (1–3). The symposium was also cosponsored by the International Nutrition Council of ASN. The original study was a community-randomized, food supplementation trial that contributed important and novel information about the effects of improved nutrition on maternal and newborn nutrition and on child growth and development. Several studies, both cross-sectional and longitudinal, have been undertaken to collect a variety of information on former participants of the study and their families. This unique collection of studies allows the tracing of long-term effects of the nutrition intervention in early childhood on human health and function decades later. The original 1969–77 study was a product of the vigorous and novel research program in human growth and development of the INCAP in the 1960s. In the first article, Nevin S. Scrimshaw, founding director of INCAP in 1949, gives an account of the establishment of this remarkable institution and of its mission, guiding principles, and scientific culture in its early years (4). Dr. Scrimshaw also provided the intellectual (5) and motivational leadership for what became the Oriente study. In addition, Dr. Scrimshaw reviews several studies that preceded and informed the design and methods of the Oriente study. He has remained, through all these years, a stalwart supporter and promoter of the Oriente study. Manuel Ramirez-Zea, Paul Melgar, and Juan Rivera summarize the design and methods of the 1969–77 study and the many studies that have followed, including one just completed that focused on 3 generations (parents in the 1969–77 study, former participants who were children in 1969–77, and their children) and that no doubt will yield important results when the analyses are completed (6). Two articles follow that review the evidence from past and continuing analyses of the original data for the more immediate effects on the nutrition of the pregnant mother, her newborn baby, and her young child. Kathleen Rasmussen and J-P. Habicht (7) summarize the findings about the maternal characteristics that predicted improvements in maternal status and birthweight as a result of the nutrition intervention. A well-known finding from the original study is that the dietary factor limiting birthweight was energy and not protein. The authors also summarize the evidence for differential partitioning of benefits to mother and newborn depending on the mother's nutritional status. Jean-Pierre Habicht and Reynaldo Martorell (8) follow with an article about the evidence and external validity that establishes that the effect of the intervention on child growth was causal, that it was due to improved nutrition from supplementation, and that it benefited some children more than others. This sets the stage for the next article by Reynaldo Martorell, Paul Melgar, John A. Maluccio, Aryeh D. Stein, and Juan A. Rivera (9) that presents evidence of the long-term impact of this nutrition intervention during early childhood on human capital and economic productivity, relying on findings from the 1988–89 and 2002–04 follow-up studies. Perhaps the most noteworthy recent result is a 46% increase in wages in men traced to exposure before 2 y of age to the nutritious drink, Atole, compared with exposure to the less nutritious drink, Fresco. Marie Ruel (10) closes the symposium with an analysis of the implications of the findings from the Oriente study and its subsequent studies for policies and programs worldwide. Perhaps the most profound implication of the Oriente collection of studies has been the identification of the intrauterine period and the first 2 y of life as critical windows of human development when nutrition improvements will have profound and long-lasting benefits on health and well-being. As part of the display at INCAP's booth accompanying the symposium at EB2009, Paul Melgar of INCAP created a historical flyer about INCAP (Supplemental Tables 1 and 2) and developed a list of scientists who were involved with the Oriente study from its inception until today (Supplemental Table 3). We also compiled a list of the many publications in journals and books, as well as theses, that used the data from the Oriente study (Supplemental Table 4).

Reproductive performance and nutrition during childhood.

The Institute of Nutrition of Central America and Panama (INCAP) has analyzed the findings of a series of studies conducted in 4 villages in the Spanish-speaking area of Guatemala to test the hypothesis that nutrition during early childhood plays a key role in future reproductive performance. The researchers relied heavily on the findings of a study of food supplementation during pregnancy. The nutrition intervention was a nutritious drink (vegetable protein mix dry skim milk sugar and flavoring) called Atole. The control supplement was a non-protein sweet drink called Fresco. The children younger than 3 of the women who consumed Atole during pregnancy had an 11% higher intake of energy a 42% higher intake of protein and a greater growth in length for age than those whose mothers consumed Fresco (e.g. in girls an increase in length of 2.5-3.6 cm vs. little or no change). Atole consumption had reduced the proportion of children who were severely growth retarded from almost 50% to about 13%. A follow-up study of the children in the food supplementation study showed that the effects of the nutrition intervention translated into greater adult height weight and fat-free mass in women. The differences in weight and fat-free mass between the case and control villages were more than 2 kg in each case. Among the young adults who had been younger than age 3 in the food supplementation study Atole consumption during mothers pregnancy was associated with high intellectual performance especially in reading and achievement vocabulary (p < 0.001) and in those at higher levels of education. Atole had no apparent effect on intellectual performance at low levels of education however. Birth weights of the third generation appeared to be greater among children whose mothers consumed Atole during pregnancy than those whose mothers consumed Fresco (2.9 vs. 2.73 kg; low birth weight prevalence = 12% vs. 28%). These findings suggest that improving the nutrition of little girls is a key way to achieve safe motherhood and healthy child development.

Cohort Profile: The Institute of Nutrition of Central America and Panama (INCAP) Nutrition Trial Cohort Study

In the mid-1960s, protein deficiency was seen as themost important nutritional problem facing the poor inthe developing countries, and there was considerableconcernthatthisdeficiencyaffectedchildren’sabilitytolearn. The Institute of Nutrition of Central America andPanama (INCAP), based in Guatemala, became thelocusofaseriesofstudiesonthissubject,thatinformedthe development of a large-scale randomized nutri-tional intervention trial that ran from 1969 to 1977.

The Human Capital Study 2002–04: Tracking, data Collection, Coverage, and Attrition

Between 2002 and 2004, the Institute of Nutrition of Central America and Panama (INCAP), in collaboration with Emory University, the International Food Policy Research Institute (IFPRI), and the University of Pennsylvania, re-surveyed young Guatemalan adults who had, as children, been participants in a nutrition supplementation trial conducted by INCAP between 1969 and 1977. This "Human Capital Study 2002-04" complements and extends data obtained in previous studies by collecting new information on measures of physical health and well-being, schooling and cognitive ability, wealth, consumption and economic productivity, and marriage and fertility histories. This paper describes the study domains and data collection procedures. Among 2,393 members of the original sample, 1,856 (77%) were targets for enrollment. Response rates varied by gender, current place of residence, and domain of data collection, with 80% of males and 89% of females completing at least one data collection instrument. Attrition was not random and appears to be associated with a number of initial characteristics of individuals and their households that should be controlled for in future analyses. We conclude that data collection was successful and data quality is high, facilitating the successful undertaking of our planned investigation of important study hypotheses.

Social and Economic Development and Change in four Guatemalan Villages: Demographics, Schooling, Occupation, and Assets

This article uses census data and village histories to examine changes over the last 35 years in the four villages where the Institute of Nutrition of Central America and Panama (INCAP) Longitudinal Study (1969-77) was conducted and offers a rare picture of development and change in rural localities over a long period of time. In addition, by characterizing the environment in which the subjects of this study were raised, we provide context for and inputs into quantitative analyses of data collected at various points in time on these subjects. The villages have undergone massive demographic, social, and economic change. Initial differences have conditioned many of these changes, especially differences associated with agricultural potential and location. Originally these villages were rather isolated, but road and transportation access has improved substantially. The populations in the villages have more than doubled and also have aged. While marriage patterns have held steady, religious practice has changed a great deal. After many years of steady out-migration, three of the four villages are more recently experiencing net in-migration, a pattern associated with ease of access. Schooling access and outcomes also have improved, with average grades of schooling nearly tripling and literacy doubling to levels currently above national averages. Although agriculture remains an important component of individual livelihood strategies, non-agricultural sources of employment have become more important. Much of this change is associated with declining agricultural markets and increased access to non-agricultural jobs near the villages and in the capital. Accompanying these changes has been an improvement in living standards as measured by a number of indicators of household living conditions and consumer durable goods.

Research Note: A Socioeconomic Index for the INCAP Longitudinal Study 1969–77

In this note, we calculate and describe proxy measures that account for variation in standard of living across subjects in the Institute of Nutrition of Central America and Panama (INCAP) Longitudinal Study (1969-77), at the time of the original intervention. Using principal components analysis, we construct two linear indices from an array of household consumer durable goods and housing characteristics, measured at the nuclear family level in the 1975 cross-sectional census. The two indices perform well on three dimensions. First, they are internally coherent in that average ownership and quality of housing characteristics increase with the principal component score. Second, they are robust in that the different approaches yield similar results, for example, in classifying nuclear families into tertiles. And third, they are consistent in that they yield results similar to scores constructed by previous researchers. The indices can be used as background controls in analyses of the INCAP Longitudinal Study (1969-77) data and subsequent follow-up studies, including the Human Capital Study 2002-04. Several articles presented in this supplement to the Food and Nutrition Bulletin used the 1975 index.