No abstract

The objective was to review whether nutrition during pregnancy and the first 3 y of life predisposes individuals to be fatter as adults. The roles of undernutrition, overnutrition and breastfeeding were considered. The evidence that poor nutrition in early life is a risk factor for increased fatness later in life is inconclusive. Overnutrition, as proxied by high birthweight or gestational diabetes, on the other hand, is associated with subsequent fatness. Two large, well-conducted studies in developed countries suggest that breastfeeding has a protective effect. Nutrition in early life has a demonstrable but small impact on adult obesity.

Current knowledge on the role of intergenerational effects on linear growth is reviewed on the basis of a literature search and recent findings from an ongoing study in Guatemala. Fourteen studies were identified, most of which examined the intergenerational relationships in birth weight. Overall, for every 100 g increase in maternal birth weight, her child's birth weight increased by 10-20 g. The study samples were primarily from developed countries, and birth weight data were extracted from hospital records and/or birth registries. Among the few studies that examined associations between the adult heights of parents and their offspring, correlation coefficients of 0.42-0.5 were reported. None of the studies examined intergenerational relationships in birth length or linear growth patterns during early childhood, preadolescence and/or adolescence. Prospectively collected data from long-term studies being carried out in rural Guatemala provide the first evidence of intergenerational relationships in birth size in a developing country setting. Data were available for 215 mother-child pairs. Maternal birth size was a significant predictor (P < 0.05) of child's birth size after adjusting for gestational age and sex of the child and other potential confounders. Child's birth weight increased by 29 g/100 g increase in maternal birth weight which is nearly twice that reported in developed countries. Similarly, child's birth length increased by 0.2 cm for every 1 cm increase in mother's birth length. The effect of maternal birth weight remained significant even after adjusting for maternal adult size. More evidence from developing countries will help explain the underlying mechanisms and identify appropriate interventions to prevent growth retardation.

To examine whether poor growth in utero or young childhood is associated with adult abdominal fatness in a developing country context, the authors analyzed prospectively collected data on 372 female and 161 male Guatemalans measured as children between 1969 and 1977 and remeasured as adults in 1988-1989 (men and women) and 1991-1994 (women only). Childhood stunting (height-for-age z score) was associated with a lower body mass index and percent body fat in men, while no associations were found in women. In both sexes, however, severely stunted children had significantly greater adult abdominal fatness (waist:hip ratio), once overall fatness and confounders were controlled. The adult waist:hip ratio (x100) was increased by 0.65 (95% confidence interval 0.10 to 1.20) in men and 0.29 (95% confidence interval -0.03 to 0.61) in women for each height-for-age z score less at age three. Migration to urban centers was significantly associated with an even greater waist:hip ratio in severely stunted females (p = 0.03). In a subsample of 137 women, short and thin newborns had significantly greater adult abdominal fatness compared with long and thin or short and fat newborns or children who became stunted postnatally. The adult waist:hip ratio (x100) was increased by 1.58 (95% confidence interval 0.35 to 2.81) for each kilogram less birth weight. The authors conclude that, in countries where maternal and child malnutrition exists alongside rapid economic development and urban migration, abdominal obesity and related chronic diseases are likely to increase.

Objective: The purpose of the study was to assess the validity of a 52-item semiquantitative food-frequency questionnaire (FFQ) by comparing it with multiple 24-hour dietary recalls. Design: Three non-consecutive 24-hour dietary recalls and one FFQ were administered over a one-month period. Setting: Four communities of El Progreso, Guatemala. Subjects: Seventy-three individuals aged 22 -55 years. Results: Intakes of energy and other nutrients as measured by the FFQ were higher than intakes measured by 24-hour recalls. Energy was overestimated by 361 kcal, and nutrient overestimates were particularly great for vitamin C and iron. Pearson correlation coefficients for crude energy and nutrients intakes ranged from 0.64 for energy to 0.12 for vitamin C. Exact agreement for both methods (measured by the concordance correlation coefficient) ranged from 0.59 (fat) to 0.06 (vitamin C). Pearson correlation coefficients for energy-adjusted nutrients ranged from 0.59 (carbohydrates) to 0.11 (thiamin). Pearson correlation coefficients for the proportion of total energy derived from specific foods ranged from 0.59 (tortillas) to 0.01 (sugared beverages). Cross-classification of quartiles of crude nutrient intakes for both methods indicated that , 11% were grossly misclassified; after adjusting for energy intake, ,13% were grossly misclassified. Conclusions: This FFQ provides good measures of energy and macronutrient intakes and a reasonably reliable measure of micronutrient intake, indicating its suitability for comparing exposures within a study population in reference to heath-related endpoints. Our results highlight the need to adapt any FFQ to specific cultural needs -in this case, the Guatemalan 'core foods' (tortilla, bread and beans), for which interindividual variability in intake is high. Keywords Concordance Correlation Dietary assessment Food frequency Twenty-four-hour dietary recalls ValidityFood-frequency questionnaires (FFQs) have become popular for the assessment of usual dietary intakes. The theory underlying their use relates to their use of a longer reference period than is typically used in dietary recall or diet record approaches, obviating the need for multiple days of data collection. Since an FFQ ascertains dietary habits over a longer reference period, this instrument is commonly used for epidemiological studies of the relation between habitual diet and disease. A 24-hour recall estimates more accurately the intake of individuals over a short period of time, but more days of data collection are needed to estimate habitual intakes due to the variability within a person 1 . Many studies have compared food and nutrient intake estimates derived from FFQs with those derived from measures usually considered more accurate, namely multiple 24-hour dietary recalls or records. In North America, Europe, Asia and Mexico, FFQs have been shown to provide good measures of energy and macronutrient intakes and a reasonable measure of micronutrient intake 2 -13 . Most FFQs were developed and have been validated...