Appendix S2. ISCOLE Diet and Lifestyle questionnaire (Adapted from the Health Behavior in School-... more Appendix S2. ISCOLE Diet and Lifestyle questionnaire (Adapted from the Health Behavior in School-aged Children Survey). (DOCX 248 kb)
is highly urbanized and unequal with serious urban health and sustainability challenges 19 of the... more is highly urbanized and unequal with serious urban health and sustainability challenges 19 of the world's 30 most unequal cities are in Latin America and > 80% of the population lives in urban areas It offers lessons on how to implement effective policies, technologies and interventions Other developing countries may follow the same pathway of rapid urbanization in limited resource settings Latin America is a major hub for innovation in urban transport and mobility policies that promote efficiency, prioritize people over vehicles and reduce spatial and social segregation Latin America's innovative urban transportation policies, technologies, and interventions have delivered important mobility and accessibility benefits and improved health and wellbeing. This experience can inspire policy change in other cities around the world Why is Learning About Mobility Policies in Latin American Cities Important? Glossary Sustainable transport: The provision of services and infrastructure for residents and visitors to access destinations in a manner that is safe, affordable, efficient, inclusive and resilient, while minimizing environmental impacts for current and future generations. 1 Active transport: Any type of human-powered transportation, including walking and cycling. 2 Urban health: The description of the health of urban populations as a whole and as particular subgroups as well as the understanding of the determinants of population health in cities. 3
Introduction The Ciclovía is a worldwide program in which streets are temporarily closed to motor... more Introduction The Ciclovía is a worldwide program in which streets are temporarily closed to motorized transport to create a space for recreation and outdoor play among children and adults. The aim of this study was to assess the associations between physical activity (PA), sedentary time (SED), body mass index and Ciclovía participation among children aged 9 to 13 years. Methods All students in the 4 th and 5 th grades from the selected schools were invited to participate in the study. The study included 923 children. PA and SED were measured using waist-worn accelerometers, and height and weight were measured using standardized procedures. Ciclovía participation was self-reported. The analyses included multilevel linear, generalized mixed and generalized additive models.
Background: Existing research has documented inconsistent findings for the associations among bre... more Background: Existing research has documented inconsistent findings for the associations among breakfast frequency, physical activity (PA), and sedentary time in children. The primary aim of this study was to examine the associations among breakfast frequency and objectively-measured PA and sedentary time in a sample of children from 12 countries representing a wide range of human development, economic development and inequality. The secondary aim was to examine interactions of these associations between study sites. Methods: This multinational, cross-sectional study included 6228 children aged 9-11 years from the 12 International Study of Childhood Obesity, Lifestyle and the Environment sites. Multilevel statistical models were used to examine associations between self-reported habitual breakfast frequency defined using three categories (breakfast consumed 0 to 2 days/week [rare], 3 to 5 days/week [occasional] or 6 to 7 days/week [frequent]) or two categories (breakfast consumed less than daily or daily) and accelerometry-derived PA and sedentary time during the morning (wake time to 1200 h) and afternoon (1200 h to bed time) with study site included as an interaction term. Model covariates included age, sex, highest parental education, body mass index z-score, and accelerometer waking wear time. Results: Participants averaged 60 (s.d. 25) min/day in moderate-to-vigorous PA (MVPA), 315 (s.d. 53) min/day in light PA and 513 (s.d. 69) min/day sedentary. Controlling for covariates, breakfast frequency was not significantly associated with total daily or afternoon PA and sedentary time. For the morning, frequent breakfast consumption was associated with a higher proportion of time in MVPA (0.3%), higher proportion of time in light PA (1.0%) and lower min/day and proportion of time sedentary (3.4 min/day and 1.3%) than rare breakfast consumption (all p ≤ 0.05). No significant associations were found when comparing occasional with rare or frequent breakfast consumption, or daily with less than daily breakfast consumption. Very few significant interactions with study site were found. Conclusions: In this multinational sample of children, frequent breakfast consumption was associated with higher MVPA and light PA time and lower sedentary time in the morning when compared with rare breakfast consumption, although the small magnitude of the associations may lack clinical relevance.
Neighborhood environmental attributes have been found to be associated with residents' time s... more Neighborhood environmental attributes have been found to be associated with residents' time spent walking and in physical activity, in studies from single countries and in multiple-country investigations. There are, however, mixed findings on such environmental relationships with sedentary (sitting) time, which primarily have used evidence derived from single-country investigations with self-reported behavioral outcome measures. We examined potential relationships of neighborhood environmental attributes with objectively-assessed sedentary time using data from 5712 adults recruited from higher and lower socio-economic status neighborhoods in 12 sites in 10 countries, between 2002 and 2011. Ten perceived neighborhood attributes, derived from an internationally-validated scale, were assessed by questionnaire. Sedentary time was derived from hip-worn accelerometer data. Associations of individual environmental attributes and a composite environmental index with sedentary time were ...
Low-and middle-income countries (LMICs) are experiencing a nutritional transition in which the bu... more Low-and middle-income countries (LMICs) are experiencing a nutritional transition in which the burden of obesity tends to shift towards the lower-socioeconomic status (SES) group. We propose a system dynamics (SD) model for assessing the nutritional stage dynamics of the Colombian urban population by age and SES projected to 2030. This SD model captures the ageing population according to body mass index (BMI) categories and SES. In this model, the transference rates (TRs) between BMI categories by age and SES are estimated using a heuristic based on data obtained from national surveys. The simulation results show that the Colombian population, particularly those aged 20 to 39 years with a lower SES, is moving towards the overweight and obese categories. The TRs for overweight and obese categories in the lower SES group (the mean TR from not overweight to overweight = 0.0215 (per year) and mean TR from overweight to obese = 0.0098 (per year)) are increasing more rapidly than the thos...
To evaluate the relationship between children's lifestyles and health-related quality of life... more To evaluate the relationship between children's lifestyles and health-related quality of life and to explore whether this relationship varies among children from different world regions. This study used cross-sectional data from the International Study of Childhood Obesity, Lifestyle and the Environment. Children (9-11 years) were recruited from sites in 12 nations (n = 5759). Clustering input variables were 24-hour accelerometry and self-reported diet and screen time. Health-related quality of life was self-reported with KIDSCREEN-10. Cluster analyses (using compositional analysis techniques) were performed on a site-wise basis. Lifestyle behavior cluster characteristics were compared between sites. The relationship between cluster membership and health-related quality of life was assessed with the use of linear models. Lifestyle behavior clusters were similar across the 12 sites, with clusters commonly characterized by (1) high physical activity (actives); (2) high sedentary b...
The Ciclovías comprise worldwide programs in which streets are closed to motor-vehicles and open ... more The Ciclovías comprise worldwide programs in which streets are closed to motor-vehicles and open to individuals for leisure activities. Currently, 93% of the regular programs are in Latin American countries (LAC). The aims of this study were to describe the characteristics of regular Ciclovías in 7 LAC and to analyze the factors that influence the sustainability and scaling-up of five case studies. We conducted a survey of 67 Ciclovías in 2014-2015. In addition, we conducted semi-structured interviews with current and former program coordinators and reviewed policy documents from Ciclovías in 5 LAC. The greatest expansion of Ciclovías has occurred since 2000. The number of participants per event ranged from 40-1,500,000 (mean 41,399 ±193,330; median 1,600), and the length ranged from 1-113.6 km (mean 9.1 ±16.4; median 3). Ciclovía routes connect low-middle and high income neighborhoods (89.3%), and include the participation of minority populations (61.2%). The main complementary act...
Background: Overweight and underweight increase the risk of metabolic impairments and chronic dis... more Background: Overweight and underweight increase the risk of metabolic impairments and chronic disease. Interventions at the household level require the diagnosis of nutritional status among family members. The aim of this study was to describe the prevalence and patterns of various anthropometric typologies over a decade in Colombia using a novel approach that considers all children in the household as well as the mother. This approach also allows identifying a dual burden of malnutrition within a household, where one child may be overweight and another one undernourished.
Introduction Information from high-income countries is often used to design childhood obesity pre... more Introduction Information from high-income countries is often used to design childhood obesity prevention interventions in low-and middle-income countries, even though determinants may differ greatly between settings. Methods We examined the associations of individual, family (household), and community (municipality) characteristics with body mass index (BMI) z scores and likelihood of overweight among children aged 5 to 18 years measured for the Colombian National Nutrition surveys of 2005 (n = 9,119) and 2010 (n = 21,520). We used 3level hierarchical linear models with child as level 1, household as level 2, and municipality as level 3. Results The prevalence of combined overweight and obesity among Colombian children and adolescents was 15.7% in 2005 and 16.6% in 2010. The household level explained 40% in 2005 and 31% in 2010 of the variability in BMI z scores. Wealth was positively associated with BMI in 2005 (0.09 increase in z score per wealth quintile) and 2010 (0.13 increase in z score per wealth quintile) (P < .01). Children and adolescents from extended families had higher BMI z scores than those from nuclear families; BMI z scores were inversely associated with the number of family members living in the same household. The municipality level explained only between 2% and 3% of the variability in BMI. Income inequality was positively associated with BMI z scores in 2010. Conclusion These patterns differ from those commonly described in high-income countries and suggest more appropriate opportunities for interventions to prevent child and adolescent obesity in Colombia and other Latin American settings and populations.
Objective The present study aimed to evaluate the nutritional status of pregnant women in Colombi... more Objective The present study aimed to evaluate the nutritional status of pregnant women in Colombia and the associations between gestational BMI and sociodemographic and gestational characteristics.Design Cross-sectional study. A secondary analysis was made of data from the 2005 Demographic and Health Survey of Colombia.Setting Bogotá, Colombia.Subjects Pregnant adolescents aged 13–19 years (n 430) and pregnant women aged 20–49 years (n 1272).Results The gestational BMI and sociodemographic characteristics of the adolescents differed from those of the pregnant adult women. Thirty-one per cent of the adolescents were underweight for gestational age, compared with 14·5 % of the adult women. Eighteen per cent of adolescents were overweight for gestational age, in contrast to 37·3 % of adult women. The overall prevalence of anaemia was 44·7 % and the prevalence of low serum ferritin was 38·8 %. Women within the high quintiles of the wealth index (prevalence odds ratio (POR) = 0·56; 95 % ...
A. Torres performed data analysis and interpretation, and was the main writer of the article. O. ... more A. Torres performed data analysis and interpretation, and was the main writer of the article. O. L. Sarmiento participated in study and data collection design and coordination, provided feedback on the analysis and interpretation of the results, and contributed to the article writing. C. Stauber provided feedback on the data analysis and interpretation of the results, and contributed to the article writing. R. Zarama performed grant writing, provided feedback on sampling, and designed the instruments to collect the information for the study.
Citation: Mejia-Arbelaez, C.; Sarmiento, O.L.; Mora Vega, R.; Flores Castillo, M.; Truffello, R.;... more Citation: Mejia-Arbelaez, C.; Sarmiento, O.L.; Mora Vega, R.; Flores Castillo, M.; Truffello, R.; Martínez, L.; Medina, C.; Guaje, O.; Pinzón Ortiz, J.D.; Useche, A.F.; et al. Social Inclusion and Physical Activity in Ciclovía Recreativa Programs in Latin America. Int. J. Environ. Res. Public Health 2021, 18, 655. https://doi.
The built environment of cities is complex and influences social and environmental determinants o... more The built environment of cities is complex and influences social and environmental determinants of health. In this study we, 1) identified city profiles based on the built landscape and street design characteristics of cities in Latin America and 2) evaluated the associations of city profiles with social determinants of health and air pollution. Landscape and street design profiles of 370 cities were identified using finite mixture modeling. For landscape, we measured fragmentation, isolation, and shape. For street design, we measured street connectivity, street length, and directness. We fitted a two-level linear mixed model to assess the association of social and environmental determinants of health with the profiles. We identified four profiles for landscape and four for the street design domain. The most common landscape profile was the “proximate stones” characterized by moderate fragmentation, isolation and patch size, and irregular shape. The most common street design profile...
Appendix S2. ISCOLE Diet and Lifestyle questionnaire (Adapted from the Health Behavior in School-... more Appendix S2. ISCOLE Diet and Lifestyle questionnaire (Adapted from the Health Behavior in School-aged Children Survey). (DOCX 248 kb)
is highly urbanized and unequal with serious urban health and sustainability challenges 19 of the... more is highly urbanized and unequal with serious urban health and sustainability challenges 19 of the world's 30 most unequal cities are in Latin America and > 80% of the population lives in urban areas It offers lessons on how to implement effective policies, technologies and interventions Other developing countries may follow the same pathway of rapid urbanization in limited resource settings Latin America is a major hub for innovation in urban transport and mobility policies that promote efficiency, prioritize people over vehicles and reduce spatial and social segregation Latin America's innovative urban transportation policies, technologies, and interventions have delivered important mobility and accessibility benefits and improved health and wellbeing. This experience can inspire policy change in other cities around the world Why is Learning About Mobility Policies in Latin American Cities Important? Glossary Sustainable transport: The provision of services and infrastructure for residents and visitors to access destinations in a manner that is safe, affordable, efficient, inclusive and resilient, while minimizing environmental impacts for current and future generations. 1 Active transport: Any type of human-powered transportation, including walking and cycling. 2 Urban health: The description of the health of urban populations as a whole and as particular subgroups as well as the understanding of the determinants of population health in cities. 3
Introduction The Ciclovía is a worldwide program in which streets are temporarily closed to motor... more Introduction The Ciclovía is a worldwide program in which streets are temporarily closed to motorized transport to create a space for recreation and outdoor play among children and adults. The aim of this study was to assess the associations between physical activity (PA), sedentary time (SED), body mass index and Ciclovía participation among children aged 9 to 13 years. Methods All students in the 4 th and 5 th grades from the selected schools were invited to participate in the study. The study included 923 children. PA and SED were measured using waist-worn accelerometers, and height and weight were measured using standardized procedures. Ciclovía participation was self-reported. The analyses included multilevel linear, generalized mixed and generalized additive models.
Background: Existing research has documented inconsistent findings for the associations among bre... more Background: Existing research has documented inconsistent findings for the associations among breakfast frequency, physical activity (PA), and sedentary time in children. The primary aim of this study was to examine the associations among breakfast frequency and objectively-measured PA and sedentary time in a sample of children from 12 countries representing a wide range of human development, economic development and inequality. The secondary aim was to examine interactions of these associations between study sites. Methods: This multinational, cross-sectional study included 6228 children aged 9-11 years from the 12 International Study of Childhood Obesity, Lifestyle and the Environment sites. Multilevel statistical models were used to examine associations between self-reported habitual breakfast frequency defined using three categories (breakfast consumed 0 to 2 days/week [rare], 3 to 5 days/week [occasional] or 6 to 7 days/week [frequent]) or two categories (breakfast consumed less than daily or daily) and accelerometry-derived PA and sedentary time during the morning (wake time to 1200 h) and afternoon (1200 h to bed time) with study site included as an interaction term. Model covariates included age, sex, highest parental education, body mass index z-score, and accelerometer waking wear time. Results: Participants averaged 60 (s.d. 25) min/day in moderate-to-vigorous PA (MVPA), 315 (s.d. 53) min/day in light PA and 513 (s.d. 69) min/day sedentary. Controlling for covariates, breakfast frequency was not significantly associated with total daily or afternoon PA and sedentary time. For the morning, frequent breakfast consumption was associated with a higher proportion of time in MVPA (0.3%), higher proportion of time in light PA (1.0%) and lower min/day and proportion of time sedentary (3.4 min/day and 1.3%) than rare breakfast consumption (all p ≤ 0.05). No significant associations were found when comparing occasional with rare or frequent breakfast consumption, or daily with less than daily breakfast consumption. Very few significant interactions with study site were found. Conclusions: In this multinational sample of children, frequent breakfast consumption was associated with higher MVPA and light PA time and lower sedentary time in the morning when compared with rare breakfast consumption, although the small magnitude of the associations may lack clinical relevance.
Neighborhood environmental attributes have been found to be associated with residents' time s... more Neighborhood environmental attributes have been found to be associated with residents' time spent walking and in physical activity, in studies from single countries and in multiple-country investigations. There are, however, mixed findings on such environmental relationships with sedentary (sitting) time, which primarily have used evidence derived from single-country investigations with self-reported behavioral outcome measures. We examined potential relationships of neighborhood environmental attributes with objectively-assessed sedentary time using data from 5712 adults recruited from higher and lower socio-economic status neighborhoods in 12 sites in 10 countries, between 2002 and 2011. Ten perceived neighborhood attributes, derived from an internationally-validated scale, were assessed by questionnaire. Sedentary time was derived from hip-worn accelerometer data. Associations of individual environmental attributes and a composite environmental index with sedentary time were ...
Low-and middle-income countries (LMICs) are experiencing a nutritional transition in which the bu... more Low-and middle-income countries (LMICs) are experiencing a nutritional transition in which the burden of obesity tends to shift towards the lower-socioeconomic status (SES) group. We propose a system dynamics (SD) model for assessing the nutritional stage dynamics of the Colombian urban population by age and SES projected to 2030. This SD model captures the ageing population according to body mass index (BMI) categories and SES. In this model, the transference rates (TRs) between BMI categories by age and SES are estimated using a heuristic based on data obtained from national surveys. The simulation results show that the Colombian population, particularly those aged 20 to 39 years with a lower SES, is moving towards the overweight and obese categories. The TRs for overweight and obese categories in the lower SES group (the mean TR from not overweight to overweight = 0.0215 (per year) and mean TR from overweight to obese = 0.0098 (per year)) are increasing more rapidly than the thos...
To evaluate the relationship between children's lifestyles and health-related quality of life... more To evaluate the relationship between children's lifestyles and health-related quality of life and to explore whether this relationship varies among children from different world regions. This study used cross-sectional data from the International Study of Childhood Obesity, Lifestyle and the Environment. Children (9-11 years) were recruited from sites in 12 nations (n = 5759). Clustering input variables were 24-hour accelerometry and self-reported diet and screen time. Health-related quality of life was self-reported with KIDSCREEN-10. Cluster analyses (using compositional analysis techniques) were performed on a site-wise basis. Lifestyle behavior cluster characteristics were compared between sites. The relationship between cluster membership and health-related quality of life was assessed with the use of linear models. Lifestyle behavior clusters were similar across the 12 sites, with clusters commonly characterized by (1) high physical activity (actives); (2) high sedentary b...
The Ciclovías comprise worldwide programs in which streets are closed to motor-vehicles and open ... more The Ciclovías comprise worldwide programs in which streets are closed to motor-vehicles and open to individuals for leisure activities. Currently, 93% of the regular programs are in Latin American countries (LAC). The aims of this study were to describe the characteristics of regular Ciclovías in 7 LAC and to analyze the factors that influence the sustainability and scaling-up of five case studies. We conducted a survey of 67 Ciclovías in 2014-2015. In addition, we conducted semi-structured interviews with current and former program coordinators and reviewed policy documents from Ciclovías in 5 LAC. The greatest expansion of Ciclovías has occurred since 2000. The number of participants per event ranged from 40-1,500,000 (mean 41,399 ±193,330; median 1,600), and the length ranged from 1-113.6 km (mean 9.1 ±16.4; median 3). Ciclovía routes connect low-middle and high income neighborhoods (89.3%), and include the participation of minority populations (61.2%). The main complementary act...
Background: Overweight and underweight increase the risk of metabolic impairments and chronic dis... more Background: Overweight and underweight increase the risk of metabolic impairments and chronic disease. Interventions at the household level require the diagnosis of nutritional status among family members. The aim of this study was to describe the prevalence and patterns of various anthropometric typologies over a decade in Colombia using a novel approach that considers all children in the household as well as the mother. This approach also allows identifying a dual burden of malnutrition within a household, where one child may be overweight and another one undernourished.
Introduction Information from high-income countries is often used to design childhood obesity pre... more Introduction Information from high-income countries is often used to design childhood obesity prevention interventions in low-and middle-income countries, even though determinants may differ greatly between settings. Methods We examined the associations of individual, family (household), and community (municipality) characteristics with body mass index (BMI) z scores and likelihood of overweight among children aged 5 to 18 years measured for the Colombian National Nutrition surveys of 2005 (n = 9,119) and 2010 (n = 21,520). We used 3level hierarchical linear models with child as level 1, household as level 2, and municipality as level 3. Results The prevalence of combined overweight and obesity among Colombian children and adolescents was 15.7% in 2005 and 16.6% in 2010. The household level explained 40% in 2005 and 31% in 2010 of the variability in BMI z scores. Wealth was positively associated with BMI in 2005 (0.09 increase in z score per wealth quintile) and 2010 (0.13 increase in z score per wealth quintile) (P < .01). Children and adolescents from extended families had higher BMI z scores than those from nuclear families; BMI z scores were inversely associated with the number of family members living in the same household. The municipality level explained only between 2% and 3% of the variability in BMI. Income inequality was positively associated with BMI z scores in 2010. Conclusion These patterns differ from those commonly described in high-income countries and suggest more appropriate opportunities for interventions to prevent child and adolescent obesity in Colombia and other Latin American settings and populations.
Objective The present study aimed to evaluate the nutritional status of pregnant women in Colombi... more Objective The present study aimed to evaluate the nutritional status of pregnant women in Colombia and the associations between gestational BMI and sociodemographic and gestational characteristics.Design Cross-sectional study. A secondary analysis was made of data from the 2005 Demographic and Health Survey of Colombia.Setting Bogotá, Colombia.Subjects Pregnant adolescents aged 13–19 years (n 430) and pregnant women aged 20–49 years (n 1272).Results The gestational BMI and sociodemographic characteristics of the adolescents differed from those of the pregnant adult women. Thirty-one per cent of the adolescents were underweight for gestational age, compared with 14·5 % of the adult women. Eighteen per cent of adolescents were overweight for gestational age, in contrast to 37·3 % of adult women. The overall prevalence of anaemia was 44·7 % and the prevalence of low serum ferritin was 38·8 %. Women within the high quintiles of the wealth index (prevalence odds ratio (POR) = 0·56; 95 % ...
A. Torres performed data analysis and interpretation, and was the main writer of the article. O. ... more A. Torres performed data analysis and interpretation, and was the main writer of the article. O. L. Sarmiento participated in study and data collection design and coordination, provided feedback on the analysis and interpretation of the results, and contributed to the article writing. C. Stauber provided feedback on the data analysis and interpretation of the results, and contributed to the article writing. R. Zarama performed grant writing, provided feedback on sampling, and designed the instruments to collect the information for the study.
Citation: Mejia-Arbelaez, C.; Sarmiento, O.L.; Mora Vega, R.; Flores Castillo, M.; Truffello, R.;... more Citation: Mejia-Arbelaez, C.; Sarmiento, O.L.; Mora Vega, R.; Flores Castillo, M.; Truffello, R.; Martínez, L.; Medina, C.; Guaje, O.; Pinzón Ortiz, J.D.; Useche, A.F.; et al. Social Inclusion and Physical Activity in Ciclovía Recreativa Programs in Latin America. Int. J. Environ. Res. Public Health 2021, 18, 655. https://doi.
The built environment of cities is complex and influences social and environmental determinants o... more The built environment of cities is complex and influences social and environmental determinants of health. In this study we, 1) identified city profiles based on the built landscape and street design characteristics of cities in Latin America and 2) evaluated the associations of city profiles with social determinants of health and air pollution. Landscape and street design profiles of 370 cities were identified using finite mixture modeling. For landscape, we measured fragmentation, isolation, and shape. For street design, we measured street connectivity, street length, and directness. We fitted a two-level linear mixed model to assess the association of social and environmental determinants of health with the profiles. We identified four profiles for landscape and four for the street design domain. The most common landscape profile was the “proximate stones” characterized by moderate fragmentation, isolation and patch size, and irregular shape. The most common street design profile...
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