Developing a cooperative multicenter study in Latin America: Lessons learned from the Latin American Study of Nutrition and Health Project

This report examines the challenges of conducting a multicenter, cross-sectional study of countries with diverse cultures, and shares the lessons learned. The Latin American Study of Nutrition and Health (ELANS) was used as a feasibility study involving the most populous cities of eight countries in Latin America (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela) in 2014–2015, about 40% of the population of the Americas. The target sample included 9 000 individuals, 15–65 years of age, and was stratified by geographic location (only urban areas), gender, age, and socioeconomic status. Six principal challenges were identified: team structuring and site selections; developing a single protocol; obtaining ethic approvals; completing simultaneous fieldwork; ensuring data quality; and extracting data and maintaining consistency across databases. Lessons learned show that harmonization, pilot study, uniformity of procedures, high data quality control, and communication and collaboration across sites are imperative. Barriers included organizational complexity, recruitment of collaborators and research staff, institutional cooperation, development of infrastructure, and identification of resources. Consensus on uniform measures and outcomes and data collection methodology, as well as a plan for data management and analysis, communication, publication, and dissemination of study results should be in place prior to beginning fieldwork. While challenging, such studies offer great potential for building a scientific base for studies on nutrition, physical activity, and other health topics, while facilitating comparisons among countries.

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Energy intake and food sources of eight Latin American countries: results from the Latin American Study of Nutrition and Health (ELANS)

Public Health Nutrition ◽

10.1017/s1368980018001222 ◽

2018 ◽

Vol 21 (14) ◽

pp. 2535-2547 ◽

Cited By ~ 17

Author(s):

Irina Kovalskys ◽

Mauro Fisberg ◽

Georgina Gómez ◽

Rossina G Pareja ◽

Martha C Yépez García ◽

...

Keyword(s):

Dietary Intake ◽

Energy Intake ◽

Latin American ◽

Urban Areas ◽

Food Sources ◽

American Study ◽

Latin American Study ◽

Nutrition And Health ◽

Main Food ◽

Sugary Drinks

AbstractObjectiveFew previous studies in Latin America (LA) have provided data on dietary intake composition with a standardized methodology. The present study aimed to characterize energy intake (EI) and to describe the main food sources of energy in representative samples of the urban population from eight LA countries from the Latin American Study in Nutrition and Health (ELANS).DesignCross-sectional study. Usual dietary intake was assessed with two non-consecutive 24 h dietary recalls.SettingUrban areas from eight countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, Venezuela), September 2014 to July 2015.SubjectsAdolescents and adults aged 15–65 years. Final sample comprised 9218 individuals, of whom 6648 (72·1 %) were considered plausible reporters.ResultsOverall, mean EI was 8196 kJ/d (1959 kcal/d), with a balanced distribution of macronutrients (54 % carbohydrate, 30 % fat, 16 % protein). Main food sources of energy were grains, pasta and bread (28 %), followed by meat and eggs (19 %), oils and fats (10 %), non-alcoholic homemade beverages (6 %) and ready-to-drink beverages (6 %). More than 25 % of EI was provided from food sources rich in sugar and fat, like sugary drinks, pastries, chips and candies. Meanwhile, only 18 % of EI was from food sources rich in fibre and micronutrients, such as whole grains, roots, fruits, vegetables, beans, fish and nuts. No critical differences were observed by gender or age.ConclusionsPublic health efforts oriented to diminish consumption of refined carbohydrates, meats, oils and sugar and to increase nutrient dense-foods are a priority in the region to drive to a healthier diet.

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Total and whole grain intake in Latin America: findings from the multicenter cross-sectional Latin American Study of Health and Nutrition (ELANS)

European Journal of Nutrition ◽

10.1007/s00394-021-02635-8 ◽

2021 ◽

Author(s):

Regina Mara Fisberg ◽

Mariane Mello Fontanelli ◽

Irina Kowalskys ◽

Georgina Gómez ◽

Attilio Rigotti ◽

...

Keyword(s):

Latin America ◽

Latin American ◽

American Study ◽

Latin American Study ◽

Whole Grain ◽

Cross Sectional ◽

Health And Nutrition

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Contribution of food groups to energy, grams and nutrients-to-limit: The Latin American Study of Nutrition and Health/Estudio Latino Americano de Nutrición y Salud (ELANS)

Public Health Nutrition ◽

10.1017/s136898002100152x ◽

2021 ◽

pp. 1-34

Author(s):

Regina Mara Fisberg ◽

Ana Carolina Barco Leme ◽

Ágatha Nogueira Previdelli ◽

Aline Veroneze de Mello ◽

Angela Martinez Arroyo ◽

...

Keyword(s):

Latin American ◽

Saturated Fatty Acids ◽

Food Sources ◽

American Study ◽

Food Groups ◽

Latin American Study ◽

Nutrition And Health ◽

Cross Sectional ◽

Added Sugars ◽

Latin Americans

ABSTRACT Objective: To quantify the energy, nutrients-to-limit and total gram amount consumed, and identify their top food sources consumed by Latin Americans. Design: Data from The Latin American Study of Nutrition and Health (ELANS). Setting: ELANS is a cross-sectional study representative of eight Latin American countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela. Participants: Two 24h dietary recalls on non-consecutive days were used to estimate usual dietary intake of 9218 participants with ages between 15-65years. “What We Eat in America” food classification system developed by USDA was adapted and used to classify all food items consumed by the ELANS population. Food sources of energy, added sugars, saturated fatty acids (SFA), sodium and total gram amount consumed were identified and ranked based on percentage contribution to intake of total amount. Results: Three-highest ranked food categories of total energy consumed were: rice (10.3%), yeast breads (6.9%), and turnovers and other grain-based items (6.8%). Highest ranked food sources of total gram amount consumed were: fruit drinks (9.6%), other 100% juice (9.3%), and rice (8.3%). Three highest ranked sources for added sugars were: other 100% juice (24.1%), fruit drinks (16.5%), and sugar and honey (12.4%). SFA ranked foods were: turnovers and other grain-based (12.6%), cheese (11.9%), and pizza (10.3%). Three top sources of sodium were: rice (13.9%), soups (9.1%), and rice mixed dishes (7.3%). Conclusion: Identification of top sources of energy and nutrients-to-limit among Latin Americans is critical for designing strategies to help them meet nutrient recommendations within energy needs.

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Latin American Study of Nutrition and Health (ELANS): rationale and study design

BMC Public Health ◽

10.1186/s12889-016-2765-y ◽

2015 ◽

Vol 16 (1) ◽

Cited By ~ 38

Author(s):

M. Fisberg ◽

◽

I. Kovalskys ◽

G. Gómez ◽

A. Rigotti ◽

...

Keyword(s):

Latin American ◽

Study Design ◽

American Study ◽

Latin American Study ◽

Nutrition And Health

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Intake of Vitamin E and C in Women of Reproductive Age: Results from the Latin American Study of Nutrition and Health (ELANS)

Nutrients ◽

10.3390/nu13061954 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1954

Author(s):

Dolores Busso ◽

Andrea David ◽

Reyna Penailillo ◽

Guadalupe Echeverría ◽

Attilio Rigotti ◽

...

Keyword(s):

Vitamin E ◽

Vitamin C ◽

Latin American ◽

Reproductive Age ◽

Food Sources ◽

American Study ◽

Latin American Study ◽

Women Of Reproductive Age ◽

Nutrition And Health ◽

Vitamin E And C

Vitamin E was identified as a lipophilic compound essential to maintain rat pregnancy. Low vitamin E intake during early pregnancy associates with congenital malformations and embryonic loss in animals and with miscarriage and intrauterine growth restriction in humans. Vitamin E protects cell membranes from lipoperoxidation and exerts non-antioxidant activities. Its function can be restored by vitamin C; thus, intake and circulating levels of both micronutrients are frequently analyzed together. Although substantial vitamin E inadequacy was reported worldwide, its consumption in Latin America (LatAm) is mostly unknown. Using data from the Latin American Study of Nutrition and Health (Estudio Latinoamericano de Nutrición y Salud, ELANS), we evaluated vitamin E and C intake in women of reproductive age (WRA) from eight LatAm countries and identified their main food sources. Two non-consecutive 24-h dietary recalls in 3704 women aged from 15 to 49 years and living in urban locations showed low average intake of vitamin E (7.9 mg/day vs. estimated average requirement (EAR) of 12 mg/day) and adequate overall vitamin C consumption (95.5 mg/day vs. EAR of 60 mg/day). The mean regional inadequacy was 89.6% for vitamin E and 36.3% for vitamin C. The primary food sources of vitamin E were fats and oils, as well as vegetables. Vitamin C intake was explained mainly by the consumption of fruit juices, fruits, and vegetables. Combined deficient intake of both vitamins was observed in 33.7% of LatAm women. Although the implications of low antioxidant vitamins’ consumption in WRA are still unclear, the combined deficient intake of both vitamins observed in one-third of ELANS participants underscores the need for further research on this topic.

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