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Growing short and fat:
The Maya from Mexico are now a dual-burden
group
Dr Inês Varela-Silva
Centre for Global Health
and Human Development
Loughborough University, UK
M.I.O.Varela-Silva@lboro.ac.uk
Twitter: @inesvarelasilva
(with F Dickinson, H Wilson,
H Azcorra, PL Griffiths and B Bogin)
Developed
countries
Growth
status

Immigrants in
developed countries

Developing
countries

Normal/tall
Fat

Normal/short
Fatter

Stunted
Fat

Micronutrients and dietary fat
Excessive intake of vitamins?
Excessive caloric comsumption

Common
factors
EE / P. Act
levels

Very
low

Probably
low

Not
known

Metabolic
pathways

High fat
oxidation & low
carb oxidation

Probably reduced fat
oxidation
Energy conserving
mechanisms

Discordant
information

Positive growth

Interof mothers &
generational
grandmothers:
and early
positive lasting
life effects

effect on current
generation

(Probably)...Negative growth of mothers &
grandmothers: negative lasting effect on
current generation
The Maya in Mérida, Mexico
Intergenerational effects
Nutritional status
based on growth data
Height-for-age

Stunting (chronic malnutrition)

Weight-for-age

Underweight

Weight-for-height

Wasting (acute malnutrition)

BMI-for-age

Overweight
Obesity
Saturday, January 11, 2014
Anthropometric classification: physical growth & nutritional status
(Adapted from Frisancho, 2008; www.cdc.gov/growthcharts , www.who.org)
Indices
Categories

Height-for-age

Weight-for-age

Weight-forheight

BMI-for-age

< 5.0 percentile
Z< -1.650

Stunting

Underweight

Wasting

Low

5.0-15 percentile
-1.645 <Z< -1.040

Below the
mean

Below the
mean

Below the
mean

Below the
mean

15.1-85 percentile
-1.036 <Z< +1.030

Healthy range

Healthy range

Healthy range

Healthy range

85.1-95 percentile
+1.036 <Z< +1.640

Above the
mean

Above the
mean

Above the
mean

Overweight

95.1-100 percentile
Z> +1.645

Tall

Excessive

Heavy for
height

Obese

Saturday, January 11, 2014

(not reliable)
Children

Mothers

WHO CDC

IOTF

p-value

WHO

CDC

p-value

Stunting

15.5

31.0

N/A

<0.001

55.2

81.0

<0.001

Underweight

1.7

5.2

6.9

Ns

0.0

N/A

Overweight

8.6

12.1

17.2

<0.001

51.7

N/A

Obesity

0.0

15.5

10.3

<0.001

39.7

N/A
Cut-off points selection
Body composition, energy expenditure
and physical activity
• Lean mass (muscle): strongest
predictor of energy expenditure
• The shorter the stature, the lower
the levels of activity energy
expenditure
• Girls and stunted children: lowest level of physical activity
However
• Children: overall highly active, above the guidelines
Inactivity doesn’t seem to explain the high levels of OW/OB
Wilson et al (2012)
Developed
countries
Growth
status

Immigrants in
developed countries

Maya in
Merida

Normal/tall
Fat

Normal/short
Fatter

Dual-burden

Micronutrients and vitamins
Excessive intake of dietary fat
Excessive Unknown – needs testing
caloric comsumption

Common
factors
EE / P. Act
levels

Very
low

Probably low, but needs
testing

High

Metabolic
pathways

High fat
oxidation & low
carb oxidation

Probably reduced fat
oxidation, but needs
testing

Not known

(Probably)...Negative
growth of mothers &
grandmothers: negative
lasting effect on current
generation

Negative
growth of
mothers,
negative effect
on children.

Positive growth

Interof mothers &
generational
grandmothers:
and early
positive lasting
life effects

effect on
children

Grandmothers
being tested
Three-generation study 2012
Grandmothers

Mothers

Children

p

Stunting

88.75%

68.75%

7.50%

0.001

Underweight

2.50%

0.0%

0.0%

N/A

Overweight

28.75%

42.50%

26.25%

0.061

Obesity

63.75%

42.50%

7.50%

0.001

OW/OB

92.50%

85.0%

33.75%

0.001

NDB*

81.25%

58.75%

0.0%

0.001

* Nutritional individual dual-burden (stunting+ OW/OB)
Thank you

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Growing short and fat: The Maya from Mexico are now a dual-burden group