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| 3. |
- Assey, Vincent D., et al.
(författare)
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Improved salt iodation methods for small-scale salt producers in low-resource settings in Tanzania
- 2009
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 9, s. 187-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Universal salt iodation will prevent iodine deficiency disorders (IDD). Globally, salt-iodation technologies mostly target large and medium-scale salt-producers. Since most producers in low-income countries are small-scale, we examined and improved the performance of hand and knapsack-sprayers used locally in Tanzania. METHODS: We studied three salt facilities on the Bagamoyo coast, investigating procedures for preparing potassium-iodate solution, salt spraying and mixing. Different concentrations of solution were prepared and tested using different iodation methods, with the aim of attaining correct and homogeneous iodine levels under real-life conditions. Levels achieved by manual mixing were compared to those achieved by machine mixing. RESULTS: The overall median iodation level in samples of salt iodated using previously existing methods was 10.6 ppm (range 1.1 - 110.0 ppm), with much higher levels in the top than the bottom layers of the salt bags, p < 0.0001. Experimentation using knapsack-sprayers and manual mixing led to the reliable achievement of levels (60.9 ppm +/- 7.4) that fell within the recommended range of 40 - 80 ppm. The improved methods yielded homogenous iodine concentrations in all layers of salt-bags (p = 0.58) with 96% of the samples (n = 45) falling within 40 - 80 ppm compared to only 9% (n = 45) before the experiment and training (p < 0.0001). For knapsack-spraying, a machine mixer improved the iodine levels and homogeneity slightly compared to manual mixing (p = 0.05). CONCLUSION: Supervised, standardized salt iodation procedures adapted to local circumstances can yield homogeneous iodine levels within the required range, overcoming a major obstacle to universal salt iodation.
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| 4. |
- Assey, Vincent D., et al.
(författare)
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Iodine deficiency persists in the Zanzibar Islands of Tanzania
- 2006
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Ingår i: Food and Nutrition Bulletin. - : SAGE Publications. - 0379-5721 .- 1564-8265. ; 27:4, s. 292-299
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Tidskriftsartikel (refereegranskat)abstract
- Background. Iodine is an essential micronutrient for normal human growth and development. It is estimated that more than 1.6 billion people live in iodine-deficient environments, yet there are still some countries and areas where the prevalence of iodine-deficiency disorders is unknown. Objective. To establish the prevalence of iodine-deficiency disorders in the Zanzibar Islands, a community assumed to have ready access to iodine-rich seafoods. Methods. In a cross-sectional study, 11, 967 schoolchildren were Palpated for goiter prevalence, a subsample was evaluated for urinary iodine concentration, and the availability of iodated salt was assessed at the household and retail levels. Results. The mean total goiter prevalence was 21.3% for Unguja and 32.0% for Pemba. The overall median urinary iodine concentration was 127.5 ug/L. For Unguja the median was 185.7 mu g/L, a higher value than the median of 53.4 mu g/L for Pemba (p <.01). The household availability of iodated salt was 63.5% in Unguja and 1.0% in Pemba. The community was not aware of the iodine-deficiency problem and had never heard of iodated salt. Conclusions. The inadequate intake of iodine documented in the Zanzibar Islands belies the common assumption that an island population with access to seafood is not at risk for iodine-deficiency disorders. We urge health planners to implement mandatory salt iodation and education efforts to alleviate the situation.
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| 5. |
- Assey, Vincent D., et al.
(författare)
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Remaining challenges in Tanzania's efforts to eliminate iodine deficiency
- 2007
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Ingår i: Public Health Nutrition. - 1368-9800 .- 1475-2727. ; 10:10, s. 1032-1038
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To determine iodine levels in salt and iodine deficiency prevalence in school-aged children in 16 districts in Tanzania with previous severe iodine deficiency. Design: A cross-sectional study in schoolchildren. Systematic probability sampling was used to select schools and subjects for goitre assessment and urinary iodine determination. Setting: Sixteen districts randomly selected from the 27 categorised as severely iodine-deficient in Tanzania. Subjects: The stndy population was primary-school children aged 6-18 years who were examined for goitre prevalence and urinary, iodine concentration (UIC). Salt samples from schoolchildren's homes and from shops were tested for iodine content. Results. The study revealed that 83.3% of households (n = 21 160) in the surveyed districts used iodised salt. Also, 94% of sampled shops (n = 397) sold iodised salt, with a median iodine level of 37.0 ppm (range 4.2-240 ppm). Median UIC in 2089 schoolchildren vas 235.0 mu g 1(-1) and 9.3% had UIC values below 50 mu g 1(-1). The overall unweighted mean visible and total goitre prevalence was 6.7% and 24.3%, respectively (n = 16 222). The age group 6-12 Nears had the lowest goitre prevalence (3.6% visible and 18.0% total goitre, 11 = 7147). The total goitre prevalence had decreased significantly in all districts from an unweighted mean of 65.4% in the 1980s to 24.3% in 1999 (P < 0.05). We believe this difference was also biologically significant. Conclusion: These findings indicate that iodine deficiency is largely eliminated in the 16 districts categorised as severely iodine-deficient in Tanzania, and that the iodine content of salt purchased from shops is highly variable.
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| 6. |
- Assey, V. D., et al.
(författare)
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Sustainable universal salt iodization in low-income countries : time to re-think strategies?
- 2008
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Ingår i: European Journal of Clinical Nutrition. - : Springer Science and Business Media LLC. - 0954-3007 .- 1476-5640. ; 62:2, s. 292-294
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Sustained iodine deficiency control requires sustainable mechanisms for iodine supplementation. We aim to describe the status of salt iodation machines, salt producers' experiences and quality of salt produced in Tanzania. Methods: Qualitative and quantitative data was collected from the factory sites, observations were made on the status of UNICEF-supplied assisted-iodation machines and convenience samples of salt from 85 salt production facilities were analysed for iodine content. Results: A total of 140 salt works visited had received 72 salt iodation machines in 1990s, but had largely abandoned them due to high running and maintenance costs. Locally devised simple technology was instead being used to iodate salt. High variability of salt iodine content was found and only 7% of samples fell within the required iodation range. Conclusion: Although iodine content at factory level is highly variable, overall iodine supply to the population has been deemed largely sufficient. The need for perpetual iodine fortification requires reassessment of salt iodation techniques and production-monitoring systems to ensure sustainability. The emerging local technologies need evaluation as alternative approaches for sustaining universal salt iodation in low-income countries with many small-scale salt producers.
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| 7. |
- Assey, Vincent D, et al.
(författare)
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Tanzania national survey on iodine deficiency : impact after twelve years of salt iodation.
- 2009
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 55, s. 295-295
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In many low-income countries, children are at high risk of iodine deficiency disorders, including brain damage. In the early 1990s, Tanzania, a country that previously suffered from moderate to severe iodine deficiency, adopted universal salt iodation (USI) as an intervention strategy, but its impact remained unknown. METHODS: We report on the first national survey in mainland Tanzania, conducted in 2004 to assess the extent to which iodated salt was used and its apparent impact on the total goitre prevalence (TGP) and urinary iodine concentrations (UIC) among the schoolchildren after USI was initiated. In 2004, a cross-sectional goitre survey was conducted; covering 140,758 schoolchildren aged 6 - 18 years were graded for goitre according to new WHO goitre classification system. Comparisons were made with district surveys conducted throughout most of the country during the 1980s and 90s. 131,941 salt samples from households were tested for iodine using rapid field test kits. UIC was determined spectrophotometrically using the ammonium persulfate digestion method in 4523 sub-sampled children. RESULTS: 83.6% (95% CI: 83.4 - 83.8) of salt samples tested positive for iodine. Whereas the TGP was about 25% on average in the earlier surveys, it was 6.9% (95%CI: 6.8-7.0) in 2004. The TGP for the younger children, 6-9 years old, was 4.2% (95%CI: 4.0-4.4), n = 41,965. In the 27 goitre-endemic districts, TGP decreased from 61% (1980s) to 12.3% (2004). The median UIC was 204 (95% CF: 192-215) microg/L. Only 25% of children had UIC <100 microg/L and 35% were > or = 300 microg/L, indicating low and excess iodine intake, respectively. CONCLUSION: Our study demonstrates a marked improvement in iodine nutrition in Tanzania, twelve years after the initiation of salt iodation programme. The challenge in sustaining IDD elimination in Tanzania is now two-fold: to better reach the areas with low coverage of iodated salt, and to reduce iodine intake in areas where it is excessive. Particular attention is needed in improving quality control at production level and perhaps the national salt iodation regulations may need to be reviewed.
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| 8. |
- Chopra, Mickey, 1967-
(författare)
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Prevention of Mother to Child Transmission of HIV in Africa : Operational Research to Reduce Post-natal Transmission and Infant Mortality
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis assesses the effectiveness of the National Prevention of Mother to Child Transmission of HIV (PMTCT) programme in 3 sites in South Africa, and the quality of infant feeding counselling across four countries, Botswana, Kenya, Malawi and Uganda . Implementation and outcome of PMTCT services were very different across the 3 sites. The Paarl site is achieving results comparable to clinical trial studies with a HIV-free survival rate of 85% at 36 weeks, while Umlazi is somewhat lower (74%) and Rietvlei, with HIV-free survival of 64%. Maternal viral load, prematurity and site were independent risk factors for infection and/or death. The regression analysis suggests that some of this difference is explained by the differences in quality of health systems across the sites. Traditional risk factors (e.g. viral load, prematurity) do not seem to explain the substantial differences in HIV-free survival between the Paarl and Rietvlei sites.The overall mortality rate for HIV exposed infants in this cohort was 155 per 1000 live births at 36 weeks, a level higher than most other HIV exposed cohorts. The excess mortality is occurring almost completely amongst HIV infected infants who had a nine fold increased risk of mortality compared with HIV exposed but HIV negative infants. There was no significant difference in 36 week survival rates between those HIV exposed but uninfected infants and those who were not HIV exposed, Hazard ratio 0.7 (95% CI 0.3-1.5).With respect to HIV and infant feeding most health workers across the four countries (234/334, 70%) were unable to correctly estimate the transmission risks of breastfeeding. Exposure to PMTCT training made little difference to this. Infant feeding options were mentioned in 307 out of 640 (48%) observations of PMTCT counselling session and in only 35 (5.5%) were infant feeding issues discussed in any depth; of these 19 (54.3%) were rated as poor. South Africa was similar with only two out of thirty four HIV positive mothers being asked about essential conditions for safe formula feeding before a decision was made. This body of work has demonstrated that the gap between efficacy and effectiveness can be significant.
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| 12. |
- Doherty, Tanya, 1976-
(författare)
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HIV and Infant Feeding : Operational Challenges of Achieving Safe Infant Feeding Practices
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis assesses the uptake of the national Prevention of Mother to Child Transmission of HIV (PMTCT) programme in South Africa, and the challenges of achieving safe infant feeding practices in the context of HIV. The research studies contained in this thesis utilised a variety of quantitative and qualitative research methods in order to provide a full understanding of the challenges of moving from efficacy to effectiveness in PMTCT programmes. The first paper utilised a cross-sectional approach to a programme evaluation, papers two and three utilised qualitative methodologies, and paper four was based on a longitudinal cohort study design. The findings highlight the low uptake of PMTCT interventions and inappropriate infant feeding choices. The experiences of women with HIV provide an important insight into the difficulties of operationalising the WHO/UNICEF HIV and infant feeding recommendations in real life settings, where rates of HIV disclosure are low and mixed feeding is the norm. Several personal and environmental characteristics were identified that contributed to success in maintaining exclusive infant feeding practices. The research provides some guidance on the definition of appropriateness in infant feeding choices, and highlights the poor outcomes associated with formula feeding under unsafe conditions. Modifying infant feeding practices is essential in order to reduce postnatal HIV transmission and improve child survival. Interventions to improve infant feeding need to include improving the quality of counselling and support provided by health workers, with more structured assessments used to guide infant feeding choices. Efforts are also needed at the community level to increase rates of disclosure and to promote exclusive infant feeding as a norm.
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| 15. |
- Greiner, Ted
(författare)
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The concept of weaning : definitions and their implications
- 1996
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Ingår i: Journal of Human Lactation. - : SAGE Publications. - 0890-3344 .- 1552-5732. ; 12:2, s. 123-
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Tidskriftsartikel (refereegranskat)abstract
- "Weaning" is usually said to refer to the entire process during which the infant changes from full dependence on breast milk to complete independence from it. However, "wean" is sometimes used to refer to provision of an "educational diet" during the first six months when exclusive breastfeeding is the ideal; to complementary feeding; to replacement of breastmilk; or to the cessation of breastfeeding. The processes involved are illustrated by a graph that theoretically compares the infant's nutritional needs with the proportion of those needs that can come from breastmilk under ideal circumstances. The development of consistent, relevant research, policies and programs on young child feeding may be particularly hindered by the failure to discriminate between complementation and replacement.
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| 17. |
- Jiang, Jingxiong, et al.
(författare)
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Relationship of parental characteristics and feeding practices to overweight in infants and young children in Beijing, China
- 2009
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Ingår i: Public Health Nutrition. - 1368-9800 .- 1475-2727. ; 12:7, s. 973-978
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Tidskriftsartikel (refereegranskat)abstract
- Background Childhood obesity has become a major public health problem in many countries. To explore the risk factors of overweight in infants and young children might be helpful in developing an early overweight intervention strategy. Objective To assess the prevalence of overweight and the relationship of parental characteristics and feeding practices to overweight in infants and young children in Beijing, China. Design Data on weight and length/height were collected on 4654 children aged 1–35 months in twelve communities in Beijing from a cross-sectional study. Overweight was defined as weight-for-length/height ≥2sd above the median of the WHO reference. Two hundred and fifteen families with overweight children and 215 families with normal-weight children were interviewed using a questionnaire to obtain feeding practices. Results The overall prevalence of overweight was 4·7 %. Both parental overweight and low parental education were significantly higher among overweight than normal-weight children. The total energy intake was significantly higher in overweight than in normal-weight children at 12–35 months of age. Compared with normal-weight children, significantly fewer overweight children were breast-fed for at least 4 months. Overweight children were also more likely to have been introduced to infant formula and semi-solid foods during the first 4 months. Conclusion Early prevention strategies should include feeding practices identified as putting children at risk of obesity. These include early cessation of breast-feeding and premature introduction of other foods.
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| 18. |
- Jiang, Jingxiong, et al.
(författare)
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Risk factors for overweight in 2- to 6-year-old children in Beijing, China
- 2006
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Ingår i: International Journal of Pediatric Obesity. - : Informa UK Limited. - 1747-7166 .- 1747-7174. ; 1:2, s. 103-108
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To assess the prevalence of overweight among Chinese preschool children and to explore risk factors of childhood obesity focusing on parental characteristics, feeding practice and lifestyle. Methods. Data on 930 families with 2- to 6-year-old children in five kindergartens were obtained in a cross sectional study. Families were randomly selected from two of all six urban districts in Beijing, China. Information on parental characteristics, dietary habits, lifestyle habits, and feeding practice was collected by parental self-report questionnaires. The children's stature and weight were measured in light clothing and without shoes. Overweight and obesity were defined according to international cut-off values, as proposed by the International Obesity Task Force. Multivariate regression analysis was used to explore risk factors of child overweight. Results. The overall prevalence of overweight and obesity was 10.7% and 4.2%, respectively, and increased with age. The prevalence of child overweight was 14.1% and 7.5% in obese and non-obese families, respectively. Significant associations were observed between child and parent characteristics for overweight, frequency of eating in restaurant, television hours, and hours of physical activity. Child overweight was associated with parental overweight (Odds Ratio [OR] 2.43, 95% CI 0.78, 6.59), low maternal education level (OR 2.22, 95% CI 1.39, 3.55), food restriction (OR 2.68, 95% CI 1.64, 4.29), and television watching>2h/d (OR 1.56, 95% CI 1.17, 2.09), after adjusting for sex, age, family income and kindergarten (for cluster study design). Conclusions. Overweight prevalence among Chinese preschool children in Beijing is comparable to some European countries. Prevention strategies should include identified lifestyle risk factors.
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| 19. |
- Jiang, Jingxiong, et al.
(författare)
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The effects of a 3-year obesity intervention in schoolchildren in Beijing
- 2007
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Ingår i: Child: Care, Health and Development. - : Wiley. - 0305-1862 .- 1365-2214. ; 33:5, s. 641-646
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Tidskriftsartikel (refereegranskat)abstract
- Background: Childhood obesity has become a health problem in urban areas in China. Intervention to reduce childhood obesity should be of high priority. School-based intervention programmes are needed to deal with the growing prevalence of childhood obesity in China. Methods: Five primary schools were selected randomly for this study in the Beijing urban area in China; two were allocated to the intervention group and three to the control group. A total of 2425 children (1029 children in intervention schools and 1396 children in control schools) took part in the study for 3 years. In the intervention group, children and their parents were involved in a programme of nutrition education and physical activity. Control school students followed their usual health and physical education curriculum with no extra intervention. Results: After the 3-year intervention, the prevalence of overweight and obesity were significantly lower in the intervention schools than in the control schools (overweight: 9.8% vs. 14.4%, P < 0.01; obesity: 7.9% vs. 13.3%, P < 0.01). The prevalence of overweight and obesity decreased by 26.3% and 32.5% in intervention schools respectively after intervention. The prevalence of overweight and obesity increased in control schools. There was also significant difference in body mass index between intervention and control schools (18.2 ± 2.6 vs. 20.3 ± 3.4, P < 0.01) after intervention. More non-obese children became obese in the control schools (7.0%) than in the intervention schools (2.4%) at end line (P < 0.01). Among the children who were obese at baseline, 49.2% remained obese at end line in intervention schools while 61.9% remained obese in control schools (P < 0.01). Conclusions: Our study showed that an intervention programme could be feasible in schools in Beijing, China. The prevalence of overweight and obesity was reduced in schoolchildren in Beijing through an intervention focused on nutrition education and physical activity. Overweight and obesity children as well as normal weight children and their parents should be involved in such an intervention programme.
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| 20. |
- Jing Xiong, Jiang, et al.
(författare)
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A two-year family-based behaviour treatment for obese children
- 2005
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Ingår i: Archives of Disease in Childhood. - : BMJ. - 0003-9888 .- 1468-2044. ; 90:12, s. 1235-8
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Tidskriftsartikel (refereegranskat)abstract
- Background: Childhood obesity has become a nutritional problem in China since the 1990s. Aims: A family based behavioural treatment was developed and tested, to see if its use was feasible in China and to evaluate its impact on obese schoolchildren. Methods: In a single school in Beijing, 33 obese children were randomly assigned to a treatment group and 35 to a control group. The treatment group participated in a family based behavioural treatment programme for two years. Height and weight were measured every six months for all participants. Blood pressure, cholesterol, and triglyceride levels were measured at baseline and after two years of programme implementation. Results: Body mass index (BMI, kg/m2) was significantly reduced in the treatment group (from 26.6 (1.7) to 24.0 (0.9), 95% CI 2.06 to 3.18) but not in the control group (from 26.1 (1.5) to 26.0 (1.6)). Total cholesterol decreased 5.5% and triglycerides 9.7% in the treatment group. There was a significant correlation between change in BMI and change in triglycerides. There were no significant changes in plasma lipids in the controls. Blood pressure values also decreased significantly in the treatment, but not the control group. Conclusions: A family based behavioural intervention was feasible to use in treating obesity in schoolchildren in Beijing, China. After two years of implementation, it successfully decreased the degree of obesity, reduced levels of blood pressure, and decreased serum lipids in treatment; there were no significant changes among control children.
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| 21. |
- Jingxiong, Jiang, et al.
(författare)
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Influence of grandparents on eating behaviors of young children in Chinese three-generation families
- 2007
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Ingår i: Appetite. - : Elsevier BV. - 0195-6663 .- 1095-8304. ; 48:3, s. 377-83
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To investigate how grandparents influence their young grandchildren's eating behaviors in Chinese three-generation families. Methods: This qualitative study used semi-structured in-depth interviews with 12 parents (3 male and 9 female) and 11 grandparents (4 male and 7 female) in Beijing, China. Results: Three domains emerged in this study: (1) grandparents were the primary caretakers of children in the three-generation families. They played an important role in planning and cooking family meals; (2) grandparents' attitudes influenced young children's nutrition and eating habits. They held the belief that children being heavy at a young age would assure that they had a good nutrition status and would become tall in the future. They showed a tendency towards urging the children to eat more meals and larger portions at served meals; (3) grandparents used food as an educational and emotional tool. They shaped the behavior of their grandchildren and expressed love and caring through food. Conclusions: Grandparents were dominant in shaping children's eating behavior in some three-generation families in Chinese urban areas. Nutrition education involving grandparents is a potential framework for developing a healthy dietary behavior in young children.
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| 22. |
- Jingxiong, Jiang, 1963-
(författare)
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Intervention for Childhood Obesity in Beijing, China
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Childhood obesity appears to be increasing throughout the world. China has joined the global epidemic. Childhood obesity is not only a chronic disease which is associated with lifestyle, but also a public health problem in children. Obesity intervention should become a public health priority in China. This thesis reports on intervention to treat and prevent childhood obesity. The field work was implemented in Beijing, China. This thesis is based on four papers: Paper I evaluated the feasibility and impact of family-based behavior treatment on obese children. Two years of intervention resulted in obese children with improvements in body mass index, total cholesterol, triglycerides, and blood pressure. Paper II assessed the effects of a school-based intervention on obesity among primary school children. After a three-year intervention, the prevalence of overweight and obesity were significantly lower in the intervention schools than in the control schools. Fewer non-obese children became obese in the intervention schools than in the control schools. Paper III explored the family related factors of overweight in 2- to 6-year-old children. Significant associations were observed between children’s overweight and parent characteristics for frequency of eating in restaurants, daily time spent viewing television, and engaging in physical activity. Child overweight was associated with parental overweight, low maternal education level and television watching >2h/d. Paper IV investigated how grandparents influence their young grandchildren’s eating behaviors in Chinese three-generation families, using qualitative method. Three domains identified through the seven themes included: (1) Grandparents as primary caretakers of children in the three-generation family, (2) Grandparents' attitudes to child nutrition and healthy eating habits, and (3) The role of food as an educational and emotional tool. The results showed that nutrition education involving grandparents is thus a potential framework for improving healthy dietary behaviors in young children.
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| 25. |
- Monárrez-Espino, Joel, 1967-
(författare)
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Health and Nutrition in the Tarahumara of Northern Mexico : Studies among Women and Children
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Belonging to an indigenous group in Mexico is usually associated with poor health, mainly as the result of social isolation from the mainstream society. The Tarahumara are no exception. They constitute the largest indigenous group in northern Mexico and one of the most marginalized ethnic minorities in North America. Health conditions are precarious, yet very little data are available to facilitate the design and implementation of programs to prevent and manage the main public health problems affecting this people. This thesis aims at overcoming part of this information gap. It presents and discusses the results from studies focusing on the nutrition of women and children carried out between 1997 and 2002.A survey in a representative district sample of Tarahumara women of reproductive age found the highest prevalence of anemia among pregnant women in their third trimester (38.5%) and those lactating during the first 6 months after delivery (42.9%), along with a high prevalence of iron deficiency. In this study a technique was developed to collect capillary serum samples spotted onto filter paper to measure serum ferritin in remote settings. In the same study, 52.5% of adult women were overweight, suggesting a process of ‘de-Indianization’ of their traditional diet and activity patterns. This issue was followed-up in a later study based on perceptions of food and body shape using cognitive anthropological methods. Speaking Spanish emerged as a clear indication of acculturation that could be associated with an increase in the prevalence of obesity and its consequences. A nutrition survey among Tarahumara children at boarding schools found evidence of zinc, vitamin B12, iron, and iodine deficiencies but found similar anthropometric status to other rural Mexicans. Finally, a qualitative assessment was carried out to identify culturally accepted foods to redesign a food aid basket aimed at alleviating malnutrition among young Tarahumara children.The results from this thesis provide relevant data for an improved design of interventions to combat and prevent some of the nutritional problems that affect the Tarahumara. These data could also constitute a baseline to which future changes can be compared if similar sampling strategies are used. Overall, the findings highlight the importance and challenge of achieving modernization in a way that not only improves health but at the same time supports, maintains and encourages traditional cultural values. These are not only the foundations of the Tarahumara society, but in some cases also contribute to a better diet and health.
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