Michele Monroy-Valle

BACKGROUND Osteoporosis is a major global public health concern, and optimizing peak bone mass during young adulthood is a main preventive strategy for reducing fracture risk later in life. Dairy foods, including milk and yogurt, provide nutrients, including calcium and protein, that support bone health. However, their long-term comparative effects on bone, body composition, and the gut microbiome in Canadian young adults are unknown. OBJECTIVE This study aims to evaluate the effects of two-year supplementation with fermented (yogurt) and non-fermented (milk) dairy products, compared to a habitual diet, on femoral neck bone mineral density (BMD) in Canadian adults aged 19 to 30 years. Secondary objectives include changes in BMD at other skeletal sites, including the total hip, lumbar spine, and whole body, as well as body composition, hormonal and bone turnover markers, gut microbiota composition and diversity following the intervention. METHODS The Fermented-Non-Fermented-Dairy (FNFD) trial is a two-year, prospective, randomized, three-arm, parallel-group controlled trial. In this study, 120 eligible healthy adults aged 19-30 years living in Saska-toon, Canada, with calcium intake <800 mg/day were randomized to one of three arms: 1) milk (375 mL) with habitual diet, 2) yogurt (350 g) with habitual diet, or 3) control (habitual diet). Data is collected at five time points; baseline, month 6, month 12, month 18, and month 24. The primary outcome is the change in femoral neck BMD. Secondary outcomes include BMD at other skeletal sites (total hip, lumbar spine, whole body), BMC (total hip, femoral neck, lumbar spine, whole body), bone structure and geometry, biochemical markers of bone turnover (osteocalcin, bone-specific alkaline phosphatase (BALP), C-terminal telopeptide of type 1 collagen (CTx-1), transforming growth factor-beta 1 (TGF-β1), TGF-β2, TGF-β3, and TGF-β receptor II (TGF-β RII), hormonal markers related to bone metabolism (parathyroid hormone (PTH), 25-hydroxyvitamin D [25(OH)D], and serum and salivary insulin-like growth factor-1 (IGF-1)), anthropometrics, body composition (total fat and lean mass), and gut microbiota. RESULTS Recruitment was conducted between July 2024 and July 2025, with an allocation ratio of 1:1:1 for the three study arms. All participants have completed all measurements until the month 6 time point, while month 12 follow-ups are ongoing. Month 24 assessments will take place from November 2026 to July 2027, followed by data analysis and dissemination through peer-reviewed publications and the trial registry. CONCLUSIONS This study uses a robust methodology and multidimensional outcome assessment to evaluate the effects of milk and yogurt supplementation on skeletal and metabolic health in young adults. The findings will contribute to evidence on dairy-based nutritional strategies to optimize long-term bone health in young Canadian adults. CLINICALTRIAL This trial is registered at ClinicalTrials.gov (Identifier: NCT06265246).

Stunting, also known as growth retardation, is a prominent health challenge for Mayan children, stemming from the complex interaction of malnutrition, inflammation, limited healthcare access, poverty, and food insecurity. Diet plays a key role in early childhood growth. A monotonous diet may lack essential nutrients, potentially affecting growth and developmental trajectories. Our objective was to explore the dietary patterns of Guatemalan Mayan children, comparing stunted children to those with typical growth. We conducted a cross-sectional study involving 155 Mayan children aged 2 to 5 years in Guatemala. Dietary intake was assessed using three 24-hour recalls. A questionnaire assessed WASH (water, sanitation, and hygiene) service availability and household food insecurity via the Household Food Insecurity Access Scale (HFIAS). Additionally, we measured weight, height, age, body composition, and recent common childhood communicable diseases (CCCD). The dietary data was analyzed based on two approaches: The nutrient approach yields the prevalence of inadequacy, and A-posteriori approach using K-means cluster analysis informed about the dietary pattern of the sample, including types of foods, and their energy contribution to the diet. Stunting affected 53.5% of the children, and nearly half of the children (49.7%) had experienced one or more recent CCCD. The majority resided in food-insecure households (81.9%), with more than half located in rural areas (61.6%). They had a low intake of omega-3, omega-6 fatty calcium and choline. We found two distinct dietary patterns: the grain-based diet, represented by high intakes of cereal-based drinks and corn-based meals. The second was a dairy, poultry, and corn dietary pattern; distinguished by higher consumption of dairy products and poultry. Significantly more children living in severely food insecure households consumed a grain-based dietary pattern. The stunted children on the grain-based diet consumed more calories from grain-based drinks than any other food group. Beyond dietary monotony and poor nutritional quality, additional factors likely contribute to the high stunting rate, requiring further investigation.

Identify the impacts of climate changes on food production, community food security and household food security in rural Momostenango, Guatemala. Cross sectional mixed methods study involving in-depth interviews with 12 agricultural group leaders in six communities and surveys with 55 mothers in 13 distinct communities. Food secure and food insecure households were compared using chi squared tests. Key informant interview themes were subsistence agriculture; commercial production; climate, capital, market, and capacity challenges; and sustainable opportunities. Eighty-five % of interviewed households were food insecure. The vast majority of households (93%) were engaged in agriculture, with food secure families working their own or leased land, while food insecure families worked their own land in addition to engaging in day labor. During seasonal periods of food scarcity, families reported altering food use, reducing expenses, and generating funds. Severely food insecure families were significantly more likely to reduce portion sizes (72%), while food secure families only ate less preferred foods. Reduced intake of beans - a primary protein source - was only reported by some severely food insecure households (22%). Overall, food insecure households are characterized by being larger, having an older mother with less education due to economic restraints during childhood, and deriving most family income from agricultural day labor. Community members indicated interest in establishing small-scale home-based interventions such as hen and egg operations and trying high protein or climate-adapted corn to enhance food security. Severely food insecure families consumed a less diverse diet, smaller portions, and reduced bean intake (key protein source) during periods of food scarcity; while moderately food insecure families consumed a less diverse diet and smaller portions; and food secure families only ate less preferred foods. Food insecurity in rural Guatemala is a long-term structural phenomenon associated with limited family resources that reproduces itself in subsequent generations. Queen Elizabeth Scholars through Universities Canada.

Global demand for capacity building has increased interest for eLearning. As eLearning resources become more common, effective implementation is required to scale up utilization in Low- and Middle-Income Countries (LMICs). This paper describes the process of implementing a malnutrition eLearning course, effectiveness of course delivery models devised, factors affecting course completion, and cost comparison between the models and face-to-face training at healthcare and academic institutions in Ghana. Four delivery models: Mobile Training Centre (MTC), Online Delivery (OD), Institutional Computer Workstation (ICW) and Mixed Delivery (MD) – a combination of OD and ICW – were determined. Participants were enabled to access the course using one of the four models where contextually appropriate. Pre and post-assessments and questionnaires were administered to compare participants’ course completion status and knowledge gain between delivery models. The effect of access to computer and Internet at home and relevance of course to job and academic progression on course completion were further investigated. Comparison of delivery model costs against face-to-face training was also undertaken. Of 7 academic and 9 healthcare institutions involving 915 people, 9 used MTC (34.8%), 3 OD (18.8%), 3 ICW (34.2%) and 1 MD (12.2%). Course completion was higher among institutions where the course was relevant to job or implemented as part of required curriculum activities. Knowledge gain was significant among most participants, but higher among those who found the course relevant to job or academic progression. The implementation costs per participant for training with MTC were £51.0, OD £2.2, ICW £1.2 and MD £1.1, compared with a face-to-face training estimate of £105.0 (1 GHS = 0.14 GBP). The malnutrition eLearning course makes global capacity building in malnutrition management achievable. Adopting contextually appropriate delivery models and ensuring training is relevant to job/academic progression can enhance eLearning effectiveness in LMICs.

Background Scaling up improved management of severe acute malnutrition (SAM) has been identified as the nutrition intervention with the greatest potential to reduce child mortality but it requires improved operational capacity. Objective To investigate whether an eLearning course, which can be used at scale in resource-poor countries, leads to improved diagnosis, clinical management and survival of children with SAM. Design A 2-year preintervention and postintervention study between January 2015 and February 2017. Setting Eleven healthcare facilities: nine in Ghana, one in Guatemala, and one in El Salvador. Intervention Scenario-based eLearning course ‘Caring for infants and young children with severe malnutrition’. Main outcome measures Identification of children with SAM, quality of care, case-fatality rate. Methods Medical record reviews of children aged 0–60 months attending eleven hospitals between August 2014 and July 2016, observations in paediatric wards, and interviews with senior hospital personnel. Results Postintervention there was a significant improvement in the identification of SAM: more children had the requisite anthropometric data (34.9% (1300/3723) vs 15.9% (629/3953)) and more were correctly diagnosed (58.5% (460/786) vs 47.1% (209/444)). Improvements were observed in almost all aspects of the WHO ‘Ten Steps’ of case-management, and case-fatality fell from 5.8% (26/449) to 1.9% (14/745) (Post-pre difference=−3.9%, 95% CI −6.6 to −1.7, pConclusions High quality, interactive eLearning can be an effective intervention in scaling up capacity building of health professionals to manage SAM effectively, leading to a reduction in mortality.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

BACKGROUND Scaling-up improved management of severe acute malnutrition has been identified as the nutrition intervention with the largest potential to reduce child mortality but lack of operational capacity at all levels of the health system constrains scale-up. We therefore developed an interactive Malnutrition eLearning course that is accessible at scale to build capacity of the health sector workforce to manage severely malnourished children according to guidelines of the World Health Organization (WHO). OBJECTIVE The study aim was to test whether the Malnutrition eLearning course improves knowledge and skills of in-service and pre-service health professionals in managing children with severe acute malnutrition. METHODS This 2-year prospective, longitudinal, empirical research study took place in Ghana, Guatemala, El Salvador and Colombia between January 2015 and February 2017. A subset of 354 in-service health personnel from 12 hospitals and 2 Ministries of Health, 703 pre-service trainees from 9 academic institutions, and 204 online users participated. Knowledge gain after training and retention over time were measured through pre- and post-assessments, comprising questions pertaining to screening, diagnosis, pathophysiology, and treatment and prevention of malnutrition. Comprehension, application and integration of knowledge were tested. Changes in perception, confidence, and clinical practice were assessed through questionnaires and interviews. RESULTS Before the course, awareness of the WHO guidelines was 36.7% (389/1059) overall and 26.3% (94/358) among in-service professionals. The mean score gain in knowledge after access to the course of 606 participants who had pre-and post-assessment data was 11.8 (95% CI 10.8, 12.9 P<.001) – a relative increase of 41.5%. The proportion who achieved above the pass mark post-training was 58.7% (356/606), compared with 18.2% (110/606) pre-training. Of the in-service professionals, 86% (128/149) reported applying their knowledge by changing their clinical practice in screening, assessment, diagnosis and/or management. This group demonstrated significantly increased, retained knowledge 6-months after training (mean difference (SD) from pre-assessment:12.1 (11.8)), retaining 65.8% (12.1/18.4) of gained knowledge from the training. Changes in the management of malnutrition were reported by trained participants, and institutional operational and policy changes were also found. CONCLUSIONS The Malnutrition eLearning course improved knowledge, understanding and skills of health professionals in the diagnosis and management of children with severe acute malnutrition, and changes in clinical practice and confidence were reported following completion of the course.

Determinantes dietéticos del consumo de zinc en menores de cinco años con retardo de crecimiento en comunidades mayas de Guatemala