My research centers on topics that promote health through nutrition and prevent nutrition related illness, with a focus in the mother-child dyad and other vulnerable populations.

Breastfeeding

Breastfeeding has many benefits, both for infants and for women. However, some mother-child dyads experience difficulties establishing breastfeeding, which can increase the risk of early breastfeeding discontinuation.  Understanding the risk factors for early breastfeeding problems could assist targeting efforts to provide extra lactation support early on. We conducted research in a low-income community in Lima, Peru to determine the prevalence of early lactation problems (i.e. delayed lactogenesis, excessive newborn weight loss and sub-optimal breastfeeding behavior), and their association with later optimal breastfeeding practices (i.e. exclusive breastfeeding).  We found that early breastfeeding problems were less prevalent in this setting, compared to the US, which may relate to the differences in childbirth practices between these two countries. Interestingly, we did not observe an association between early lactation problems and early discontinuation of exclusive breastfeeding, as has been observed in the US. This finding highlights the importance of cultural/environmental support towards breastfeeding.

In Northern California, we studied the risk factors for delayed lactogenesis (i.e. arrival of milk after 72 h postpartum) among women who had been diagnosed with gestational diabetes mellitus (GDM). In this population, obesity, severity of GDM and suboptimal breastfeeding performance were risk factors for delayed lactogenesis. Information on these potentially modifiable risk factors is usually available in clinical settings, making these findings potentially useful for screening GDM women at higher risk of delayed lactogenesis and consequently of early breastfeeding discontinuation.

Latino health

Latinos experience higher rates of obesity than Whites, and these rates are higher in rural areas. Rural populations face unique environmental conditions because of its rural and isolated location, and the limited infrastructure and resources available. Using data from a cohort of Latino farmworkers in the Central Valley, we assessed the association between acculturation and dietary patterns in this generally low acculturated population. Despite their low acculturated levels, several of the acculturation indicators we measured were associated with fruit/vegetable consumption and fat intake, all except one in the anticipated direction (i.e., low acculturation, healthier dietary patterns). So, acculturation is an important factor to be taken into account when designing culturally tailored interventions in this population. Another interesting result from this study was the association between attendance to school in the US and having a child at home with higher fat intake in this adult population. These findings could assist targeting efforts when planning nutrition education interventions for Latino farmworkers.

Next, we moved from understanding the Latino population dietary practices to promoting behavioral change. In an unprecedented partnership with the largest berry producer in California, we implemented a randomized pilot intervention targeting Latino farmworkers in the areas of Oxnard and Watsonville. This intervention aimed to reduce obesity and prevent diabetes and was implemented in collaboration with the farmworkers’ employer organization. In addition to nutritional education this pilot intervention included a strong component on physical activity. This pilot intervention increased consumption of water and fruits and vegetables servings and the time spent in moderate physical activity in the overall sample, and reduced weight, body mass index and waist circumference among females.

Evaluation research

My research program also includes impact and process evaluation research. In particular, I have evaluated the effectiveness of a novel nutritional product, lipid-based nutrient supplements (LNS). LNS products provide key macronutrients, including essential fatty acids, and several micronutrients in amounts appropriate for the needs of specific population groups (women and infants) and are added to a regular meal as they are considered home fortification products. This product has arisen as a promising alternative to prevent stunting and potentially anemia in low-income settings.

We conducted two randomized effectiveness trials to evaluate the effectiveness of LNS on reducing stunting and anemia and improving child development: 1) a longitudinal, cluster- randomized trial with four arms involving women and children in Bangladesh (n=4,011), and 2) a randomized trial with two arms allocating infants (n=422) to receive either LNS or the standard of care in Peru. Because LNS was a novel approach and not produced locally we also conducted a process evaluation and a cost analysis study. This type of information is needed for advancing public health decisions and policy.

Both of these LNS interventions were added into existing programs, thus the implementation of these trials relied on successful partnerships beyond academia. In Bangladesh, we collaborated with a non-profit organization already implementing a community-based program in the study area. In Peru, collaboration between academia, a humanitarian non-profit organization and the government sector was fundamental for implementing the trial using the platform of a national program delivered in health centers targeting infants and young children. These types of collaborations are critical for conducting community-based interventions and testing the feasibility of scaling up successful nutrition interventions.