My research centers in topics that a) promote health through nutrition and b) prevent nutrition related conditions, with a focus in disadvantaged populations.

Breastfeeding

Breastfeeding has many benefits, for both infants and 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 studied the prevalence of early lactation problems (i.e. delayed lactogenesis, excessive newborn weight loss, sub-optimal breastfeeding behavior), and their association with later optimal breastfeeding practices (i.e. exclusive breastfeeding) in a low-income community in Lima, Peru.  We found less early breastfeeding problems in this setting, compared to the US, which may relate to the differences in childbirth practices between these two countries. Interestingly,  early lactation problems were not associated with early discontinuation of exclusive breastfeeding, as has been observed in the US. This finding highlights the importance of cultural and environmental support towards breastfeeding.

In Northern California, we investigated the risk factors for delayed lactogenesis (i.e. arrival of breastmilk after 72 h postpartum) among women with a gestational diabetes mellitus (GDM) diagnostic. In this population, obesity, severity of GDM and suboptimal breastfeeding performance were risk factors for delayed lactogenesis. Because information on these potentially modifiable risk factors is generally available in clinical settings, these findings are useful for screening GDM women at higher risk of delayed lactogenesis, and consequently at higher risk of early breastfeeding discontinuation.

Latino health

Latinos experience higher rates of obesity than Whites do, with even higher rates in rural areas. Rural populations face unique environmental conditions because of its isolated location, the limited infrastructure and resources available. Using data from a cohort of Latino farm workers in the California Central Valley, we assessed the association between acculturation and dietary patterns in this population. Despite their low acculturation levels, several acculturation indicators were associated with fruit/vegetable consumption and fat intake, all except one in the anticipated direction (i.e., low acculturation -> healthier dietary patterns). Thus, acculturation is an important factor to consider when designing culturally tailored interventions in this immigrant farm worker population. Another interesting finding was the association between school attendance in the US and having a child at home with higher fat intake in this adult population. These findings could inform nutrition education interventions for Latino farm workers.

Next, we moved from understanding the Latino population dietary practices to promoting behavioral change. In an unprecedented partnership with a berry producer in California, we implemented a randomized pilot intervention targeting Latino farm workers in the areas of Oxnard and Watsonville. This intervention aimed to reduce obesity and prevent diabetes and was implemented in collaboration with the farm workers’ employer organization. In addition to nutritional education this pilot intervention promoted physical activity. This intervention resulted in increased consumption of water, fruits and vegetables 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 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 is 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 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 beyond academia are critical for conducting community-based interventions and testing the feasibility of scaling up successful nutrition interventions.