Mexico Hosts the XXII Latin American Congress of Nutrition

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The XVIII Latin American Congress on Nutrition was held in Guadalajara in the state of Jalisco in Mexico from November 11 – 16, 2018. Since 2016, the Presidency of the Latin American Society of Nutrition (SLAN) has been in the hands of Dr. Juan Rivera-Domarco, a graduate of Cornell University and currently the Director of the National Institute of Public Health (INSP) in Cuernavaca, Mexico. On January 1, 2019, the Presidency of SLAN will have passed from Juan Rivera and Mexico to Rafael Figueredo-Grijalba and Paraguay, for the following triennial congress in Asuncion in 2021. Meanwhile, Dr. Wilma Freire of Ecuador was installed as President-Elect of SLAN, such that her Andean nation will host of the 2024 meeting of SLAN.

The theme of the 22nd SLAN Congress was “Healthful Eating for a Sustainable Planet.” The watchword of the Organizers was the limitation of “Conflict of Interest,” interpreted as undisclosed involvement with the food and beverage manufacturers who constitute the commercial marketplace. None of these foods, drinks and snacks, deemed as unhealthy, were permitted as part of the Congress in sponsorship or on the premises; the boast was made that the congress was financed without industry support, relying on registrations, membership fees, and a major contribution from UNICEF as well as other NHOs, with some in-kind support by the local Jalisco authorities. In symbolic manner, the coffee break snacks were fresh fruits, accompanied by plain drinking water and coffee without sugar, creamer or artificial sweeteners. With limited funding, austerity was the watchword. Not a single performance by the Mariachimusical genre of Jalisco was seen in the Congress and the gala dinner was a bring-your-own-bottle affair.

Themes of the Congress were brought forward to its 1800 attendees, who brought 1280 free-papers as oral presentations or posters to the spacious confines of the Expo Guadalajara conference center. These were joined by 77 invited or arranged events, of which 55 were 1.5-hour Symposia, Thematic Panels or Discussion Forums.  An additional four were Plenary Lectures in the main auditorium. They included:

1) Brent Loken, Science Liaison Officer of EAT-Commission, with the topic directly crafted verbatim after the Congress’ title theme;
2) Barry Popkin of the University of North Carolina, with “Policies for the Prevention of Obesity and Chronic Disease in Latin America”;
3) Dr. Francesco Branca, Director of the Department of Nutrition for Health Development of the World Health Organization, with “the Double Burden of Malnutrition”; and
4) Cesar Victora, Professor Emeritus at the University of Pelotas in Brazil, with “the First 1000 Days and the Sustainable Development Goals.” 

The first three were based primarily on the excesses in nutrition whereas the last focused on stunting, which was attributed more to poverty, poor sanitation and inequality than to dietary factors.

The Congress wrapped up with a final plenary session in the format of an interactive panel discussion on the topic of “Nutrition Priorities on the Horizon of the Sustainable Development Goals (SDG).” It was moderated by Lynnette Neufeld of GAIN, President-Elect of the International Union of Nutritional Sciences, and including as panelists, Marc-André Prost of the World Food Program, Victor Aguayo of UNICEF, and Dr. Rafael Flores-Ayala of the Center for Disease Control and Prevention in Atlanta. The general consensus was sage and modest, with emphasis on harmonizing new policy initiatives with both the underlying evidence and the population needs in transparent focus.

The Dominant Thematic Thread of the Congress

The mantra for the global nutrition community has been malnutrition in all of its forms. The Program of the SLAN Congress covered a broad front of themes and topics. The most dominant, however, were aspects of quality, selection and provision of food and the adverse consequences from exposures to sugars, sodium, saturated and transfat, packaging and environmental toxins, as well as the issue of excess calories. Of 55 major, non-plenary sessions, 34 were in this domain. Nine had the terms obese or obesity in the titles. Four involved front or back nutritional labeling of commercial food.  So-called ultra-processing of commercial food was woven into this thematic area as well. The integration of the entire food system in terms of the social, cultural and environmental impact aspects of satisfying the foodstuff needs of populations at local, regional and global bases. The qualifying principle of “sustainable” accompanied many of these sessions, in line with the Congress title and the corresponding SDGs for 2030.

Outside of the major focus on dietary pattern, food- and ingredient-avoidance, and sustainability and food-system domains, there were assorted other topics treated in the major sessions. Across the life-cycle from infants, to pregnancy to aging, nutritional health issues were treated, as was nutritional and gastrointestinal health and the importance of phytonutrients. Certain sessions addressed methodological issues such as food security assessment, bioelectrical impedance and body composition and nutritional modeling.

The Micronutrient Agenda

Sessions dedicated to micronutrients were scarce, counted as one pre-congress event and five major sessions within the Congress Program. The Symposium and Workshop on “Lipid-soluble Nutrients in Human Milk: Pathway to International Collaboration” was a collaborative, pre-congress effort of the Fundacion Iberoamericana de Nutrición (FINUT) of Granada, Spain, the DSM Nutritional Products of Basel, Switzerland, and the Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM) in Guatemala. The nutrients of interest were vitamin D, vitamin E and omega-3 fatty acids. The morning session was dedicated to the symposium aspects, with biological functions of the nutrients and the epidemiological and quantitative-analysis issues regarding human milk. The presenters were Angel Gil (Spain), Noel W. Solomons (Guatemala), Alfonso Valenzuela (Chile) and Doug Bibus (USA). The afternoon session provided practical instruction on field investigation of these nutrients in breast milk including protocol development, bioethics, and milk collection, processing and handling, based on the experience of the CeSSIAM staff members who conducted the workshop. The goal of the effort was to enroll up to 20 diverse sites in Spain and the Americas to obtain dried milk samples for fatty-acid profile assays and up to 10 of these with analyses of vitamin D vitamers and alpha-tocopherol from liquid milk samples in addition.
 
The four symposia and single thematic panel focused on micronurient malnutrition are outlined in the Insert Box, with the session title, moderator and speakers. Within the five dedicated sessions were 22 individual presentations. The consensus findings from a global inquiry on selected micronutrients via the New York Academy of Sciences with funding from the Bill and Melinda Gates Foundation were presented with a regional focus. A strong realization is that, at least for the micronutrients of conventional public health interest, the situation in Latin America has improved and the task ahead consists of dedicated refinements and improvements in the implementation of programs to close the remaining gaps. This was true for folate and thiamine in the region, in which the situation is superior to that on other developing continents. Vitamin D nutriture was identified as a problematic area in this conclave. Elsewhere in the congress Program, data from Mexico and other sunny countries, confirm that customary solar exposures are not sufficient for prevention of the deficiency and insufficiency of this vitamin. From another session focusing on traditional nutrients, attention to the fortification of salt with iodine was identified as an enduring need due to on-going variation. Anemia prevalence has declined progressively across the region, but focus in under-five children and elderly over 60 years old is still warranted. The reminder was made that reliance on the validity of commonly-used biomarkers of micronutrient status must be tempered by the endemic nature of infectious and inflammatory states, and the distortion this exerts on interpretation of diagnostic findings for vitamin A and iron.  

A micronutrient that is not a vitamin or a mineral was the subject  of a symposium relenvant to the region. Presented by DSM Nutritional Products, four international experts were featured, covering the combined theme of the basic biology and region-wide epidemiology of the omega-3 fatty acid, docosahexaenoic acid (DHA). The relationship between adequate intakes of this essential fatty acid and neuronal development and cognitive function was reviewed and explained.

Interventions to prevent micronutrient malnutrition were the subject of two sessions with involvement of international agencies or non-governmental organizations. Food fortification with conventional (folic acid, iron) and emerging (vitamins D and E, choline and omega-3 fatty acids) nutrients was addressed in a session sponsored by the Fundación Iberoamericana de Nutrición(FINUT) of Granada, Spain. A corollary was that the meticulous efforts in monitoring and surveillance required to determine the state of fortification coverage and potential needs for adjustments in levels or changes in food vehicles. The Global Alliance for Improved Nutrition (GAIN) and the World Food Program (WFP) updated the status for home-fortification of complementary food with micronutrient powders (MNP). Efficacy studies have shown robust capacity of MNPs to reduce iron deficiency anemia, but there effectiveness at the public health level has been problematic in their implementation. A series of qualitative and mixed-methods research findings examined the underlying social and household barriers in MNPs and proposed corrective solutions.

Notable Special Events

The V Rainer Gross Prize was awarded in Guadalajara. This prize recognizes the expression of the spirit of the late Dr. Rainer Gross, leader in scientific discovery and capacity building first in Brazil, Indonesia and Peru in his career with the German Gesellschaft für Technische Zusammenarbeit (GTZ) and later at UNICEF Headquarters in New York. The award is sponsored by the Hildegard Grunow Foundation of Munich, Germany. Dr. Sun-Eun Lee, an Assistant Scientist in the Department of International Health of the Johns Hopkins Bloomberg School of Health in its Center for Human Nutrition in Baltimore was the winner of the fifth prize. The innovative direction that her research takes is in the proteomic profiles of micronutrient populations of Nepal and Bangladesh. Her research has provided alternative biomarkers for nutritional status and strengthened the associations of functional aspects of immune and cognitive function with specific micronutrients.  Dr. Lee was unable to travel to Mexico as her first child had been born four days earlier, but she presented an awards lecture by pre-recorded video presentation. Dr. Rebecca Kanter, who received her doctoral degree from the same Center of the JHSPH received the certificate plaque on behalf of Dr. Lee.

Summary Comments

The distribution of the themes featured in Guadalajara at the 22nd SLAN Congress is a reflection of how far ahead of the African and Asia continents is the Latin American and Caribbean region in terms of the alleviation of macro- and micronutrient deficiency states at the population level. It was announced that, even at UNICEF, historically a bastion to address problems of undernutrition in the context of social and economic deprivation, initiatives to combat childhood obesity have recently been initiated, specifically for the Western Hemisphere. A poignant and troubling exception is the public health nutrition situation of a humanitarian crisis in contemporary Venezuela; this was brought to the attention of the gathering with a Symposium and numerous free papers. 
 
Nonetheless, emphasis on feeding patterns that would eliminate overweight, chronic degeneration and metabolic condition was clearly expressed in the SLAN Congress Program. It is in the emerging micronutrients, vitamins D, E, K, choline and essential fatty acids, which justify research investment in the region. It is to be hoped that ongoing investigation in these areas can sustain an increased representation of micronutrient themes in Paraguay and Ecuador in the coming congresses of the Latin American Nutrition Society.