摘要：Objectives. To assess obesity risk among mothers participating in Community Kitchens and children participating in Glass of Milk (Peru food assistance programs). Methods. We analyzed prospective data from the Young Lives study. The exposure consisted in varying degrees of benefit from any of the programs (no participation in any of the programs, program participation for some months, or program participation nearly every month) at baseline (2006–2007). The outcome was overweight and obesity in mothers and children at follow-up (2009–2010). Results. Prevalence of childhood overweight and obesity was 15.5% and 5.1%, respectively; the corresponding figures for mothers were 40.5% and 14.6%. Children exposed nearly every month to the Glass of Milk program had a 65% lower risk of becoming obese compared with children not participating in the program (relative risk [RR] = 0.35; 95% confidence interval [CI] = 0.18, 0.66). Mothers participating frequently in the Community Kitchens program had almost twice the risk of becoming obese compared with those who did not participate (RR = 1.93; 95% CI = 1.18, 3.15). Conclusions. Participating in food assistance programs in Peru was associated with a lower risk of obesity in children and greater risk of obesity in mothers. Obesity is a global health issue from which Latin America is not exempt. 1 For women aged 20 years and older in Andean Latin America, obesity prevalence is 23.4%, 2 which is higher than in some countries in Asia, Africa, and Europe. Childhood obesity is also a concern in Latin America, where between 22 million and 25 million school-aged children are overweight or obese. 3 In Peru, obesity rates for adults and children (aged 5–9 years) are 28.5% and 8.9%, respectively. 4 These estimates vary according to rural, urban, coastal, or highland setting. 4,5 Peru shows a greater prevalence rate of childhood and adolescent obesity than other countries in the region, and in Asia, Africa, and Europe. 2,3 Although Peru has experienced significant economic growth over the past few decades, there are still inequalities across the country: the 24% national poverty rate conceals a great deal of variation because poverty rates reach 48% in rural areas. Poor families would benefit from food assistance programs (FAPs). Unfortunately, studies in the United States have linked FAPs with obesity, particularly for women. 6 However, the evidence regarding children is less conclusive. Infants whose mothers participate in FAPs have higher odds of being overweight, 7 but for older children, the association is not as clear as that observed in the United States and Mexico. 8–10 Studies in Chile have reported increasing rates of obesity as well as excess energy intake among beneficiary children. 11–14 A study in Peru found a 29% higher obesity prevalence among women participating in these programs. 15 However, this study combined FAPs as the exposure, precluding an assessment of the impact of specific FAPs. Two programs with great impact in Peru are Vaso de Leche (Spanish for Glass of Milk) and Comedores Populares (Spanish for Community Kitchens; File A, available as a supplement to the online version of this article at http://www.ajph.org ). Most of the existing evidence of the association between FAPs and obesity comes from cross-sectional studies in developed countries. 6–8,10,16 Previous studies have been unable to discriminate in detail the exposure of interest because of the broad use of participation in FAPs or the focus on only 1 program. The present study includes the frequency of participation in 2 specific programs, and the outcomes were measured separately for mothers and children. This study improves upon previous studies that have put together FAPs instead of singling them out. We aimed to assess the obesity risk of mothers and children who are beneficiaries of 2 FAPs: Community Kitchens for mothers and Glass of Milk for children.
