Anthropometric Indicators and Dietary Intake in Toddlers Aged from 12 to 24 Months Who Attended Private Clinics in the Metropolitan Area of Guadalajara

The objective was to evaluate the anthropometric indicators and dietary intake of toddlers attending private clinics in Guadalajara. In a cross-sectional study, 101 toddlers aged 12 to 24 months were included. They were born full term, had an adequate weight for gestational age, and attended private clinics in Guadalajara. Two 24 h dietary recalls were administered. Anthropometric measurements were taken, and anthropometric indices were estimated. Student's t test or the Mann-Whitney U test, chi-square test, and odds ratio were used for quantitative or qualitative variables. Males had lower Z scores for the weight/age index than females. During the week, energy intake was excessive in males [OR = 5.5 (95% CI 1.4, 20.8)], and cholesterol intake was insufficient in females [OR = 3.03 (95% CI 1.2, 7.1)]. On weekends, energy [OR = 2.5 (95% CI 1.1, 5.7)] and fiber intake [OR = 3.1 (95% CI 1.2, 7.8)] were insufficient in females. Most of the toddlers who attend the private clinics in the upper-middle socioeconomic stratum of the Guadalajara Metropolitan Area had excessive protein intake, excessive consumption of added sugars was frequent, and there was insufficient intake of vitamin D and calcium. Sex was shown to be a factor influencing nutrient intake in these toddlers aged 12-24 months. Males had a Z-score of weight/age lower than females, suggesting nutritional risk.

Gurka vs Slaughter equations to estimate the fat percentage in children with cerebral palsy from all subtypes and levels of the Gross Motor Function Classification System

BACKGROUND

Body composition assessment in children with cerebral palsy (CP) is a challenge, specially the fat percentage. There are different methods that can be used to estimate the fat percentage in this population, such as anthropometric equations, but there is still a need to determine which is the best and most accurate. The purpose of the study was to determine the method that best estimates the fat percentage in children from all CP subtypes and levels of the Gross Motor Function Classification System (GMFCS).

METHODS

Analytical cross-sectional study in which 108 children with CP diagnosed by a pediatric neurologist were included with any type of dysfunction and from all levels of the GFMCS. Slaughter equation, Gurka equation and Bioelectrical impedance analysis (BIA) as reference method, were used. Groups were stratified by sex, CP subtypes, GMFCS level and Tanner stage. Median differences, Kruskal-Wallis, Mann-Whitney U test, Spearman's correlation coefficients and simple regressions were used, also multivariate models were performed.

RESULTS

The Slaughter equation differed from the other methods in the total population and when it was compared by sex, CP subtypes, gross motor function and Tanner stage. The Gurka equation showed significant differences by sex and gross motor function. Gurka equation correlated positively and significantly with BIA to estimate the fat percentage in all the CP subtypes and levels of the GMFCS. Tricipital skinfold (TSF), arm fat area (AFA) and weight for age index (W/A) showed the highest variability with respect to fat percentage.

CONCLUSION

Gurka equation is more appropriate and accurate than Slaughter equation to estimate the fat percentage in children with CP from all subtypes and levels of the GMFCS.

Adiposity and feeding practices in the first two years of life among toddlers in Guadalajara, Mexico

BACKGROUND

Feeding practices in the first two years of life have a direct impact on nutritional status and adiposity. The purpose of this study was to identify the differences in feeding practices during the first two years of life by sex and type of feeding in the first semester of postnatal life and their relationships with adiposity in toddlers.

METHODS

An analytical cross-sectional study that included 150 toddlers aged 12 to 24 months who were healthy, full-term, and had adequate weight for their gestational ages, was conducted at the New Civil Hospital and at a private practice in Guadalajara. Body compositions were obtained by bioelectrical impedance (BIA) measurements, and a modified questionnaire was used. Then, the parents completed two 24-h dietary recalls. In addition to the descriptive statistics, ANOVA, Kruskal-Wallis and Mann-Whitney U tests were used in the contrast analysis of the quantitative variables. To analyze the qualitative variables, we used X² tests. Afterward, linear regression tests were conducted to identify the relationships between adiposity and feeding practices during the first two years.

RESULTS

There were direct relationships between adiposity and duration of full breastfeeding (r = 0.610, p = 0.021), age of introduction of ultra-processed products (r = 0.311, p = 0.011), sugar (r = 0.186; p = 0.024) and age at which eggs were introduced (r = -0.202; p = 0.016).

CONCLUSIONS

Adiposity was related to feeding practices in the first two years of life in toddlers.

Bone mineral density and body composition in normal weight, overweight and obese children

BACKGROUND

There is a possibility that excess body fat affects bone mass gain and may compromise skeletal health in obese children. The purpose of the study was to identify the relationship between bone mineral density (BMD) and body composition in normal weight, overweight and obese children.

METHODS

This was a cross-sectional study of 6- to 11-year-old children who attended the hospital's outpatient clinic. They were apparently healthy and had no history of prematurity, low birth weight, or chronic diseases. Body mass index (BMI) was used to identify subjects as normal weight, overweight or obese. BMD and body composition were assessed by dual energy X-ray absorptiometry. The BMD values (total and lumbar spine) were compared between normal weight, overweight and obese children. Correlation coefficients were calculated, and multivariate models were performed.

RESULTS

Forty-nine children were included: 16 with normal weight, 15 that were overweight and 18 with obesity; the mean age was 8.4 ± 1.7 years. All the participants had a normal BMD (> - 2 SD). BMD was higher in obese children and had a positive correlation with total and trunk lean mass in the three study groups (p < 0.001). In obese children, an inverse correlation of lumbar spine BMD (Z score) with total and trunk fat mass (p < 0.05) was identified. In the multivariate models (with the whole group), the total lean mass was the only significant variable that explained BMD variability.

CONCLUSIONS

BMD in obese children was higher than that in normal weight children, which is explained by their greater lean mass and not by excess body fat. In obese children, a higher fat mass was related to a lower lumbar spine BMD. Lean mass had a direct correlation with BMD in the three study groups and was the most important predictor of BMD, reflecting the importance of strengthening the muscular system through performing physical activity and practicing a healthy lifestyle.

Examining the validity and consistency of the Adult Eating Behaviour Questionnaire-Español (AEBQ-Esp) and its relationship to BMI in a Mexican population

PURPOSE

Appetitive traits in adults and their associations with weight can be measured using the Adult Eating Behaviour Questionnaire (AEBQ). The aim of this study was to confirm the factor structure of the Spanish AEBQ (AEBQ-Esp) in a Mexican sample and explore associations between the eight traits with body mass index (BMI).

METHOD

A sample of 1023 adults, mean age of 36.8 ± 12.8 years, was recruited from Guadalajara, Mexico. Researchers weighed and measured participants, and they completed the AEBQ-Esp either online or in paper format and reported sociodemographic data. To test two alternative factor structures (eight factors including Hunger; seven factors excluding Hunger), confirmatory factor analysis (CFA) was used. Internal reliability was assessed using Cronbach's alpha; test-retest reliability was assessed using intra-class correlation coefficients. Multivariate linear regressions were used to test for associations between the AEBQ subscales and BMI, adjusted for age, sex, format of AEBQ responses, education, marital and employment status.

RESULTS

A seven-factor structure was the best model fit using CFA, excluding the Hunger subscale but similar to the original AEBQ. Internal reliability was good for all subscales (Cronbach's α = 0.70-0.86), and the intra-class correlation coefficient (0.70-0.91) reflected good test-retest reliability. In the fully adjusted models, Satiety Responsiveness [β = - 0.61; (- 1.01, - 0.21)] and Slowness in Eating [β = - 0.70; (- 1.01, - 0.39)] were negatively associated with BMI, and Emotional Over-Eating [β = 0.94; (0.62, 1.27)] was positively associated with BMI.

CONCLUSIONS

The AEBQ-Esp (excluding Hunger) appears to be a valid and reliable psychometric questionnaire for measuring appetitive traits in a Mexican Spanish-speaking population. Some traits appear to be associated with BMI in adulthood and warrant further exploration.

LEVEL OF EVIDENCE

Level III evidence obtained from well-designed cohort or case-control analytic studies. Although this was just an observational study, it was well designed and provided new evidence.

Influence of the Type of Breastfeeding and Human Milk Polyamines on Infant Anthropometric Parameters

Feeding choices in the early months of life are key determinants of growth during infancy. Polyamines participate in cell proliferation and differentiation, and it has also been suggested that polyamine metabolism plays a role in adipogenesis. As the main exogenous source of polyamines in the infant is human milk, the aim of this work was to study if the type of breastfeeding received and the polyamine intake from human milk has an influence on infant anthropometric parameters. A cohort of 78 full-term healthy newborns was followed up until 4 months of age; 55 were fully and 23 partially breastfed. Anthropometric measurements were taken at 2 and 4 months, when human milk samples were also collected for analysis of polyamine content by UHPLC-FL. Fully breastfed infants had a better anthropometric profile than those partially breastfed (p < 0.05). Furthermore, polyamine intake in partially breastfed infants was significantly lower compared to those fully breastfed. However, only two of the 15 anthropometric indicators evaluated (triceps skinfold and mean upper arm circumference) showed a significant inverse association with polyamine content in human milk and intake (p < 0.05). Infant growth and body composition differ according to the type of breastfeeding received. Based on the weak associations between polyamines and anthropometric indicators, it is not possible to conclude the influence of polyamines in infant growth and body composition.

Influence of Breastfeeding Factors on Polyamine Content in Human Milk

The polyamine content of human breast milk, which is the first exogenous source of polyamines for the newborn, can be affected by several factors associated with the mother, the infant, or breastfeeding itself. The aim of this study was to evaluate the influence of different breastfeeding factors on the polyamines found in human milk. For this study, a cohort of 83 mothers was considered for up to 4 months, and a subgroup of 33 mothers were followed during the first six months of breastfeeding. Two breast milk samples were collected at each sampling point (foremilk and hindmilk) and the polyamine content was determined by UHPLC-FL. Polyamine levels varied considerably between the mothers and tended to decrease over time. Putrescine was the minor polyamine, whereas spermidine and spermine contents were very similar. The concentrations of the three polyamines were significantly higher in hindmilk than foremilk (p < 0.001). Spermidine and spermine levels decreased significantly through the lactation progress (p < 0.05). Finally, slightly higher levels of polyamines were observed in the milk of mothers providing partial, rather than full, breastfeeding, although the differences were not significant. The polyamine content in human milk was found to change during a single feed (foremilk versus hindmilk) and as lactation progressed, mainly in response to the specific circumstances of the newborn.

Full Breastfeeding Modifies Anthropometric and Body Composition Indicators in Nursing Mothers

Background: It has been observed that breastfeeding mobilizes the deposits of fat that accumulate during pregnancy and promotes weight loss through energy expenditure. The purpose of this study was to demonstrate that full breastfeeding (FBF) reduces anthropometric and body composition indicators in women between the 8th and the 16th week postpartum. Methods: In a nonrandom cohort study, 170 mothers at the Hospital Civil de Guadalajara, Guadalajara, México, were enrolled: FBF 74, partial breastfeeding (PBF) 57, and human milk substitutes (HMS) 39. Anthropometric indicators and body composition were measured at the 8th and 16th week postpartum. We performed analysis of variance to compare body composition according to the type of feeding and paired Student's t-test to compare the changes from the 8th to 16th week postpartum. Results: We found that FBF mothers had a trend to lower arm fat area and triceps skinfold than PBF and HMS mothers at 8 and 16 weeks postpartum. We observed a decrease in weight (p = 0.004), weight/age index (p = 0.003), body mass index (p = 0.003), hip circumference (p = 0.037), and lean mass (p = 0.003) from 8 to 16 weeks postpartum in mothers who offered FBF. The mid-upper arm circumference, the arm total area, and their z-score increased in the three feeding groups. Conclusions: Our results show that FBF mothers had some lower adiposity from 8 to 16 weeks postpartum compared with the result observed among PBF mothers and those who utilized HMS.

Appetitive traits in children aged 6 to 12 years: association with obesity and differences by gender

BACKGROUND

Overweight and obesity in schoolchildren are a major public health problem in Mexico. The objective of this study was to demonstrate the association of appetitive traits with the presence of obesity and identify gender differences in children attending a university hospital.

METHODS

A cross-sectional study was conducted on 176 children with obesity and 175 children with normal weight in the outpatient clinic of the Nuevo Hospital Civil de Guadalajara. The body mass index (BMI) of the participants was calculated. The parents completed the Children's Eating Behaviour Questionnaire to measure eight appetitive traits. The mean appetitive trait scores were compared between children with obesity and normal weight, and between genders. Statistical analysis was performed using Student's t-tests for independent samples and regression analysis between appetite traits and BMI Z-scores.

RESULTS

The mean food responsiveness score (or food onset appetitive trait) was higher in children with obesity (p < 0.001), while the mean satiety responsiveness (or food offset trait) was higher in children with normal weight (p < 0.001). Normal weight males showed higher scores for Food responsiveness, Emotional over-eating, and Desire to drink (p < 0.05).

CONCLUSIONS

Children with obesity show appetitive traits that could lead to higher food consumption. Normal weight males showed appetitive traits that could represent a risk of developing obesity.

[Stunting, overweight and obesity during the nutrition transition in schoolchildren of Arandas, Jalisco, Mexico]

BACKGROUND

Nutrition transition provokes changes in the nutritional status of individuals subjected to the interaction of various environmental factors; therefore, the aim was to demonstrate that nutrition transition is associated with socioeconomic changes, eating habits and physical activity, potentially involved in stunting, overweight and obesity of schoolchildren.

METHODS

Case-control study. 102 participants from the Instituto Alteño para el Desarrollo de Jalisco (cases) and 194 from the elementary school system (controls), aged 5 to 12 years, were included. Dependent variables were these indexes weight/age (Z), height/age (Z), BMI (Z). Independent variables were the socioeconomic and demographic characteristics. Student's t test, chi square, odds ratio (OR) and 95% confidence intervals (95% CI) were estimated.

RESULTS

Family income was low (p = 0.031) and unstable job was higher in cases: OR = 4.1, 95% CI = 2.8-6.0. The frequency of stunting was higher in cases (9.9% vs. 5.9%). The combination of overweight/obesity was higher in controls (27.3% vs. 16.8%), OR = 1.85, 95% CI = 1.0-3.4.

CONCLUSIONS

The nutritional status of children of Arandas, Jalisco, has been modified by an accelerate nutrition transition, provoked by socioeconomic, educational and demographic factors that might have influence on the persistence of stunting and an increasing prevalence of overweight/obesity.

[Factors associated with physical activity and body mass index among schoolchildren from Arandas, Jalisco, Mexico]

BACKGROUND

In 2015, Mexico was the top country for childhood obesity. The objective was to identify the association between physical activity and sedentary lifestyle with the social and demographic characteristics of families of schoolchildren in Arandas, Jalisco, Mexico.

METHODS

In a cross-sectional study, 192 schoolchildren were randomly selected. Body mass index (BMI), active and sedentary behaviors, and socio-demographic characteristics of families were obtained. Logistic regression models with the included variables were constructed.

RESULTS

Males living in not-crowding houses [OR 6.12 (2.17-17.25), p = 0.001], whose mothers were housewives [OR 2.44 (1.00, 5.94), p = 0.05], practiced more physical activity. Active transport to school was more common in schoolchildren whose fathers had lower income [OR 3.13 (1.27, 7.7), p = 0.013] and employment as peasant or mason [OR 5.12 (1.13, 23.3), p = 0.034]. Schoolchildren of nuclear families spent more hours watching television [OR 2.69 (1.10, 6.58), p = 0.03]. The frequency of outdoor playing was higher in males whose fathers had unstable employment [OR 2.93 (1.06, 8.1), p = 0.038] and low education [OR 2.94 (0.96, 8.98), p = 0.059].

CONCLUSION

Families with lower socioeconomic strata (less educated parents, unstable employment and family overcrowding) are more associated with active activities that do not require active economic spending.

[First year of life. Human milk and human milk substitutes]

The nutritional improvement of mothers and their children is one of the most cost-effective tools to achieve optimal human growth and development. The World Health Organization recommends offering «exclusive breastfeeding for the first six months, and then begin the introduction of safe and nutritious food while breastfeeding continues until the second year of life.» Since the second half of the 20th century to date extraordinary progress in the manufacturing and formulation of substitutes for human milk has been accomplished, these being partial or complete substitutes for human milk, whether or not suitable for this purpose. Whole (cow´s) milk is not an adequate substitute for human milk during the first six months of life because of its great nutritional disparity and excess solutes with potential deleterious effects in infants. Therefore, it is an ethical responsibility of health professional to educate and advise parents and caregivers on the proper and timely use of human milk substitutes available in our country.

ENERGY CONSUMPTION, THE DISTRIBUTION OF MACRONUTRIENTS AND BMI IN MOTHERS AND THEIR MEXICAN SCHOOLCHILDREN

OBJECTIVE

to identify the association between the percentage of adequacy of energy and protein and the distribution of macronutrients and sugar in the diets of mothers and schoolchildren with their respective BMI.

METHODS

in a cross-sectional study, 174 5-12-year-old schoolchildren and their mothers were randomly selected. BMI was measured, and 24-hour dietary surveys were administered on weekdays and weekends. The associations between the dietetic indicators in the mothers and their children and the BMI of the mothers and their children were assessed. The chi-square test, linear regression and odds ratio were used for analysis.

RESULTS

excessive energy consumption in the mothers increased the risk of excessive energy consumption in their daughters by 11-fold (p=0.04). Maternal lipid intake was associated with the consumption of lipids in their sons and daughters (p.

THE ASSOCIATION BETWEEN PRE-PREGNANCY OBESITY AND WEIGHT GAIN IN PREGNANCY, WITH GROWTH DEVIATIONS IN NEWBORNS

INTRODUCTION

obesity in pregnancy has been associated with increased morbidity for the mother and fetus.

OBJECTIVE

to quantify the association between obesity in pregnancy with growth deviations of their newborn infants.

METHODS

a study of non-matched cases and controls was performed based on the Nuevo Civil Hospital of Guadalajara "Dr. Juan I Menchaca" 2012-2013. The dependent variables were the newborn being either large (LGA) or small for gestational age (SGA), and the independent variable was pre-pregnancy obesity. Gynecoobstetric and socioeconomic data were collected. The association between the dependent and independent variables was assessed with logistic regression.

RESULTS

one-hundred and forty-three mother-child dyads were studied with growth deviations of their newborn infants, and 137 mother-child dyads without growth deviations were studied. The age of the patients was 24.7 ± 6.3 vs. 24.0 ± 6.0 years, and the gestational age was 38 ± 1.2 vs. 38 ± 1.5. Factors associated with growth deviations were pre-pregnancy obesity (OR 2.65, 95% CI 1.29- 5.44), elevated weight gain during pregnancy (OR 1.98, 95% CI 1.04-3.76) and disease during pregnancy (OR 2.62, 95% CI 1.05-6.76). A multivariate model with the dependent variable LGA and associated covariates showed that pre-pregnancy obesity and high gestational weight gain were predictors of LGA (OR 2.43, 95% CI 1.10-5.40) and (OR 3.31, 95% CI 1.83-5.96).

CONCLUSIONS

in a population of young women with scarce economic resources, pre-pregnancy obesity and high weight gain during pregnancy were predictors of LGA.

Energy expenditure in children with cerebral palsy and moderate / severe malnutrition during nutritional recovery

OBJECTIVE

To analyze the total energy expenditure (TEE) and resting energy expenditure (REE) in children with cerebral palsy (CP) and moderate or severe malnutrition during nutritional recovery.

METHODS

In an intervention study, thirteen subjects with CP (10 females and 3 males with a mean age of 9y11m ± 2y3m), level V of the Gross Motor Function Classification System and moderate or severe malnutrition were included. Eight were fed by nasogastric tube and five by gastrostomy. They were compared with 57 healthy participants (31 females and 26 males with mean age of 8y7m ± 10m). Anthropometric measurements, body composition and energy expenditure by bioelectrical impedance analysis (BIA) and indirect calorimetry (IC) were performed in both groups.

RESULTS

TEE and REE were higher in healthy children than in children with CP in kcal/d and kcal/cm/d but were lower in kcal/kg/d (p <0.001). Intensive nutritional support for four weeks in children with CP produced a significant increase in energy expenditure.

CONCLUSION

TEE and REE, in children with CP, are lower than in healthy children. Estimating the REE in children with CP and malnutrition is better performed in kcal/kg/d than in kcal/cm/d. Fat-free mass (FFM) is a good predictor of the REE in healthy children and children with CP.

[Body composition and lipidic profile in women's during the third trimester of pregnancy]

OBJECTIVE

To demonstrate the behavior of body composition and lipid profile in pregnant women during the third trimester and who attended a Regional hospital Tepatitlán, Jalisco, Mexico.

METHODS

In an observational study, transversal, analytic 36 apparently healthy pregnant women were included with gestational age between 33 to <42 weeks. Anthropometric measurements, body composition and lipid profile were obtained. Student t test, Mann Whitney, chi square, Pearson and Spearman correlation for data analysis were used.

RESULTS

11 participants were overweight and 8 obese. Significant association between higher concentrations of triglycerides and TG / HDL-c index and pre-gestational BMI (p = 0.039 and p = 0.032 respectively) were found. Concentration greater than 200 mg / dL triglycerides are associated with an increased interpregnancy period of 3 years (p = 0.012). There was a significant correlation between abdominal deliveries with anthropometric indicators, pre-gestational weight, pre-gestational BMI and current BMI.

CONCLUSION

There is a direct correlation between body composition and lipid profile with age and the incidence of cesarean section. It is necessary to establish a more precise reference criterion for both the longitudinal track for every pregnant woman and for purposes of parametric comparison.

[Associated factors to the calcium intake in mexican pregnant adolescents]

OBJECTIVE

To explore food habits, demographic and socioeconomic factors associated to calcium intake of pregnant adolescents.

METHODS

In a cross sectional study 321 participants of 13 to 19 years old attending to the division of gynecology- obstetrics of the Civil Hospital of Guadalajara were included. All participants were healthy, in any moment of pregnancy and belonging to the low and middle-low socioeconomic status. The calcium intake was obtained through a food frequency questionnaire and a 24-hour dietary recall. Demographic and socioeconomic data were also included. A chi square test, an odds ratio (95% CI) and a regression logistic model for the identification of the epidemiologic meaning of the associated variables to the calcium intake were obtained.

RESULTS

Sixty one percent of adolescents consumed less that 80% of the diary recommended intake of calcium. The domestic labor occupation of adolescents [OR 2.66 (1.28-5.53)], low milk [OR 2.54 (1.37-4.0)] and dairy intake [OR 2.75 (1.09-7.0)], excess of carbonated beverages consumption [OR 1.84 (1.04-3.28)] and low literacy of mothers [OR 1.83 (1.15-2.90)] were the most epidemiological meaning factors associated to deficient calcium intake.

CONCLUSION

The results suggest that the calcium intake was deficient in the majority of pregnant adolescents and that there are some risk factors that must be identified and attended. Likewise, it is necessary to evaluate the nutritional status of calcium in this especial group with more precise and specific methods.

Anthropometric indicators of nutritional status and growth in very low birth-weight premature infants hospitalized in a neonatal intensive care unit

BACKGROUND

Anthropometric indicators are difficult to interpret in very low birth weight (VLBW) premature infants, including both appropriate for gestational age (AGA) and small for gestational age (SGA) infants. Therefore, the purpose was to describe the anthropometric indicators of growth and nutritional status in VLBW premature infants AGA and SGA, hospitalized in a neonatal intensive care unit (NICU).

STUDY DESIGN

The descriptive and prospective study design included 114 preterm infants, adequate for gestational age/small for gestational age hospitalized in the intensive care unit. Head, thigh, mid upper arm circumference, skin-fold measurements and weight/age, length/ age, and weight/length indices were obtained. Correlations were made among the anthropometric indices, and a multivariate regression analysis with weight/age as dependent variable was performed.

RESULTS

Weight/age in AGA premature infants had high number of significant anthropometric correlations. The SGA premature infants had few and weak correlations. The regression analysis showed that anthropometric indices better explain changes in the weight/age index in adequate for gestational age premature infants.

CONCLUSION

Weight/age in the VLBW/AGA premature infants could reflect growth, nutritional status and energy stored as fat, but in the VLBW/SGA premature infants, thigh circumference and mid arm circumference would be better indicators just of nutritional status.

Intensive nutritional support improves the nutritional status and body composition in severely malnourished children with cerebral palsy

OBJECTIVE

To demonstrate that a nutritional support intervention, via naso-enteral tube-feeding or gastrostomy, has a significant impact on the nutritional status and body composition in severely malnourished children with cerebral palsy spastic quadriplegia.

METHODS

Thirteen patients with moderate/severe malnutrition and cerebral palsy spastic quadriplegia who were fed via naso-enteral tube-feeding or gastrostomy were included in a cohort study. Anthropometric measurements and estimated body composition by bioelectric impedance analysis were obtained. ANOVA and Wilcoxon tests were used.

RESULTS

During the four weeks of nutritional recovery, an average weight increase of 2700 g was achieved. There were significant increases in anthropometric indicators, including BMI and weight/length (p < 0.01). The increase in arm fat area was significantly higher than the increase in arm muscle area (104.5 vs 17.5%).

CONCLUSION

Intensive nutritional support for four weeks had a significant effect on the nutritional status and body composition of severe and moderately malnourished children with cerebral palsy spastic quadriplegia.

Risk factors associated with iron depletion and parasites in preschool and school children of Arandas, Jalisco, México

OBJECTIVE

The objective of this study is to explore factors associated with iron depletion and parasites in preschool and school children attending the Instituto Alteño para el Desarrollo de Jalisco (INADEJ) and children who attend preschools and schools in Arandas, Jalisco.

METHODS

This cross sectional study assessed two groups of children. In the INADEJ group, 102 children aged 60 to 144 months old were included, and in the School group of Arandas, Jalisco, 206 children were randomly selected from schools and preschools in the same municipality.

VARIABLES

Ferritin concentration (μg/ml), parasites, demographic, socioeconomic, educational and dietary data were collected. The Student's t test, U Mann Whitney, chi square, odds ratio and logistic regressions were estimated.

RESULTS

Family income in the Schools group was $5,707 Mexican pesos (MP), which was higher than the family income in the INADEJ group ($4,311 MP), p = 0.031. The proportion of parents with incomplete primary education was higher in the INADEJ group (41.3%) than in the Schools group (35.4%) [OR = 1.88 (1.0-3.55)]. Unstable work was more frequent in the INADEJ group than in the Schools group [OR = 5.6 (3.26-9.62)]. The ferritin concentration was lower in the INADEJ group than in the Schools group (25 μg/L vs. 60 μg/mL, respectively), p <0.001. Having giardiasis and two or more parasites was more common in the INADEJ group compared with the Schools group [OR = 7.2 (2.25-23.0)] and [RM 3.86 (1.35-10.98)]. Heme iron intake was lower in the INADEJ group.

CONCLUSION

Low family income, father's job instability, lower levels of education, overcrowding, living with animals and lower consumption of heme iron were associated with parasites and iron depletion.

[Calcium intake and adiposity in adolescents aged 12-16 years in Guadalajara, Mexico]

The purpose was to evaluate the association between calcium (Ca) intake and adiposity in adolescents. A cross-sectional study of 125 adolescents 12 to 16 years. Ca intake was evaluated by 24-hour recall dietary surveys and food frequency consumption. Adiposity was measured by anthropometric methods and bioelectrical impedance (BIA). The association between Ca intake and adiposity was identified by simple correlation and multivariate models adjusted to energy consumption, age, sex and menarche. Mean age of adolescents was 13.5 +/- 0.8 years. A negative correlation was identified between Ca intake and anthropometric indicators weight, skinfolds, body mass index, fat mass and percentage of fat (the latter two by BIA and only in women). Multivariate analysis, including energy consumption showed no association between Ca intake and adiposity. In conclusion, Ca consumption does not associate with adiposity in adolescents; multivariate models showed that energy intake and menarche are the variables that show a higher association with adiposity at this stage of life.

[The family dysfunction as a risk factor of obesity in Mexican school children]

BACKGROUND

it has been demonstrated that children obesity is a multifactorial disease and probably, the alteration of the family dynamic is another potential risk factor. The objective was to identify the association between obesity and family dysfunction in school children who attend to a family medicine unit.

METHODS

case and control study at Mexican Social Security Institute in Guadalajara, Jalisco, Mexico. Sociodemographic factors and family dynamic of obese and non-obese subjects (n = 452) of six to nine years old from nuclear families were achieved.

RESULTS

the association between family dysfunction and obesity was [OR = 1.63 (1.08-2.46), p = 0.01]. Area II, Identity formation, and area VI, Discipline and methods, showed a lower score in cases of children with obesity (p < 0.001 and p = 0.005, respectively). In a logistic regression model family dysfunction [RM 1.79 (1.19, 2.71), p = 0.005] and low literacy of mothers [RM 1.61 (1.06, 2.45), p = 0.02)] were risk factors for obesity in school children.

CONCLUSIONS

the results showed an association between family dysfunction and obesity in school children. We suggest to consider it in the prevention of obesity in Mexican school children.

[Socioeconomic, demographic and family dysfunction related to obesity in 6 to 9 year-old children]

OBJECTIVE

To identify the association between family dysfunction and obesity in children six to nine year-old.

METHODS

A case-control study that included children with obesity (cases, n = 64) with body mass index (BMI) > 95th percentile and triceps skinfold (TSF) > 90th percentile; and a control group (n = 120) with BMI < 85th percentile and TSF < 90th percentile was performed. Anthropometric measurements were made and a questionnaire assessing eight areas of family dynamics was applied. We compared the frequency of family dysfunction among cases and controls with the χ² test and its association with obesity through the odds ratio.

RESULTS

The average score of the questionnaire was 80.8 ± 11.3 with no differences between groups. The categories "probably dysfunctional" and "dysfunctional" were more common in the obese group but the differences were not significant. The score of the areas "dynamics of parents as a couple" (p = 0.053) and "structure of authority in the family" (p = 0.061) was higher in the control group.

CONCLUSIONS

Although no association was seen between family dysfunction and obesity, we found a tendency toward obesity in dysfunctional families.

Predominant breast-feeding from birth to six months is associated with fewer gastrointestinal infections and increased risk for iron deficiency among infants

Iron deficiency (ID) is prevalent among infants world-wide and may be more likely among infants born to women living in disadvantaged environments. A strategy to address ID in this context is to feed iron-fortified formula, but this may create risk for gastrointestinal (GI) infection. Our objective was to investigate the relationship between infant feeding practices, iron status, and likelihood of a GI infection in the first 6 mo of life. We conducted a prospective study at a public hospital in Guadalajara, Mexico. Healthy women who gave birth to a healthy term infant were eligible to participate. Each month, mothers (n = 154) provided information on infant feeding methods and symptoms of GI infection. At 6 mo of age, infants' iron status was assessed [hemoglobin (Hb) and serum ferritin concentration]. When compared with nonpredominantly breast-fed [partially breast-feeding (PBF) and formula feeding (FF) combined], predominantly breast-fed (PRBF) infants to 6 mo had a lower incidence of GI infection from 0-6 mo [18 vs. 33%; P = 0.04; adjusted odds ratio (OR) = 0.4; 95% CI = 0.2, 1.0] but a higher risk for ID (serum ferritin < 12 microg/L) at 6 mo (22 vs. 4%; P = 0.001; adjusted OR = 9.2; 95% CI = 2.3, 37.0). Anemia (Hb < 110 g/L) prevalence did not differ among feeding groups (13% for PRBF, 19% for PBF, and 4% for FF; P = 0.09). In this low-income population, our results suggest that PRBF should be promoted and the risk for ID managed using public health and nutrition strategies.

[Food habits and culture factors in pregnant adolescents]

The purpose of this study was to identify the food habits of pregnant adolescents and their perception about which, of her cultural concepts, have higher influence. 54 subjects between 12 and 19 years old from Guadalajara City were included and socioeconomic, dietetic data, as food frequency consumption and cultural concepts about feeding were also explored. Chi square was used for identifying association between variables. The fat intake was lower in late vs. Early and middle stage of adolescence (57 vs. 71 g/d, p = 0.05). The iron, calcium and zinc intake was also deficient in the early/middle stage; meanwhile, the folic acid consumption was very low in the late stage of adolescence. Corn tortillas were the most consumed cereal and food (93-96%); junk food and sodas (62 and 55%) prevailed in the early/middle stage. About local costumes, "tacos", "pozole" and burgers were the most referred (74.1%). They also mentioned that fat (36.7%), junk food (30%), chili (26.7%), sodas (23.3%), processed meals (26.7%) and salt (10%) were harmful. They also believed that vegetables (77%), fruits (60 %), milk (21%), broths (17%), and meat (12.5%) were beneficial; and, 96% considered that chicken and bean broths were nutritious (myth). There were some prohibited foods (taboos) during pregnancy: chili (48%), junk food (20%), and salt (16%). Prejudices were more common among later adolescents (60.9%) (p = 0.03). The erratic food habits and the conceptual confusion of these adolescents cause a low intake of nutrients and place them in a nutritional risk.

Factores de riesgo de dislipidemia en niños y adolescentes con obesidad

OBJECTIVE

To assess the risk of dislypidemia associated with obesity in children and adolescents.

MATERIAL AND METHODS

A cross sectional study was conducted with 62 obese children (BMI > 95 centile and tricipital skinfold thickness > 90 centile) and 70 non-obese children (BMI 5-85 centile) ages 5-15 years, without chronic diseases. Subjects' characteristics and family background of chronic diseases were collected and a lipid profile was determined. The risk of lipid alterations in the obese children was calculated using odds ratio (OR) and multivariate analysis.

RESULTS

Mean age was 9.8 +/- 2.7 years in both groups; 63 girls and 69 boys were included. Obesity was associated with abnormal values for cholesterol, triglycerides, LDL, HDL and dislypidemia (> 1 abnormal value) (OR 4.47-15.0). In obese children and adolescents the multivariate analysis showed that female gender was associated with dislypidemia.

CONCLUSION

Obesity in children and adolescents is associated with high risk of dislypidemia; the risk is higher among females.

[Clinical guide for diagnosis, treatment and prevention of overweight and obesity in children]

The prevalence of overweight has significantly increased thorough the world and Mexico is not an exception considering that the National Survey of Nutrition (1999) showed that 19.5% of scholar children in Mexico have overweight and other survey from Mexico City (ENURBAL, 2002) have shown that 17% in the same range of age are obese. Therefore, this clinical guide pretends to be an instrument for supporting the professionals of health for the diagnosis, treatment and prevention of obesity in children using the levels of medical attention. It is known that the treatment is difficult and it requires a full multidisciplinary team of professionals and that the key of prevention is the modification of the sedentary lifestyle and the decrease of energy intake. This guide was elaborated by pediatricians working in nutrition in public and university institutions, family and general physicians and pediatricians with private practice.

[The nutritional status of the child entering the Nuevo Hospital Civil de Guadalajara]

With the purpose to evaluate the nutritional status of children hospitalized in the Nuevo Hospital Civil de Guadalajara, they were included 278 subjects that entered in the infant, preschool, schoolchildren and infectious disease clinical ward of the Division of Pediatrics. There were chosen two subjects every day during one year. It was obtained information about family and sociodemographic background. In addition, there were undertaken anthropometric measurements; weight/age, weight/height and height/age indices were also calculated. It was obtained the parameters of median, percentiles and Z-score. Undernutrition was determined by the Gómez and Waterlow classifications. Is was also compared the reference pattern of Ramos-Galván and National Center for Health Statistics (NCHS). Blood was drawn for total protein and hemoglobin. Mean of height/age was 95.74% (NCHS), weight/age 84.04% and weight/height 89.7%. It was not difference on weight/age between Ramos-Galván and NCHS. Weight/height and height/age had little difference. The median system identified more cases with deficit than Z-score, which seems to be more specific and conservative. There is a high prevalence of acute and chronic malnutrition identified with the median system, and maybe reflects the poor quality of life and major morbidity in this population.

[Nutritional recommendations for the newborn infant]

The nutritional recommendations for newborn babies and infants change when there is an improvement on the technics and knowledge for evaluating requirements of each nutrient. In general, breast milk is enough for covering the nutritional requirements on healthy infants during the first six months of life. Therefore, the nutritional recommendations are focused to newborn babies and infants who do not receive exclusively breast milk or preterm infants whether they receive their own mother's milk or formula. The calculations are based on the assumption that mothers who breast fed their babies are healthy, well nourished and supplying daily a mean of 750 mL of breast milk during the period of lactation.

[Mortality in children under 5 years of age in families of marginal settlements in Guadalajara]

The purpose was, to determine the frequency of infant mortality in the marginal areas of Guadalajara and, find its association with sociodemographic and economical factors, which are known as determinant of the nutritional status of children. There were included 898 families in a cross sectional design among children who applied to the food supplementation program of ONI of Guadalajara. Through an interview and home visit, it was obtained information about sociodemographic and economical characteristics and food habits. The data was recorded and analyzed by the Dbase III Plus and Epi-Info program. It was also used Chi square test and Odds Ratio for the statistical analysis. Education of the mother and income per capita for feeding (as a percentage of the minimum salary) had a significantly and inverse association with infant mortality (P less than 0.0001 and P less than 0.001 respectively). There was also major mortality among children with no social security (P less than 0.05). The Odds Ratio for infant mortality was of 3.02 for education of the father, 8.42 for education of the mother and 6.8 for income per capita for feeding. Meanwhile the level of education and the economical situation of the studied population remain so low, it seems improbable to decrease the rate of infant mortality.

[Evaluation of the nutritional status of children seen at the ONI of Guadalajara]

The nutritional status of 701 subjects from 6 to 36 months of age was evaluated. They were living in the poorest neighborhoods of the metropolitan area of Guadalajara City. We looked for the association between diet, social, economic and family variables with anthropometric nutritional indicators. Some variables were associated with the nutritional indicators weight for age and arm circumference. Age (P less than 0.05), literacy of the mother (P = 0.01), episodes of diarrhea in the last 12 months (P less than 0.001), number of children in the family (P less than 0.001) and income for feeding per capita as a percentage of the minimum salary (P = 0.02), were those factors with a strong relationship to the nutritional indicator weight for age. A score of nutritional risk for children under 36 months of age is proposed, which could be useful for detecting those with the need for a food supplement program in marginal areas of Guadalajara.

[Nutritional recovery in marasmus using soy formula enriched with L-methionine]

It was evaluated the nutritional recovery of infants with marasmus using two different formulas: formula "X", soy based formula enriched con L-methionine; formula "Y" modified milk based formula; both, added with corn syrup at 10%. Seventeen infants were fed formula "X" and seventeen infants received formula "Y". The calorie and water intake were similar in both groups (p greater than 0.05). The protein intake was higher with formula "X" (p less than 0.05). After four weeks of study weight, height, triceps and sub-scapular skinfold, weight/age, height/age and weight/height did not showed significative differences (p greater than 0.05). Arm circumference was higher in the group fed formula "Y" (p less than 0.025). The final serum concentration of total proteins, albumin, calcium and magnesium was also higher in the group receiving formula "Y". It was required a major amount of calories and proteins per unit of gained body weight in the group of formula "X" (p less than 0.05 and p less than 0.005 respectively). Modified in fat and protein milk based formula represents a better choice for nutritional recovery of infants with severe malnutrition under one year of age. Soy based formulas enriched with l-methionine would be only used when intolerance to lactose or milk protein allergy are present.