Genetic biomarkers related to hemarthrosis, inflammation, and cartilage structure in pediatric patients with hemophilic arthropathy.

BACKGROUND: The pathophysiology of hemophilic arthropathy is complex and not completely understood. In this study, we aimed to identify biomarkers that can affect the hemophilic arthropathy severity. METHODS: Fifty patients were analyzed for biomarker frequencies; in 37 patients, articular symptoms were evaluated based on the physical joint examination score, and in 18, it was based on magnetic resonance imaging. Eight polymorphisms, namely FV 1691G>A, FII 20210G>A, MTHFR 677C>T and 1298A>C, TNFα-308G>A and -238G>A, ACAN VNTR, and IL1RN*2-VNTR were identified. RESULTS: Patients with the MTHFR 677TT genotype showed a higher number of affected joints (1.83 ± 0.9 vs. 0.55 ± 0.7 for CC; p = .023), whereas those with the MTHFR 1298AC genotype exhibited higher effusion according to two radiologists (0.90 ± 0.31/1.20 ± 0.63 vs. 0.38 ± 0.52/0.50 ± 0.53 for AA genotype; p = .043/0.036, respectively). In addition, patients with the TNFα-308GA genotype had more subchondral cysts (0.75 ± 0.95 vs. 0.07 ± 0.26 for GG genotype; p = .041). CONCLUSIONS: The distribution of risk genotypes for MTHFR and TNFα-308GA suggests their association with clinical parameters of hemophilic arthropathy. Cohort studies are essential to verify these associations.

Nutritional support strategies in pediatric cancer patients in Mexico / Estrategias de soporte nutricio en pacientes pediátricos con cáncer en México

Background: Meeting the nutritional needs of pediatric patients on oncology services in low budget public hospitals of Mexico is a continuous challenge, due to its financial resources. Objective: To evaluate the effectiveness of a nutritional strategy for children and adolescents with cancer in a public hospital of Mexico, based on a complacency diet. Methods: Across-sectional study included 58 children and adolescents (1-18 years old). An assessment of nutritional status was applied and a dietary diary was elaborated for 24 hours with the double weight method. Results: 43 patients (74.4%) had an adequate nutritional status. The average energy intake was 72.8% and average protein intake 168.3% of the requirements. The hospital meals accounted for 67.5% of the energy intake, 28.5% resulted from snacks and 3.9% from oral nutritional supplements or polymeric smoothies. Conclusion: The nutritional strategy based on offering a menu at the request supported by smoothies or oral nutritional supplements and the permission to introduce snacks to the hospital offers convenience and flexibility for meal times and favors the energy intake in hospitalized pediatric oncology patients.

Introducción: debido a la escasez de recursos económicos, los hospitales públicos de México tienen un reto continuo para satisfacer las necesidades nutricionales de niños en los servicios de oncología pediátrica. Objetivo: evaluar la eficacia de una estrategia nutricional en niños y adolescentes con cáncer, de un hospital público de México, basada en una dieta a complacencia. Métodos: se llevó a cabo un estudio transversal en el que se incluyeron 58 niños y adolescentes (1-18 años de edad). Se realizó una evaluación antropométrica del estado nutricio y se elaboró un diario dietético durante 24 horas con el método de doble pesada. Resultados: 43 pacientes (74.4%) tenían un estado nutricio adecuado. El consumo promedio de energía fue 72.8% y de proteínas 168.3% del requerimiento. Del total de las calorías consumidas 67.5% provenían del menú hospitalario, 28.5% de refrigerios y 3.9% de suplementos alimenticios o licuados artesanales. Conclusión: la estrategia nutricional basada en una dieta a complacencia apoyada por licuados y suplementos alimenticios más un permiso para la introducción de refrigerios al hospital, favoreció la ingestión calórica, ofreció comodidad y flexibilidad durante las horas de comida a los pacientes oncológicos pediátricos hospitalizados.

Energy expenditure is associated with age, anthropometric indicators and body composition in children with spastic cerebral palsy.

INTRODUCTION: proper estimation of energy requirements in children with cerebral palsy (CP) is essential in ensuring that their energy needs are optimally met. OBJECTIVE: therefore, the purpose of this study was to demonstrate that resting energy expenditure (REE) and total energy expenditure (TEE) are associated with age, anthropometric indicators and body composition in children with spastic cerebral palsy. METHODS: a cross-sectional study included 79 participants with spastic CP from 24 months to 16 years nine months. Weight and height (estimated by lower leg length) were obtained; body composition and energy expenditure were estimated by bioelectrical impedance analysis. ANOVA, post hoc tests, the Pearson correlation and determination coefficients (R2) were performed. RESULTS: significant gradual increases according to age in REE and TEE (both in kcal/d) were observed. There were highly significant positive correlations between REE and TEE (kcal/d, kcal/cm/d) with fat-free mass (FFM) and fat mass (FM), but negative correlations between REE (kcal/ kg/d) with body composition and energy indicators. FFM and total body water, and to a lesser extent FM, explained a high percentage of the direct variability of REE and TEE in kcal/d and the inverse in kcal/kg/d. CONCLUSIONS: as age increased, energy expenditure also increased. The estimated energy expenditure in kcal/cm/d did not differ with age and sex. The estimated energy expenditure, based on height, would be a practical and reliable method for estimating energy expenditure and ensuring adequate nutritional status.

Public and Private Hospital Care Disparities of Ischemic Stroke in Mexico: Results from the Primer Registro Mexicano de Isquemia Cerebral (PREMIER) Study.

BACKGROUND AND AIMS: Mortality and bad outcome by stroke are higher in developing countries than in industrialized countries. Health-care system efficiency could explain these disparities. Our objective was to identify the impact on short- and middle-term outcomes of patients with acute ischemic stroke (AIS) among public and private Mexican medical care. METHODS: We analyzed data from patients with AIS included in the Primer Registro Mexicano de Isquemia Cerebral (PREMIER) study. Transient ischemic attacks (TIAs) and ambulatory patients were excluded. Mortality and good outcome were assessed by the modified Rankin Scale (mRS) and analyzed at 1, 3, and 12 months of follow-up. RESULTS: From 1246 patients with AIS included in the registry, 1123 were hospitalized, either in public (n = 881) or in private (n = 242) hospitals. There were no significant differences regarding age and gender. In private settings, patients had a higher educational level, a major frequency of dyslipidemia, a previous stroke and TIA, less overweight and obesity, a sedentary lifestyle, and diabetes; stroke severity, the rate of systemic complications, the length of stay, and in-hospital mortality were also lower; a major frequency of thrombolysis was observed when compared with public hospitals. Our study showed a better outcome (mRS score ≤2) in private scenarios and a higher mortality in patients treated in public hospitals at short- and middle-term follow-ups. CONCLUSIONS: A polarized medical practice was observed in the AIS care in this large multicenter cohort of Mexico. There is evidence of an advantage for private scenarios, possibly related with an optimal infrastructure or with a strong patient's economic status.

Patient-Generated Subjective Global Assessment of nutritional status in pediatric patients with recent cancer diagnosis.

BACKGROUND: The subjective global assessment (SGA) is a simple, sensitive tool used to identify nutritional risk. It is widely used in the adult population, but there is little evidence on its effectiveness in children with cancer. OBJECTIVE: This cross-sectional study was undertaken to demonstrate significant correlation between a simplified version of the Patient-Generated SGA (PG-SGA) and anthropometric assessment to identify nutritional status in children recently diagnosed with cancer. METHODS: The nutritional status of 70 pediatric cancer patients was assessed with the PG-SGA and anthropometric measurements. The relation between the assessments was tested with ANOVA, independent samples t-test, Kappa statistic, and non-parametric Spearman and Kendall correlation coefficient. The PG-SGA divided the patients into four groups: well nourished, mildly, moderately and severely malnourished. RESULTS: The prevalence of malnutrition according to the PG-SGA was 21.4%. The correlations (r ≥ 0.300, p < 0.001) and the concordance (k ≥ 0.327, p < 0.001) between the PG-SGA and anthropometric indicators were moderate and significant. CONCLUSIONS: The results indicate that the PG-SGA is a valid tool for assessing nutritional status in hospitalized children recently diagnosed with cancer. It is important to emphasize that the subjective assessment does not detect growth retardation, overweight or obesity.

Diferencias entre conductas alimentarias de preescolares que recibieron lactancia materna completa y preescolares que recibieron sucedáneos de la leche humana / Eating behaviors of preschoolers who were exclusively breastfed, and preschoolers who received human milk substitutes

El propósito fue demostrar diferencias en las conductas alimentarias entre preescolares que recibieron lactancia materna completa (LMC: exclusiva o predominante) y preescolares que recibieron sucedáneos de la leche humana (SLH), que acuden a jardín de niños de la zona metropolitana de Guadalajara. En estudio trasversal analítico por conveniencia, se seleccionaron a 177 preescolares de tres a cinco años de edad, sanos, nacidos a término, peso normal al nacer, con antecedentes de alimentación con LME o SLH que acudían a tres jardines de niños. Se aplicó un cuestionario validado de conductas alimentarias que consta de ocho escalas. Se obtuvieron variables socioeconómicas y demográficas de las familias e indicadores antropométricos de los participantes. Se aplicaron pruebas t de Student, U de Mann-Whitney, Chi cuadrado, razón de momios, coeficiente de correlación de Pearson y regresión logística. Hubo 2.8 veces mayor probabilidad de puntaje elevado en la escala comer menos por emociones en el grupo de SLH [RM=2.8 (1.0, 8.3), p=0.037]. Se observaron 15 correlaciones significativas entre las diferentes escalas del cuestionario en el grupo de LMC (62.5%) y nueve en el grupo de SLH (37.5%). Hubo siete correlaciones significativas entre las escalas en el grupo LMC que no fueron significativas en el grupo de SLH. En preescolares que recibieron LMC, a mayor lentitud para comer hubo menor irritabilidad hacia los alimentos (r=-0.325, p=0.01). Los preescolares con antecedentes de LMC tendrían menor probabilidad de alteraciones de conducta alimentaria y mostraron mayor número de correlaciones significativas entre las escalas que los preescolares que recibieron SLH(AU)

The purpose was to demonstrate differences in eating behaviors among preschool children who received full breastfeeding (FBF: exclusive or predominant) and preschool children who received human milk substitutes (HMS), who attend kindergarten in the metropolitan area of Guadalajara, Mexico. In analytical cross-sectional study by convenience, 177 preschoolers, three to five years old, healthy, term infants with normal weight at birth and feeding history of FBF or HMS attending three kindergartens were selected. A validated questionnaire of eating behaviors consisting of eight scales was applied. Socioeconomic and demographic variables of families and anthropometric indicators of participants were obtained. Student's t test, U Mann-Whitney, chi-square, odds ratio, Pearson correlation coefficient and logistic regression tests were applied. There were 2.8 times more likely to score high on the scale eat less by emotions in HMS group [OR = 2.8 (1.0, 8.3), p = 0.037]. Fifteen significant correlations between different scales of the questionnaire in the FBF group (62.5%) and nine in the HMS group (37.5%) were observed. There were seven significant correlations among the scales in FBF group, but not significant in the HMS group. In preschoolers receiving FBF, more frequency of eating slowly was related to less irritability to food (r=-0.325, p=0.01).Preschoolers with a history of FBF would be less likely to have alterations in eating behavior and showed more significant correlations between the scales that preschoolers who received HMS(AU)

Assessment of anthropometric indicators in children with cerebral palsy according to the type of motor dysfunction and reference standard.

AIM: The study aimed to demonstrate that the assessment of the anthropomorphic measurements of children with cerebral palsy (CP) varies according to the type of motor dysfunction and references standard used for comparison. METHOD: In a cross-sectional design, 108 children 2 to 16 years were classified according to the type of motor dysfunction by gender and age group. Weight, mid-upper-arm-circumference (MUAC), and alternative measures for height were performed. Height/age and weight/age indexes and BMI were evaluated with percentiles and/or Z-scores with reference to a number of previously published references of growth, including those of the World Health Organization (WHO). RESULTS: Fifty-three (49.1%) were females and 55 (50.9%) males. Spastic type was predominant (73.1%) and 26.9% were other types of dysfunction. Most of the children were located on level IV (14.6%) and level V (73.1%) of the Gross Motor Function Classification System (GMFCS). Significant differences were found, suggesting that weight (p = 0.002), height (p = 0.001), and MUAC (p = 0.05) are higher in the spastic group than in other groups. CONCLUSIONS: The anthropometric indicators were significantly higher in the spastic group than in other groups. Upper-arm length (UAL) seemed less appropriate than knee height (KH) and lower-leg length (LLL) for measuring height. The WHO reference standard was not useful to evaluate the majority of anthropometric indexes in children with CP, other references as the growth charts of Day and Brooks have been more suitable.

Risk of malnutrition of hospitalized children in a university public hospital.

OBJECTIVE: The study aimed to demonstrate that the duration of hospitalization has a significant effect on the nutritional status of children treated in a university hospital. METHODS: A longitudinal study was conducted during 2014, with a non-random sampling site concentration in children from birth to 19 years who were admitted to the hospital in the past 24 hours and who met the inclusion criteria and had signed informed consent. Upon entering, at 7 days, and at discharge, anthropometric indices, including weight/age, height/age, weight/height, BMI/age, head circumference/age, triceps and subscapular skin folds, and fat percentage, were obtained. Student's t-test, U Mann-Whitney, ANOVA, chi square, Wilcoxon, and odds ratios were used to analyze the data. RESULTS: In total, 206 patients were included: 40% infants, 25% preschoolers, 15% schoolchildren, and 20% teenagers. Infants had a significant improvement from admission to discharge in the indices weight/length (p = 0.042) and BMI (p = 0.002); adolescents showed decreased BMI from admission to discharge from the hospital (p = 0.05). Patients with longer hospitalization (more than 10 days) had an increased deficit in anthropometric indices at admission (p < 0.05). Infants had a higher risk of deficit in the BMI index and height/age than preschoolers, schoolchildren, and adolescents between admission and discharge. CONCLUSION: When the nutritional condition of a child was critical at admission, the child remained hospitalized significantly longer. Infants come under the age group most vulnerable to malnutrition and require greater monitoring of nutritional status during hospitalization.

Hábitos de alimentación en adolescentes embarazadas de acuerdo a su estado civil.

Objetivo: identificar los hábitos alimentarios de adolescentes embarazadas en cuatro estados civiles diferentes: casada, cohabita con una pareja, soltera sin pareja y soltera con una pareja. Métodos: en estudio transversal, se incluyeron 321 adolescentes embarazadas de 13-19 años que acudieron al Hospital Civil de Guadalajara Dr. Juan I Menchaca, Guadalajara (Jalisco, México). Se encontraban sanas, en cualquier trimestre del embarazo y pertenecían a un nivel socioe-conómico bajo o medio-bajo. El estado civil se estratificó en: casadas; en unión libre; soltera con una pareja y soltera sin pareja. Se incluyeron datos socio-demográficos, económicos y de hábitos de alimentación. Se utilizaron pruebas de ANOVA, pruebas post-hoc para Chi 2 , razón de momios y modelos de regresión logística. Resultados: la frecuencia de las adolescentes casadas fue de 9,3%, 59,8% en unión libre, 15,3% eran solteras sin pareja y 15,6% solteras con pareja. La baja escolaridad (RM 2,6 [1,5-4,4]) y la ocupación en el hogar (RM 4,47 [1,99-10,0]) predominaron entre las adolescentes en unión libre; la ocupación en el hogar (RM 0,28 [0,127-0,61]) y cenar sin compañía (RM 4,12 [1,62-10,8]) fueron significativamente más frecuentes en adolescentes sin pareja. El consumo de verduras fue menor en las adolescentes casadas y en quienes cohabitaban con pareja; el consumo de frijoles y pan dulce fue menor en adolescentes embarazadas casadas. Conclusión: debido a que ciertas variables y hábitos de alimentación mostraron diferencias entre los grupos es pertinente analizar las adolescentes embarazadas de acuerdo a su estado civil.

INTRODUCTION OF PASTEURIZED/RAW COW'S MILK DURING THE SECOND SEMESTER OF LIFE AS A RISK FACTOR OF TYPE 1 DIABETES MELLITUS IN SCHOOL CHILDREN AND ADOLESCENTS.

OBJECTIVE: to demonstrate that type 1 diabetes mellitus (T1DM) in school children and adolescents is associated with the early introduction of pasteurized/raw cow's milk in the second semester of life. MATERIAL AND METHODS: this non-probabilistic study included 150 subjects (75 patients and 75 controls), divided according to sex and age (range, 6 to 16 years). T1DM was considered to be a dependent variable, and pasteurized/ raw cow's milk (P/RCM) was considered to be an independent variable in the study. The statistical analyses included chi-squared test, odds ratio and 95% confidence intervals. RESULTS: the subjects were 51% male, age 11 ± 3.2 years, and 80% were breastfed, 18% were exclusively breastfed, and 13% received pasteurized/raw cow's milk. The children receiving P/RCM had a higher risk of T1DM [OR, 3.9 (1.2-12.8)]. The presence of T1DM was three times higher in those consuming P/RCM vs. those receiving follow-up formula [RM, 3.2 (1.03-10.07)]. CONCLUSIONS: introducing pasteurized/raw cow's milk in the second semester of life increased by four times the likelihood of developing T1DM in children and adolescents.

Objetivo: demostrar que la diabetes mellitus tipo 1 (DMT1) en escolares y adolescentes se asocia a una temprana introducción de leche entera pasteurizada/no pasteurizada en el segundo semestre de vida. Material y métodos: en este estudio no probabilístico de casos y controles se incluyeron 150 participantes (75 pacientes y 75 controles), divididos de acuerdo a la edad y el sexo de 6 a 16 años de edad. Se consideró DMT1 como una variable independiente. El análisis estadístico incluyó la prueba de Ji cuadrada y razón de momios con su intervalo de confianza del 95% Resultados: los participantes fueron 51% varones, con edades de 11 ± 3.2 años y el 80% alimentados al pecho materno, 18% en forma exclusiva, y el 13% recibieron leche entera pasteurizada/no pasteurizada. Los niños que recibieron leche entera pasteurizada/no pasteurizada tuvieron un riesgo mayor de DMT1 [OR, 3,9 (1,2-12,8)]. La presencia de DMT1 fue tres veces más elevada en quienes consumieron leche entera pasteurizada/no pasteurizada que en aquellos que recibieron fórmula de seguimiento [RM, 3,2 (1,03-10,07)]. Conclusión: la introducción de leche entera pasteurizada/ no pasteurizada en el segundo semestre de vida incrementó cuatro veces la probabilidad de desarrollo de DMT1 en escolares y adolescentes.

Effects of Ezetimibe/Simvastatin and Rosuvastatin on Oxidative Stress in Diabetic Neuropathy: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

OBJECTIVE: To evaluate the effects of ezetimibe/simvastatin (EZE/SIMV) and rosuvastatin (ROSUV) on oxidative stress (OS) markers in patients with diabetic polyneuropathy (DPN). METHODS: We performed a randomized, double-blind, placebo-controlled phase III clinical trial in adult patients with Type 2 Diabetes Mellitus (T2DM) and DPN, as evaluated by composite scores and nerve conduction studies (NCS). Seventy-four subjects with T2DM were allocated 1 : 1 : 1 to placebo, EZE/SIMV 10/20 mg, or ROSUV 20 mg for 16 weeks. All patients were assessed before and after treatment: primary outcomes were lipid peroxidation (LPO), and nitric oxide (NO) surrogate levels in plasma; secondary outcomes included NCS, neuropathic symptom scores, and metabolic parameters. Data were expressed as mean ± SD or SEM, frequencies, and percentages; we used nonparametric analysis. RESULTS: LPO levels were reduced in both statin arms after 16 weeks of treatment (p < 0.05 versus baseline), without changes in the placebo group. NO levels were not significantly affected by statin treatment, although a trend towards significance concerning increased NO levels was noted in both statin arms. No significant changes were observed for the NCS or composite scores. DISCUSSION: EZE/SIMV and ROSUV are superior to placebo in reducing LPO in subjects with T2DM suffering from polyneuropathy. This trial is registered with NCT02129231.

The distribution of the indicator height for age of Mexican children and adolescents with Down syndrome according to different reference standards.

OBJECTIVE: To compare the indicator height for age in Mexican children with Down Syndrome (DS) with two different reference patterns of growth (American and Spanish) that might be suitable for the Mexican population. METHODS: A cross-sectional study was performed including 235 Mexican children and adolescents of both sexes with DS aged 45 days to 16 years enrolled in two specialized schools in the metropolitan area of Guadalajara. The dependent variables were weight/age; height/age; weight/ height and BMI. The data expressed was percentiles and the chi-square test was used to compare the distribution of the height/age index with American and Spanish reference patterns. In addition, a chi-square test was performed for the goodness of fit of the height/age index, with breakpoints lower and greater than the 50th percentile. RESULTS: The percentage of participants who were below the 50th percentile in the height/age index was significantly higher with the Spanish vs. the American reference pattern. The chi-square test for goodness of fit showed that the frequency of cases located below the 50th percentile in the height/age index was significantly higher with the American pattern in the age groups of 0 to 36 months (p = 0.022) and 37 to 72 months (p <0.001), but it was not significant (p = 0.225) in the older than 72 months age group. CONCLUSION: The American reference pattern is a better fit for the growth of Mexican children with DS compared with the Spanish reference pattern, and the distribution profile obtained with the standard growth and WHO reference was not suitable for the assessment of children with Down syndrome.

Objetivo: comparar el índice talla/edad en niños con síndrome de Down (SD) con dos patrones de referencia (americano y español) que podrían ser adecuados en niños mexicanos. Métodos: en un estudio transversal se incluyeron 295 niños y adolescentes de ambos sexos con SD desde 45 días hasta 16 años de edad, inscritos en dos escuelas del área metropolitana de Guadalajara. Variables dependientes: peso/edad; talla/edad; peso/talla e IMC. Los datos fueron expresados en percentiles y se utilizó la prueba de chi-cuadrado para comparar la distribución del índice de talla/edad entre los patrones de referencia de EUA y de España. Se realizó una prueba de bondad de ajuste del índice talla/edad con puntos de corte menor y mayor al percentil 50. Resultados: el porcentaje de participantes por debajo del percentil 50 en el índice de talla/edad fue significativamente mayor con la referencia española vs. americana. La prueba de bondad de ajuste mostró que la frecuencia de casos debajo del percentil 50 en el índice talla/edad fue significativamente mayor con la referencia estadounidense en el grupo de edad de 0-36 meses (p = 0,022) y 37-72 meses (p.

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.

Objetivo: Analizar el gasto energético total (GET) y gasto energético basal (GEB) en niños con parálisis cerebral infantil (PCI) y desnutrición moderada o grave durante la recuperación nutricia. Métodos: En un estudio de intervención, se incluyeron trece sujetos con PCI (10 mujeres y 3 hombres, con una edad promedio de 9a11m±2a3m), pertenecían al nivel V del Sistema de Clasificación de la Función Motora Gruesa y desnutrición moderada o grave. Ocho fueron alimentados por sonda nasogástrica y cinco por gastrostomía. Se compararon con 57 participantes sanos (31 mujeres y 26 varones con una edad promedio de 8a7m±10m). Se realizaron mediciones antropométricas, de composición corporal y de gasto energético mediante el análisis de impedancia bio-eléctrica (IBE) y calorimetría indirecta (CI) en ambos grupos. Resultados: El GET y GEB fueron mayores en los niños sanos que en los niños con parálisis cerebral en kcal/d y kcal/cm/d, pero fueron menores en kcal/kg/día (p.

[Associated factors to the calcium intake in mexican pregnant adolescents]. / Factores asociados al consumo de calcio en adolescentes Mexicanas embarazadas.

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.

Objetivo: Explorar los hábitos de alimentación y los factores socioeconómicos y demográficos que se asocian al consumo de calcio en adolescentes embarazadas. Métodos: En un estudio transversal analítico se incluyeron 321 participantes de 13 a 19 años de edad que acudieron a la consulta externa de la división de Gineco-obstetricia del Hospital Civil de Guadalajara "Dr. Juan I. Menchaca". Todas eran sanas, en cualquier trimestre del embarazo y pertenecían a los estratos socioeconómicos bajo y medio-bajo. Se realizaron encuestas dietéticas de frecuencia de consumo de alimentos y recordatorio de 24 horas para identificar la ingestión de calcio. Se incluyeron datos socio-demográficos, económicos y hábitos de alimentación. Se utilizó la prueba de ji cuadrada, razón de momios y un modelo de regresión logística para identificar el significado epidemiológico de las variables asociadas con el consumo de calcio. Resultados: La ingestión de calcio en 61% de las adolescentes cubrió menos de 80% de la ingestión diaria recomendada. La ocupación de la adolescente en labores domésticas [OR 2.66 (1.28-5.53)], el bajo consumo de leche [OR 2.54 (1.37-4.0)] y derivados [OR 2.75 (1.09-7.0)], el exceso en el consumo de refresco de cola [OR 1.84 (1.04-3.28)] y la baja escolaridad de la madre [OR 1.83 (1.15-2.90)] fueron los factores con mayor significado epidemiológico en el consumo inadecuado de calcio. Conclusión: La ingestión de calcio es deficiente en la mayoría de las adolescentes embarazadas y existen factores de riesgo que deben ser identificados y atendidos. Asimismo, por sus condiciones de riesgo, es necesario evaluar el estado nutricio de calcio con métodos más precisos y específicos.

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.

Introducción: Los indicadores antropométricos son difíciles de interpretar en prematuros de muy bajo peso al nacer (MBPN), tanto con peso adecuado para la edad gestacional (PAEG) como peso bajo para la edad gestacional (PBEG). Por tanto, el propósito fue describir los indicadores antropométricos de crecimiento y estado nutricio en prematuros con MBPN con PAEG y PBEG hospitalizados en una unidad de cuidados intensivos neonatales (UCIN). Métodos: En un estudio descriptivo y prospectivo se incluyeron 114 recién nacidos prematuros, con peso adecuado y bajo para la edad gestacional hospitalizados en la UCIN. Se obtuvieron las mediciones de circunferencia de cabeza, muslo, brazo, pliegues cutáneos y los índices peso/edad, longitud/edad y peso/longitud. Se realizaron correlaciones entre los diferentes indicadores antropométricos y se elaboraron modelos de regresión múltiple con el índice peso/edad como variable dependiente. Resultados: El índice peso/edad en prematuros con PAEG tuvo el número más elevado de correlaciones significativas. Los prematuros con PBEG tuvieron pocas correlaciones y más débiles. El análisis de regresión múltiple mostró que los indicadores antropométricos explican mejor cambios en el índice peso/edad en prematuros con peso PAEG que en prematuros con PBEG. Conclusión: El índice peso/edad en prematuros con muy bajo peso al nacer, adecuado para la edad gestacional podría reflejar el crecimiento, el estado nutricio y las reservas de energía. En prematuros con PBEG la circunferencia de muslo y de brazo serían mejores indicadores solo del estado nutricio.

Effect of rosuvastatin on diabetic polyneuropathy: a randomized, double-blind, placebo-controlled Phase IIa study.

BACKGROUND: Diabetic neuropathy affects 50%-66% of patients with diabetes mellitus. Oxidative stress generates nerve dysfunction by causing segmental demyelinization and axonal degeneration. Antioxidants are considered to be the only etiologic management for diabetic polyneuropathy, and statins such as rosuvastatin increase nitric oxide bioavailability and reduce lipid peroxidation. The aim of this study was to evaluate the antioxidant effect of rosuvastatin in diabetic polyneuropathy. METHODS: We conducted a randomized, double-blind, placebo-controlled Phase IIa clinical trial in patients with type 2 diabetes and diabetic polyneuropathy (DPN) stage ≥1b. We allocated subjects to two parallel groups (1:1) that received rosuvastatin 20 mg or placebo for 12 weeks. Primary outcomes were neuropathic symptom score, disability score, and nerve conduction studies, and secondary outcomes were glycemic control, lipid and hepatic profile, lipid peroxidation, and nerve growth factor beta (NGF-ß) levels. RESULTS: Both groups were of similar age and duration since diagnosis of diabetes and DPN. We observed improvement of DPN in the rosuvastatin group from stage 2a (88.2%) to stage 1b (41.2%), improvement of neuropathic symptom score from 4.5±2 to 2.4±1.8, and significant (P=0.001) reductions of peroneal nerve conduction velocity (from 40.8±2.2 to 42.1±1.6 seconds) and lipid peroxidation (from 25.4±2 to 12.2±4.0 nmol/mL), with no significant change in glycemic control or ß-NGF. CONCLUSION: The severity, symptoms, and nerve conduction parameters of DPN improved after 12 weeks of treatment with rosuvastatin. These beneficial effects appear to be attributable to reductions in lipid peroxidation and oxidative stress.

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.

Objetivo: Demostrar que el apoyo nutricio intensivo por vía naso-enteral o gastrostomía tiene un impacto significativo en el estado nutricio y en la composición corporal en niños desnutridos graves con parálisis cerebral cuadriplejia espástica. Métodos: En un estudio de cohorte se incluyeron trece pacientes con desnutrición moderada/grave y parálisis cerebral cuadriplejia espástica, quienes fueron alimentados por vía naso-enteral o gastrostomía. Fueron obtenidos indicadores antropométricos y de composición corporal estimada por antropometría e impedancia bio-eléctrica. Se utilizó ANOVA y prueba de Wilcoxon para el análisis estadístico. Resultados: Hubo un aumento de 2700 g durante las cuatro semanas de recuperación nutricia y un incremento significativo en los indicadores antropométricos, índice de masa corporal y peso/talla (p < 0,01). El porcentaje de incremento del área grasa del brazo fue mayor que el área muscular del brazo (104,5 vs 17,5%). Conclusión: El apoyo nutricio intensivo tuvo un efecto significativo en el estado nutricio y en la composición corporal de niños con desnutrición moderada/grave con parálisis cerebral infantil.

[Body composition and lipidic profile in women's during the third trimester of pregnancy]. / Composición corporal y perfil de lípidos en mujeres en el tercer trimestre del embarazo.

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.

Circunferencia de cintura y su asociación con factores de riesgo cardiovascular en niños y adolescentes con obesidad / Waist circumference and association with cardiovascular risk factors in obese children and adolescents

Introducción. Se ha demostrado que algunos indicadores indirectos de adiposidad, como el índice de masa corporal, se asocian con alteraciones metabólicas que incluyen los factores de riesgo cardiovascular. El objetivo de este trabajo fue evaluar la asociación de los valores del índice de masa corporal (IMC) y circunferencia de cintura (CC) con factores de riesgo cardiovascular en niños y adolescentes con obesidad. Métodos. Se llevó a cabo un estudio transversal en 115 niños y adolescentes con obesidad (IMC > + 2.0 DE). Se determinaron los valores de peso, talla y circunferencia de cintura. Se midió la presión arterial (PA) y las concentraciones séricas del perfil de lípidos, glucosa e insulina. Se calculó el índice HOMA-IR. Se identificó la correlación entre IMC y CC con parámetros bioquímicos y PA. Se realizaron modelos multivariados para evaluar la asociación de IMC y CC con factores de riesgo cardiovascular. Resultados. La edad promedio fue de 9.75 ± 3.1 años. Se identificó una correlación positiva y significativa de IMC y CC con PA, insulina y HOMA-IR. En modelos multivariados, tanto IMC como CC mostraron asociación con PA y alteraciones metabólicas. Conclusiones. En niños y adolescentes con obesidad, tanto la CC como el IMC se asocian con las alteraciones de la PA, insulina y HOMA-IR.

Background. It has been demonstrated that indirect indicators of adiposity such as body mass index are associated with metabolic disorders including cardiovascular risk factors. The objective was to evaluate the association of body mass index (BMI) and waist circumference (WC) with cardiovascular risk factors in obese children and adolescents. Methods. Cross-sectional study in 115 obese children and adolescents (BMI >+ 2.0 SD). Weight, height and waist circumference were measured. Blood pressure (BP), serum lipid profile, glucose and insulin were determined and HOMA-IR index was calculated. The correlation between BMI and WC with biochemical parameters and BP was identified; multivariate models were performed to evaluate the association of BMI and WC with cardiovascular risk factors. Results. Mean age was 9.75 ± 3.1 years. A significant positive correlation of BMI and WC with BP, insulin and HOMA-IR was identified. In multivariate models, both BMI and WC showed an association with these alterations. Conclusions. In obese children and adolescents, both the WC and BMI are associated with alterations in BP, insulin and HOMA-IR.

Association of genetic polymorphisms with histological grading of necroinflammation, staging of fibrosis, and liver function in Mexicans with chronic hepatitis C virus infection.

BACKGROUND/AIM: The aim of this work was to establish an association between the single-nucleotide polymorphisms (SNPs) of TGFB1 (rs1800471), AT (rs3789679), MMP-1 (rs17886084), MMP-3 (rs35068180), and PAI-1 (rs1799889) and the histological grading of necroinflammation, staging of hepatic fibrosis, and liver function in Mexican patients with advanced liver fibrosis due to chronic hepatitis C virus infection. METHODS: AT, MMP-1, MMP-3, and PAI-1 gene polymorphisms were analyzed by polymerase chain reaction in real time, whereas TGFB1 polymorphism was detected by polymerase chain reaction-based restriction fragment length polymorphism in 38 patients with established advanced liver fibrosis and 50 subjects from the general population. Grading of necroinflammation and staging of liver fibrosis were assessed by liver biopsy and graded according to modified histological activity index Ishak score. RESULTS: Regarding TGFB1 SNP, significant differences were found between G/G and G/C genotypes of patients with hepatic necroinflammation (P = 0.05) and hepatic fibrosis (P = 0.002). There were also significant differences among genotypes of patients with the AT SNP in hepatic necroinflammation (P = 0.01). The albumin-globulin ratio between genotypes of patients with the MMP-3 SNP gene showed significant differences (P = 0.02). CONCLUSION: Our findings demonstrate that a specific combination of genotypes associated with biochemical values and a histological high score determine more severe liver disease. The presence of the G/G genotype of TGFB1 SNP in patients was significantly associated with severity of liver necroinflammation and fibrosis. Patients with the G/G genotype of AT SNP were associated with severe necroinflammation. The albumin-globulin ratio was increased in patients with the 6A allele of MMP-3 SNP. These results might contribute to diagnosis and further establishment of liver disease treatment.