Clinical Intervention to Reduce Dietary Sugar Does Not Affect Liver Fat in Latino Youth, Regardless of PNPLA3 Genotype: A Randomized Controlled Trial.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) among Latinos is partially attributed to a prevalent C>G polymorphism in the patatin-like phospholipase 3 (PNPLA3) gene. Cross-sectional analyses in Latino children showed the association between dietary sugar and liver fat was exacerbated by GG genotype. Pediatric feeding studies show extreme sugar restriction improves liver fat, but no prior trial has examined the impact of a clinical intervention or whether effects differ by PNPLA3 genotype. OBJECTIVES: We aimed to test effects of a clinical intervention to reduce dietary sugar compared with standard dietary advice on change in liver fat, and secondary-endpoint changes in liver fibrosis, liver enzymes, and anthropometrics; and whether effects differ by PNPLA3 genotype (assessed retrospectively) in Latino youth with obesity (BMI ≥ 95th percentile). METHODS: This parallel-design trial randomly assigned participants (n = 105; mean baseline liver fat: 12.7%; mean age: 14.8 y) to control or sugar reduction (goal of ≤10% of calories from free sugar) for 12 wk. Intervention participants met with a dietitian monthly and received delivery of bottled water. Changes in liver fat, by MRI, were assessed by intervention group via general linear models. RESULTS: Mean free sugar intake decreased in intervention compared with control [11.5% to 7.3% compared with 13.9% to 10.7% (% energy), respectively; P = 0.02], but there were no significant effects on liver outcomes or anthropometrics (Pall > 0.10), and no PNPLA3 interactions (Pall > 0.10). In exploratory analyses, participants with whole-body fat mass (FM) reduction (mean ± SD: -1.9 ± 2.4 kg), irrespective of randomization, had significant reductions in liver fat compared with participants without FM reduction (median: -2.1%; IQR: -6.5% to -0.8% compared with 0.3%; IQR: -1.0% to 1.1%; P < 0.001). CONCLUSIONS: In Latino youth with obesity, a dietitian-led sugar reduction intervention did not improve liver outcomes compared with control, regardless of PNPLA3 genotype. Results suggest FM reduction is important for liver fat reduction, confirming clinical recommendations of weight loss and a healthy diet for pediatric NAFLD.This trial was registered at clinicaltrials.gov as NCT02948647.

Conocimientos y actitudes del personal de enfermería sobre la violencia de género / Knowledge and nurses' attitudes about gender violence

Objetivo: Identificar los conocimientos y las actitudes sobre la violencia de género (VG), así como las barreras personales e institucionales existentes en el personal de enfermería del Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes" (INPerIER), con el fin de identificar necesidades de capacitación del personal. Material y métodos: Es un estudio transversal, observacional y analítico. La población seleccionada fueron enfermeras que estuvieron en contacto con mujeres que acudieron a una institución de salud reproductiva de tercer nivel de atención. La recolección de la información fue voluntaria, informada y anónima, a través de la "Encuesta de Violencia contra la Mujer por parte de su pareja: Opinión del Personal de Salud". Para el análisis estadístico, se utilizó un modelo de regresión logística para evaluar el conocimiento sobre normas, guías e instituciones de referencia a los casos de VG y actitudes. Resultados: Participaron 136 enfermeras (tasa de no-aceptación de 9.4%). El promedio de edad fue 37 años, no tenía pareja 52.9% de las encuestadas, la proporción de enfermeras generales fue 51.5%, tenían estudios carrera técnica postsecundaria 47.1% y laboraban en el turno matutino 54.4%. El conocimiento sobre la VG del personal fue 92.6% nulo a bajo y 7.4% medio. Los factores asociados con la actitud cognitiva y conductual de rechazo con la VG fueron: tener edad de 23 a 35 años (RM 2.93 IC 95% 3.0-8.0), familiares con violencia (RM 2.47 IC 95% 1.13-5.37) y nivel de bachillerato (RM 5.03 IC 95% 1.20-10.21). El ser autora de violencia tiene una actitud afectiva desfavorable hacia la VG (OR 5.30 IC 95% 11.08-25.88). Las barreras institucionales y personales para la identificación de los casos de VG, fueron 74.3%. Conclusiones: Se requiere sensibilizar y capacitar para identificar y referir a los casos con VG, además de implementar programas de salud mental para las enfermeras que sean autoras o víctimas de violencia.

Objective: To identify attitudes and knowledge among nurses from Instituto Nacional de Peinatologia (INPerIER) regarding Gender Violence (GV). Material and methods: This is a cross-section, observational and analytic study. Participants were nurses who had been in contact with women attending INPerIER. Information was collected anonymously and voluntary through the "Partner violence against women: healthcare professional's opinion Survey". A logistic regression model was calculated to evaluate the association among several factors including knowledge of guidelines, counselling and centers for assistance to affected women. Results: A total of 136 nurses participated in the study (9.4% non-participants). Average age was 37 years, 52.9% did not have a partner, 51.5% were non-specialized nurses, 47.1% had a post-high school education and 54.4% had an afternoon shift. Knowledge regarding was none-low in 92.6% of the nurses and moderate in 7.4%. Factors associated with cognitive and behavioural attitude and GV included age between 23-35 years (OR 2.93; IC 95%: 3.0-8.0), family members with violence (OR 2.47; IC 95%: 1.13-5.37) and bachelor's level (OR 5.03; IC 95%: 1.20-10.21). The being violence author has an unfavourable affective attitude (OR 5.30; IC 95%: 11.08-25.88). Personal and institutional barriers to identify GV cases were present in 74.3% of the cases. Conclusions: It is necessary to sensitize and train nurses to give assistance or counselling to GV cases, as well as to implement mental health programs for nurses who act violent or are victims of violence.