Improving heart healthy lifestyles among participants in a Salud para su Corazón promotores model: the Mexican pilot study, 2009-2012.

INTRODUCTION: In Mexico, cardiovascular disease and its risk factors are growing problems and major public health concerns. The objective of this study was to implement cardiovascular health promotion and disease prevention activities of the Salud para su Corazón model in a high-risk, impoverished, urban community in Mexico City. METHODS: We used a pretest-posttest (baseline to 12-week follow-up) design without a control group. Material from Salud para su Corazón was validated and delivered by promotores (community health workers) to community members from 6 geographic areas. Two validated, self-administered questionnaires that assessed participants' knowledge and behaviors relating to heart health were administered. We used t tests and χ(2) tests to evaluate pretest and posttest differences, by age group (≤60 and >60 years), for participants' 3 heart-healthy habits, 3 types of physical activity, performance skills, and anthropometric and clinical measurements. RESULTS: A total of 452 (82%) adult participants completed the program. Heart-healthy habits from pretest to posttest varied by age group. "Taking action" to modify lifestyle behaviors increased among adults aged 60 or younger from 31.5% to 63.0% (P < .001) and among adults older than 60 from 30.0% to 45.0% (P < .001). Positive responses for cholesterol and fat consumption reduction were seen among participants 60 or younger (P = .03). Among those older than 60, salt reduction and weight control increased (P = .008). Mean blood glucose concentration among adults older than 60 decreased postintervention (P = .03). CONCLUSION: Significant improvements in some heart-healthy habits were seen among adult participants. The model has potential to improve heart-healthy habits and facilitate behavioral change among high-risk adults.

Machine learning accurately predicts food exchange list and the exchangeable portion.

Introduction: Food Exchange Lists (FELs) are a user-friendly tool developed to help individuals aid healthy eating habits and follow a specific diet plan. Given the rapidly increasing number of new products or access to new foods, one of the biggest challenges for FELs is being outdated. Supervised machine learning algorithms could be a tool that facilitates this process and allows for updated FELs-the present study aimed to generate an algorithm to predict food classification and calculate the equivalent portion. Methods: Data mining techniques were used to generate the algorithm, which consists of processing and analyzing the information to find patterns, trends, or repetitive rules that explain the behavior of the data in a food database after performing this task. It was decided to approach the problem from a vector formulation (through 9 nutrient dimensions) that led to proposals for classifiers such as Spherical K-Means (SKM), and by developing this idea, it was possible to smooth the limits of the classifier with the help of a Multilayer Perceptron (MLP) which were compared with two other algorithms of machine learning, these being Random Forest and XGBoost. Results: The algorithm proposed in this study could classify and calculate the equivalent portion of a single or a list of foods. The algorithm allows the categorization of more than one thousand foods with a confidence level of 97% at the first three places. Also, the algorithm indicates which foods exceed the limits established in sodium, sugar, and/or fat content and show their equivalents. Discussion: Accurate and robust FELs could improve implementation and adherence to the recommended diet. Compared with manual categorization and calculation, machine learning approaches have several advantages. Machine learning reduces the time needed for manual food categorization and equivalent portion calculation of many food products. Since it is possible to access food composition databases of various populations, our algorithm could be adapted and applied in other databases, offering an even greater diversity of regional products and foods. In conclusion, machine learning is a promising method for automation in generating FELs. This study provides evidence of a large-scale, accurate real-time processing algorithm that can be useful for designing meal plans tailored to the foods consumed by the population. Our model allowed us not only to distinguish and classify foods within a group or subgroup but also to perform the calculation of an equivalent food. As a neural network, this model could be trained with other food bases and thus improve its predictive capacity. Although the performance of the SKM model was lower compared to other types of classifiers, our model allows selecting an equivalent food not from a group previously classified by machine learning but with a fully interpretable algorithm such as cosine similarity for comparing food.

[Complementary feeding]. / Alimentación complementaria.

According to PAHO and WHO, supplementary feeding is the process that begins when human milk is insufficient to meet the nutritional needs of an infant and requires other foods and liquids. The decision to begin complementary feeding depends on socio-economic, physiological, nutritional and psychological factors. The maturation of the neuromuscular, gastrointestinal and renal system influences the chances of success of supplementary feeding. Reflexes and skills in a child with normal development can be expected and the consistency of foods can provide a way to, on one hand allow the ingestion of food and the other to allow the children to exercise their reflexes to enhance neuromuscular maturation. WHO recommends exclusive breastfeeding promotion to six months, as there are several benefits to mother and child; in Mexico, the NOM-043-SSA2-2005 promotes complementary feeding from 6 months. It should be noted that the order of introduction is not definitive and that the literature shows different patterns of input according to the needs of children and their socio-economic and cultural environment. Parents and caregivers select and buy food, model, and establish rules of behavior at home related to food. Evidence suggest that environmental factors acting at an early stage of development of small modeling preferences and eating behaviors.

[Nutrition and diabetes in the elderly]. / Nutrición y diabetes en el anciano.

The aging process conveys multiple changes in the organism, as well as changes in individual's surroundings. Such modifications make the appearance of this sufferance, diagnose, and treatment to be complex and different in the rest of the population. The last makes necessary the coordinated work of the multidisciplinary team, in which the diabetic senior, caretaker, or relative most be actively participants. The success of preventive and curative measures relies in increasing knowledge about health and, life conditions (economic, social, community, family, etc.) of each patient and of the senior population in general; as well as facilitating the patient with information about the means to have a better understanding about the disease, and the available resources for its treatment, and to be aware of the importance of achieving the therapeutic objectives. This last part is particularly important for the nutritional treatment for diabetes, since its objective is the change in the habit, and customs of nutrition, and the physical activity that the patient has realized throughout many years.

The consumption of antioxidants protects against cognitive and physical disabilities in aged with obesity.

INTRODUCTION: antioxidants play an important role in the antioxidant defense system. Obesity and the aging process increase oxidative stress. The disruption of the oxidant-antioxidant balance towards oxidant condition could be related to cognitive and physical disabilities. OBJECTIVE: to evaluate the consumption of antioxidants, the oxidative stress status and their relationship with cognitive and functional alterations in aged with obesity. METHOD: a cross-sectional study was conducted with 94 subjects ≥ 60 years stratified by body mass index (BMI) (76.6% were women). The antioxidants intake as well as cognitive and functional status were evaluated by validated surveys. The oxidative stress markers were thiobarbituric acid reactive substances (TBARS) and lipid-hydroperoxides (LOOH). RESULTS: the antioxidants consumption of the participants was below the recommended daily intakes (RDI) independently of the BMI group. Especially, a lower consumption of vitamins E and D, selenium and ß-carotenes was observed. The concentration of TBARS was higher (p < 0.05) in the obese (1.2 µM) versus the normal weight group (0.7 µM). The concentration of LOOH in the normal weight group (17 µM) did not show statistical difference versus obese group (15 µM). The presence of obesity in aged showed an association with walking difficulties. Multivariable analysis adjusted for several variables showed that the intake of selenium, copper and magnesium is associated with lower risk of cognitive and physical disabilities. CONCLUSIONS: aged with obesity showed a higher concentration of peripheral TBARS, walking difficulties and lower intake of antioxidants. The consumption of copper, selenium, and magnesium seems to protect against cognitive and physical disabilities in aged with obesity.

Community Health Workers-Promotores de Salud in Mexico: History and Potential for Building Effective Community Actions.

This article takes a historical perspective combining 3 illustrative examples of the origins of the community health worker (CHW) model in Mexico, as a community-based participatory strategy. Three examples were identified from the sparse literature about CHWs in Mexico emphasizing their key roles and functions in various community settings. The CHW models illustrate what is known of training-development and planning, implementation, and evaluation of the CHWs model in different settings addressing cardiovascular disease and risk factors. The potential exists for integrating CHW projects to expand the health promotion model with new emphasis on municipality and regional participation.

Clinimetric testing in mexican elders: associations with age, gender, and place of residence.

AIM: To evaluate the ability of five clinimetric instruments to discriminate between subjects >60 years of age living at home versus those living in a residency. METHODS: Trained nutritionists applied five instruments (cognition/depression/functionality/nutrition/appetite) to 285 subjects with majorities of women (64%), aged <80 years (61%), and home residents (54%). RESULTS: Multivariable regression models were generated for each instrument using age, gender, and residency as independent variables. Age was associated with worsening scores in the five instruments whereas residency showed association in three instruments, and gender in two. Score-age regressions by place of residency showed differences suggesting that Mundet residents had increasingly worse scores with increasing age than home dwellers for cognition, depression, and nutrition. Also, living at home prevented the worsening of depression with increasing age. In contrast, functionality and appetite deteriorated at a similar rate for home and Mundet residents suggesting an inability of these two instruments to discriminate between settings. Score-age regressions by gender suggested that males have less cognitive problems at 60 and 80 years of age but not at 100 years, and better appetite than women at all ages. CONCLUSION: Increasing age proved to be associated to worsening scores in the five instruments but only three were able to detect differences according to setting. An interesting observation was that living at home appeared to prevent the depression increase with increasing age seen in Mundet residents.

Association between Apolipoprotein E Variants and Obesity-Related Traits in Mexican School Children.

BACKGROUND/AIM: Genetic variation in apolipoprotein E (ApoE) has a key role in lipid metabolism. However, its contribution to the amount and distribution of body fat is under investigation. The aim of this study was to analyze the association between genetic variation in ApoE and obesity-related traits in Mexican school children. MATERIAL AND METHODS: Anthropometric, body composition and physical activity measures were conducted using standard methods in 300 children (177 girls/123 boys) who fulfilled the inclusion criteria. DNA was isolated from saliva. ApoE genotypes were analyzed by allelic discrimination. The association between variation in ApoE and anthropometric and body composition measures was investigated using the General Linear Model. RESULTS: The mean±SD values for age, body mass index (BMI) and waist circumference (WC) were 9.05±0.80 years, 19.01±3.83 and 67.98±10.97 cm, respectively. Approximately 46% of the participants were overweight or obese. A significant association between ApoE isoforms and WC was found after controlling for age, sex and the percentage of physical activity (p=0.025). Significant main effects were found for vigorous physical activity and light physical activity influencing the adiposity-related BMI (p<0.001) and WC (p=0.044), respectively. CONCLUSIONS: Variation in ApoE and physical activity intensity were associated with adiposity-related phenotypes in Mexican school children.

[Comparison of resting energy expenditure determined by indirect calorimetry and estimated by predictive formulas in women with obesity degrees I to III]. / Comparación del gasto energético en reposo determinado mediante calorimetría indirecta y estimado mediante fórmulas predictivas en mujeres con grados de obesidad I a III.

INTRODUCTION: The determination of resting energy expenditure (REE) is calculated in clinical practices by predictive formulas; however the result varies among the population due to several factors. OBJECTIVE: To compare the REE determination by indirect calorimetry and by Harris-Benedict (HB), Mifflin (MF), World Health Organization (WHO), Institute of Medicine (IOM), "Formula Rápida" (FR) and Valencia (VA) formulas, in women with obesity grades I to III. METHODS: Mexican mestizo adult women were included in the study and stratified in three groups according to their body mass index (BMI). Grade I obesity (BMI 30.0-34.9, n = 42), grade II (BMI 35.0-39.9, n = 38) and grade III (BMI > 40, n = 41). REE was determined by indirect calorimetry and by the aforementioned equations. Kruskal-Wallis ANOVA and Dunn test were used for statistical comparison and p < 0.05 was accepted as a statistical difference. RESULTS: There were no statistical difference between the REE values estimated by formulas HB, WHO and VA regarding the CI. The accuracy obtained from these formulas was 63%, 67% and 64%, respectively, when data were analyzed in a single group. The IOM, ER and MF formulas showed statistically significant difference versus the CI and their accuracy were 58%, 53%, and 54%, respectively. In grade III obesity VA (78%) and FR (71%) accuracy were the highest obtained. DISCUSSION: HB, WHO and VA formulas were the best to estimate REE in Mexican women with BMI > 30. In obesity grade III FR and VA formulas showed the best performance.

Introducción: La determinación del gasto energético en reposo (GER) se calcula cotidianamente a partir de fórmulas predictivas aunque el resultado varía dependiendo de la población. Objetivo: Comparar la determinación del GER mediante calorimetría indirecta y mediante las ecuaciones Harris-Benedict (HB), Mifflin (MF), Organización Mundial de la Salud (OMS), «Institute of Medicine¼ (IOM), Fórmula Rápida (FR) y Valencia (VA) en mujeres con grados de obesidad I a III. Métodos: Mujeres adultas mestizas mexicanas se incluyeron en el estudio y formaron 3 grupos a partir del índice de masa corporal (IMC). Obesidad grado I (IMC 30,0-34,9; n = 42), grado II (IMC 35,0-39,9; n = 38) y grado III (IMC > 40; n = 41). Se determinó el GER mediante calorimetría indirecta y mediante las ecuaciones antes señaladas. ANOVA de Kruskal-Wallis y la prueba de Dunn se emplearon para el análisis estadístico (p < 0,05 se aceptó como diferencia). Resultados: No se observó diferencia estadística entre los valores de las fórmulas HB, OMS y VA respecto a la CI. La concordancia obtenida de dichas fórmulas fue 63%, 67% y 64%, respectivamente, al analizar los datos en un solo grupo de obesidad. Asimismo, las fórmulas IOM, ER y MF mostraron diferencia estadística significativa versus la CI, siendo la concordancia 58%, 53% y 54%, respectivamente. En el grado III de obesidad la concordancia de VA (78%) y FR (71%) fue la mayor obtenida. Discusión: Las fórmulas HB, OMS y VA fueron las mejores para estimar el GER en mujeres mexicanas con IMC>30. En el grado III VA y FR muestran el mejor desempeño.

Prevalence of metilentetrahidrofolate reductase C677T polymorphism, consumption of vitamins B6, B9, B12 and determination of lipidic hydroperoxides in obese and normal weight Mexican population.

INTRODUCTION: Oxidative stress is a key factor in the development of the principal comorbidities of obesity. Methylenetetrahydrofolate reductase enzyme (MTHFR) participates in the metabolism of folate with the action of vitamins B6 and B12. The gene of MTHFR may present a single nucleotide polymorphism (SNP) at position 677 (C677T), which can promote homocysteinemia associated to the production of free radicals. OBJECTIVE: To determine the frequency of SNP C677T of the MTHFR, evaluate the consumption of vitamins B6, B9, B12 and determine the concentration of plasma lipid hydroperoxides (LOOH) in obese and control groups. METHODS: 128 Mexican mestizo according to their body mass index were classified as normal weight (Nw; n=75) and obesity (ObeI-III; n=53). Identification of SNP C677T of MTHFR was performed by PCR-RFLP technic. The consumption of vitamins B6, B9 and B12 was assessed by a validate survey. LOOH was determined as an indicator of peripheral oxidative stress. RESULTS: There was no statistical difference in the frequency of the C677T polymorphism between the TT homozygous genotype in Nw (0.19) and ObeI-III (0.25). The frequency of T allele in Nw was 0.45 and 0.51 in ObI-III group. There were no statistical differences in the consumption of vitamins B6, B9 and B12 between Nw and ObI-III groups. The LOOH showed statistical difference (p < 0.05) between Nw and ObI­III group. DISCUSSION: Oxidative stress is present in all grades of obesity although there were no differences in the vitamin consumption and the SNP C677T between Nw and ObeI­III groups.

Introducción. El estrés oxidativo es un factor clave en el inicio y el desarrollo de las comorbilidades de la obesidad. La enzima metiltetrahidrofolato reductasa (MTHFR) participa en el metabolismo del folato con la acción de las vitaminas B9 y B12. El gen MTHFR puede presentar un polimorfismo de un solo nucleótido (SNP) en la posición 677 (C677T), que puede promover homocisteinemia asociada a la producción de radicales libres. Objetivo. Determinar la frecuencia del SNP C677T de la MTHFR, evaluar el consumo de vitaminas B6, B9, B12 y determinar la concentración de hidroperóxidos lipídicos (LOOH) en plasma en un grupo de obesos y testigo. Métodos. Se clasificaron 128 mexicanos mestizos de acuerdo a su índice de masa corporal en normopeso (Nw; n=75) y obesidad (ObeI-III; n=53). Se identificó el SNP C677T de la MTHFR mediante la técnica de PCR-RFLP. El consumo de vitaminas B6, B9 y B12 se evaluó mediante una encuesta validada. Se determinaron LOOH como un indicador de estrés oxidativo periférico. Resultados. No hubo diferencia estadística significativa en la frecuencia del polimorfismo C677T entre homocigotos TT en Nw (0.19) y ObeI-III (0.25). La frecuencia del alelo T en Nw fue de 0.45, y 0.51 en el grupo ObeI-III. Los LOOH mostraron diferencia estadística significativa (p.

Variables nutricias asociadas con la ansiedad y la autopercepción corporal en niñas y niños mexicanos de acuerdo con la presencia de sobrepeso/obesidad / Nutritional variables associated with anxiety and body image self-perception in Mexican children according with the presence of overweight/obesity

Resumen: INTRODUCCIÓN: La obesidad infantil se ha asociado con la ingesta de alimentos densamente energéticos, con el sedentarismo y con indicadores de salud mental como la ansiedad manifiesta y la percepción de la imagen corporal. En México no se ha reportado la relación entre dichas variables en población infantil. OBJETIVO: Evaluar la auto-percepción corporal y el riesgo de ansiedad, de acuerdo con la presencia de sobrepeso u obesidad, controlando las variables dietéticas y los hábitos de salud en niños en edad escolar. MÉTODO: Clasificados por su Índice de Masa Corporal (IMC) se compararon 259 niños y niñas sin sobrepeso/obesidad vs. 326 quienes presentaron dicha condición, en tres escuelas públicas del Estado de México. El IMC se obtuvo por medición directa del peso y la estatura. Se exploró la relación del consumo de alimentos (dieta) y el estilo de vida con la presencia de ansiedad (cuestionario CMAS-R), auto-percepción y satisfacción corporal (test-SC). RESULTADOS: El 43% de los escolares presentan riesgo cardiovascular y 7.7% riesgo de síndrome metabólico. Los participantes sin sobrepeso/obesidad presentaron mayor satisfacción con su imagen corporal (68.3%). No se encontraron diferencias entre el IMC y la ansiedad total, ni con cada una de sus dimensiones. DISCUSIÓN Y CONCLUSIÓN: No se reportaron diferencias en la ansiedad de acuerdo con el IMC. La auto-percepción de la imagen corporal fue menos favorable, en zonas específicas del cuerpo en niñas y niños con sobrepeso u obesidad.

Abstract: INTRODUCTION: Childhood obesity has been associated with the intake of energy-dense foods and sedentary lifestyle, and with mental health indicators such as anxiety and perception of body image. In Mexico it has not been studied the relationship between these variables in children. OBJECTIVE: To assess the body self-perception and risk of anxiety according to the presence of children with normal weight for their stature and age (BMI) and children with overweight/obese, controlling for dietary variables and health habits in children of school age. METHOD: 259 boys and girls with normal BMI vs. 326 with overweight/obesity from three public schools in the State of Mexico were evaluated. Diet and lifestyle were associated with the presence of anxiety and body-image dissatisfaction. BMI was calculated from direct measures of weight and height. For anxiety assessment the CMAS-R questionnaire was used and test-SC for body image self-perception. RESULTS: 43% of school children showed cardiovascular risk and 7.7% metabolic syndrome risk. Children with normal weight have greater satisfaction with their body image and weight, compared to children with overweight or obesity (68.3% vs. 49.1%). DISCUSSION AND CONCLUSION: There were no differences in anxiety according to BM1. The self-perception of body image is less favorable in specific areas of the body, in children with overweight or obesity.

Alteraciones renales y nutrición / Renal alterations and nutrition

El riñón es fundamental para mantener el medio ambiente químico del cuerpo interno, sus funciones se agrupan en tres entidades: 1.- órgano excretor: remueve sustancias de desecho del metabolismo de nitrógeno (urea, ácido úrico, creatinina), iones de hidrógeno y sulfatos, así como agua, sodio, potasio, calcio, fosfato, magnesio y otras sustancias; 2.- órgano regulador: mantiene la cantidad necesaria de agua corporal, sodio, iones de hidrógeno y otros electrólitos; regula el volumen de líquidos corporales y su composición electrolítica; 3.- metabolismo: produce 1,25-dihidroxivitamina D, eritropoyetina, renina. Las lesiones degenerativas de los túbulos renales aumenta la permeabilidad del glomérulo. La nefrosis se caracteriza por una proteinuria severa, hipoalbuminuria, edema e hipercolesterolemia. El deterioro progresivo de las nefronas propicia la disminución de la función renal o insuficiencia renal crónica. La pérdida progresiva de nefronas desencadena el síndrome urémico o uremia. Contenido del trabajo: 1) Tratamiento nutricio. 2) Síndrome nefrótico. 3) Insuficiencia renal crónica: plan de alimentación, función de los nutrimentos (energía, proteínas, sodio, potasio, fósforo y calcio, equilibrio ácido base, hierro, zinc, vitaminas hidrosolubles y liposolubles). 4) Modificaciones en la ingestión de líquidos. 5) Nutrición de los niños con enfermedad renal. 6) Diálisis. 7) Nefrolitiasis y urolitiasis

Plan alimentario para el individuo sano y el individuo enfermo / Alimentary plan for the healthy individual and the sick individual

En algunos estudios realizados en hospitales se ha encontrado una asociación entre el estado de nutrición de los pacientes y la morbilidad y mortalidad de los mismos. Por ello es prudente considerar el cuidado de la nutrición del sujeto en tratamiento como parte primordial de los servicios hospitalarios integrales. Los objetivos del manejo nutricio son: mantener el estado de nutrición óptimo; corregir deficiencias nutricias; lograr que los pacientes obesos o desnutridos alcancen el peso adecuado o eviten la pérdida de peso; aportar la energía y nutrimentos necesarios; ofrecer orientación alimentaria; ofrecer alimentos atractivos. Se recomienda la consulta a un nutriólogo. Apartados: 1) Aspectos básicos: evaluación del estado nutricio; desarrollo del plan nutricio; implementación del plan nutricio; orientación alimentaria del paciente y su familia. 2) Plan de alimentación modificado en consistencia: dieta de líquidos claros; dieta de líquidos generales; dieta de purés; dieta suave; dieta blanda. 3) Plan de alimentación modificado en el contenido de nutrimentos: dieta modificada en el contenido de energía; dieta modificada en el contenido de proteínas; dieta modificada en el contenido de sodio; dieta modificada en el contenido de potasio; dieta modificada en el contenido de fósforo; dieta modificada en el contenido de calcio; dieta modificada en el contenido de agua; dieta modificada en el contenido de lípidos; dieta modificada en el contenido de fibra; dieta rica en hierro. 4) Plan de alimentación a complacencia

Apoyo nutricio / Nutritive support

Los avances en el apoyo nutricio durante las últimas dos décadas permiten que los pacientes sean nutridos en forma segura y efectiva a través de alimentación parenteral, enteral por sonda, oral o mixta, aminorando en forma importante la morbilidad y mortalidad hospitalaria secundarias a la desnutrición. El apoyo nutricio intensivo del paciente en condiciones hipermetabólicas compete a un equipo interdisciplinario especializado; por ello, es indispensable que los médicos, las enfermeras y el personal de nutrición sean capaces de identificar a los pacientes que requieren de cuidado nutricio. Este trabajo proporciona conocimientos generales y básicos sobre apoyo nutricio. Contenido: 1) Alimentación enteral: sitios de entrada de la sonda, tipos de sondas, características de las soluciones, fórmulas licuadas (carbono, proteínas, lípidos), fórmulas poliméricas estándar, soluciones monoméricas, soluciones especiales, métodos de infusión, indicaciones y contraindicaciones, complicaciones. 2) Alimentación parenteral: indicaciones, contenido nutrimental (energía, proteínas, hidratos de carbono, lípidos, vitaminas, electrólitos, nutrimentos inorgánicos), cálculo del contenido nutrimental, complicaciones, alimentación parenteral en casa. 3) El equipo de apoyo nutricio: responsabilidades (del médico, farmacéutico, enfermera, nutriólogo)