Impacto de la pandemia por SARS-CoV-2 en el índice de masa corporal de niños asistidos en la Ciudad Autónoma de Buenos Aires / Impact of the SARS-CoV-2 pandemic on the body mass index of children seen in the City of Buenos Aires

Introducción. El sobrepeso y la obesidad infantil constituyen un problema de salud pública. El inicio de la pandemia por COVID-19 pudo haber favorecido esta patología. El puntaje Z del índice de masa corporal (Z-IMC) es un indicador aceptado para su diagnóstico y seguimiento. Objetivo. Evaluar si la prevalencia de sobrepeso y obesidad, y el Z-IMC en niños de 2 a 5 años aumentó durante la pandemia. Población y métodos. Estudio de cohorte retrospectiva. Se incluyeron pacientes asistidos en efectores públicos de salud del Gobierno de la Ciudad Autónoma de Buenos Aires (GCABA), de 2 a 5 años de edad, con registro de peso y talla en dos consultas, antes y después de haber comenzado el aislamiento social preventivo y obligatorio (ASPO). Se registró estado nutricional (Z-IMC) y variación del Z-IMC entre ambas consultas. Resultados. Se evaluaron 3866 sujetos, edad promedio 3,4 ± 0,8 años; el 48,1 % fueron mujeres. El intervalo promedio entre consultas fue 14,3 ± 2,5 meses. La prevalencia de sobrepeso/obesidad aumentó del 12,6 % (IC95% 11,6-13,6) al 20,9 % (IC95% 19,6-22-2); p <0,001, al igual que el Z-IMC (0,4 ± 1,1 vs. 0,8 ± 1,3; p <0,001). Conclusión. La prevalencia de sobrepeso y obesidad, y el Z-IMC en niños de 2 a 5 años aumentó significativamente durante la pandemia.

Introduction. Childhood overweight and obesity are a public health problem. The onset of the COVID-19 pandemic may have contributed to this condition. The body mass index (BMI) Z-score has been accepted as an indicator for overweight and obesity diagnosis and follow-up. Objective. To assess whether the prevalence of overweight and obesity and the BMI Z-score in children aged 2 to 5 years increased during the pandemic. Population and methods. Retrospective, cohort study. Patients included were those seen at public health care facilities in the City of Buenos Aires (CABA), who were aged 2 to 5 years, had weight and height values recorded at 2 different visits, before and after the establishment of the preventive and mandatory social isolation policy. Patients' nutritional status (BMI Z-score) and the variation in this indicator between both visits were recorded. Results. A total of 3866 subjects were assessed; their average age was 3.4 ± 0.8 years; 48.1% were girls. The average interval between both visits was 14.3 ± 2.5 months. The prevalence of overweight/ obesity increased from 12.6% (95% CI: 11.6­13.6) to 20.9% (95% CI: 19.6­22.2), p < 0.001, and so did the BMI Z-score (0.4 ± 1.1 versus 0.8 ± 1.3, p < 0.001). Conclusion. The prevalence of overweight and obesity and the BMI Z-score in children aged 2 to 5 years increased significantly during the pandemic.

Sobrepeso y obesidad en infancias de Bariloche, Argentina: más allá de la alimentación y la actividad física / Childhood overweight and obesity in Bariloche, Argentina: Beyond eating habits and physical activity

La incidencia de sobrepeso y obesidad es alarmante en el mundo. En Argentina son escasos los estudios multifactoriales a pesar de los altos índices de sobrepeso y obesidad en la población infantil (SOI). En este estudio evaluamos la prevalencia de SOI y sus factores de riesgo asociados desde una perspectiva multicausal: analizamos hábitos de sueño, uso de pantallas, estrés crónico en niños y sus cuidadores, problemas de relación social, alimentación y actividad física. De los 397 niños de primer y séptimo grado que completaron los cuestionarios, el 41 % presentó SOI. Los niños con obesidad mostraron realizar menos actividad física, tener un menor consumo de alimentos protectores, más riesgos de trastornos del sueño, mayores niveles de estrés crónico (tanto en los niños como en sus cuidadores) y mayor índice de rechazo entre pares. En la mayoría de los niños se encontró un uso generalizado de pantallas antes de acostarse. El presente estudio evidencia la diversidad de factores asociados a esta problemática y destaca la conveniencia de utilizar un enfoque multidimensional para abordar la obesidad en la infancia. Asimismo, los resultados de este trabajo sugieren la necesidad de considerar los hábitos de vida como estrategia preventiva y terapéutica para el tratamiento de esta enfermedad desde etapas tempranas.

The incidence of overweight and obesity is alarming worldwide. In Argentina, multifactorial studies are scarce despite the high rates of childhood overweight and obesity (OW/OB). In this study we assessed the prevalence of childhood OW/OB and the associated risk factors from a multicausal perspective: we analyzed sleep habits, screen use, chronic stress in children and their caregivers, social relationship problems, eating habits, and physical activity. Of the 397 first and seventh graders who completed the questionnaires, 41% had childhood OW/OB. In children with obesity, a lower level of physical activity, a lower consumption of protective foods, a higher risk for sleep disorders, higher levels of chronic stress (in both children and their caregivers), and higher rates of peer rejection were observed. Widespread use of screens before bedtime was noted in most children. This study evidences the diversity of factors associated with childhood OW/OB and highlights the convenience of a multidimensional approach to address it. In addition, the results of this study suggest the need to consider lifestyle habits as a preventive and therapeutic strategy for the management of OW/OB from early stages.

Entornos escolares saludables / healthy school environments

El sobrepeso y la obesidad en niños, niñas y adolescentes (NNyA) así como en adultos, es una epidemia en aumento que está tomando proporciones alarmantes en todo el mundo y representa uno de los principales problemas de salud pública que requiere respuestas de los Estados en forma urgente1 . El sobrepeso y la obesidad muestran una curva ascendente especialmente preocupante en NNyA, en quienes el crecimiento es más acelerado que en personas adultas. El sobrepeso y la obesidad afectan tanto la salud psico-física inmediata de NNyA, como el nivel educativo que pueden alcanzar y su calidad de vida. Asimismo, los NNyA con sobrepeso y obesidad tienen mayores probabilidades de seguir siendo personas obesas en la edad adulta y presentan mayor riesgo de sufrir enfermedades no transmisibles (ENT), como las cardiovasculares, la diabetes o el cáncer2. Más información detallada sobre la evolución de la epidemia de obesidad en NNyA a nivel internacional y en Argentina, así como su impacto en la salud y en la economía de los países se desarrolló en el reciente informe publicado por la Secretaria de Gobierno de Salud en colaboración con UNICEF3. En dicho informe se analizaron el peso y la talla de NNyA de 0 a 18 años que accedieron a la atención del sistema público de salud del país y se concluyó que en Argentina, en sintonía con la reconocida "transición nutricional" global, el sobrepeso y la obesidad en NNyA representa la forma más prevalente de malnutrición. Esto se evidencia en el hecho de que entre los más de 3 millones de NNyA atendidos en el sector público del sistema de salud argentino en 2016, 31,1% tenían malnutrición por exceso (sobrepeso y obesidad) y 8,1% malnutrición por carencia (bajo peso). En la actualidad, y como consecuencia de numerosos cambios sociales, culturales y económicos, como por ejemplo los cambios en los modelos de producción de alimentos, su disponibilidad, asequibilidad, comercialización y marketing, así como por la escasa práctica de actividad física, los NNyA crecen y se desarrollan a menudo en entornos obesogénicos. Un entorno obesogénico es aquel que fomenta el consumo excesivo de kilocalorías y nutrientes críticos como azúcares, grasas y sodio, además de ofrecer múltiples barreras para el desarrollo de actividad física y fomentar el comportamiento sedentario4. Así, la falta de regulación que promueva entornos más saludables, ha favorecido en las últimas décadas al crecimiento del sobrepeso y la obesidad. Las respuestas conductuales y biológicas de NNyA ante un entorno obesogénico pueden estar determinadas por procesos anteriores incluso a su nacimiento, lo que empuja a un número cada vez mayor de NNyA hacia la obesidad, si siguen una alimentación de baja calidad nutricional y no realizan la actividad física recomendada1 . Existen pruebas convincentes de que la publicidad y la comercialización de alimentos y bebidas con alto contenido de sodio, grasas, azúcares y kilocalorías, pero deficientes en micronutrientes, pueden repercutir en las preferencias alimentarias, el comportamiento de compra y el consumo de NNyA. La comercialización y provisión en las escuelas de alimentos y bebidas con altos niveles de azúcar, grasa, sal y bajo valor nutricional, también influyen en los patrones y hábitos de consumo en niños y niñas5, 6, 7, 8. La prevención y el tratamiento de la obesidad exige un enfoque intersectorial e intergubernamental y en el que las políticas de todos los sectores tengan en cuenta sistemáticamente la salud, eviten los efectos sanitarios nocivos y, por tanto, mejoren la salud de la población y la equidad. La Organización Mundial de la Salud (OMS) y otros organismos internacionales han publicado en los últimos años, numerosos documentos que, en base a evidencia científica, establecen un conjunto de medidas para regular los entornos obesogénicos y los productos, de modo de fomentar hábitos saludables y así detener el crecimiento de esta epidemia2, 9, 10. Dentro de estas medidas recomendadas, una que resulta clave y que cuenta con alto consenso a nivel internacional es la regulación de los entornos escolares para promover la nutrición adecuada y la actividad física. Sólo a través de una serie de medidas (intervención multicomponente) de demostrada eficacia que aborde integralmente aspectos nutricionales y de actividad física en las instituciones escolares, se conseguirán las transformaciones necesarias para fomentar hábitos saludables y mejorar los patrones de conducta de NNyA. El objetivo del presente documento es establecer un conjunto de recomendaciones que, basadas en las mejores evidencias científicas disponibles, constituyan los estándares para guiar el proceso de sanción de leyes e implementación de programas efectivos, para transformar los entornos obesogénicos en entornos escolares saludables. Estos estándares están dirigidos a legisladores y decisores políticos tanto del nivel nacional como provincial y municipal así como también a organizaciones académicas y de la sociedad civil que trabajen en la temática.

Study on related factors and characteristics of multimorbidity of overweight and obesity-related diseases in children in Hunan Province / 中华预防医学杂志

From January 2019 to December 2021, overweight and obese children who visited in health outpatient Center of Hunan Children's Hospital were studied to explore and analyze the rate, related factors and patterns of multimorbidity of overweight and obesity-related diseases in children in Hunan Province. Univariate and multivariate logistic regression models were used to analyze the multimorbidity-related factors of overweight and obesity-related diseases in children. Association rules (apriori algorithm) were used to explore the multimorbidity patterns of overweight and obesity-related diseases in children. A total of 725 overweight and obese children were included in this study. The multimorbidity rate of overweight and obesity-related diseases in children was 46.07% (334/725). Age, waist circumference, the frequency of food consumption such as hamburgers and fries and adding meals before bedtime were multimorbidity-related factors of overweight and obesity-related diseases in children. The multimorbidity associated with nonalcoholic fatty liver disease (NAFLD) was relatively common. The patterns with the top three support degrees were "NAFLD+dyslipidemia","NAFLD+hypertension" and "NAFLD+hyperuricemia". The patterns with the top three confidence and elevation degrees were "Hypertension+dyslipidemia => NAFLD","Hyperuricemia => NAFLD" and "NAFLD+hypertension => dyslipidemia".

Research progress on correlation between childhood obesity and obstructive sleep apnea / 临床耳鼻咽喉头颈外科杂志

Prevalence of childhood obesity is progressively increasing, reaching worldwide levels of 5.6% in girls and of 7.8% in boys. This also leads to a corresponding increase in the prevalence of obesity-associated morbidities particularly those involving obstructive sleep apnea（OSA）. Obesity is an independent risk factor and regulator of OSA in children. There is a bidirectional causal relationship between OSA and obesity in children. The factors involved in the association between OSA and obesity are systemic inflammation, oxidative stress, and gut microbiota etc. However, a causal link between obesity-related inflammatory state and OSA pathogenesis still needs to be properly confirmed. The present review aimed to investigate the links between childhood obesity and OSA.

A cross-sectional study on the prevalence rate and influencing factors of non-alcoholic fatty liver disease in overweight/obese children / 中国当代儿科杂志

OBJECTIVES@#To investigate the prevalence rate of non-alcoholic fatty liver disease (NAFLD) in overweight/obese children who visit a hospital, and to explore the influencing factors of NAFLD, in order to provide a basis for the prevention of NAFLD in overweight/obese children.@*METHODS@#Overweight/obese children who visited Hunan Children's Hospital from June 2019 to September 2021 were recruited. The prevalence rate of NAFLD was examined. Logistic regression analysis was used to explore the factors influencing the development of NAFLD [non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH)]. Receiver operating characteristic curve analysis was used to evaluate the predictive value of the influencing factors for NAFL and NASH.@*RESULTS@#A total of 844 overweight/obese children aged 6-17 years were enrolled. The prevalence rate of NAFLD in overweight/obese children was 38.2% (322/844), among which the prevalence rates of NAFL and NASH were 28.8% (243/844) and 9.4% (79/844), respectively. Multivariate logistic regression analysis showed that the increase of waist-to-hip ratio (WHR) and low high-density lipoprotein cholesterol (HDL-C) were associated with the development of NAFL and NASH (P<0.05). The receiver operating characteristic curve analysis showed that the combined measurement of WHR and HDL-C had a predictive value for NAFL (area under the curve: 0.653, 95%CI: 0.613-0.694), and for NASH (area under the curve: 0.771, 95%CI: 0.723-0.819).@*CONCLUSIONS@#The prevalence rate of NAFLD in overweight/obese children who visit a hospital is high. WHR and HDL-C are associated with the development of NAFLD and the combined measurement of WHR and HDL-C has a certain value for predicating the development of NAFLD.

Research progress on influencing factors of early adiposity rebound in children and the effect on adolescent development in girls / 中华预防医学杂志

With the increasing rate of overweight and obesity in children worldwide, adiposity rebound(AR)closely related to obesity has become the spotlight, and early AR phase has a broad impact on pubertal development in girls, but the specific mechanism of action isn't very clear.This paper is review of the prevalence of early AR at home and abroad, and its influencing factors, the impact of AR on the adolescent development of girls and related mechanisms, to identify high-risk individuals with early AR, early AR to identify early adolescent development, and take early intervention measures to promote children's health.

Influencia de la seropositividad contra adenovirus-36 sobre riesgo de obesidad y resistencia a la insulina en población infanto-juvenil de la Región de la Araucanía / Influence of adenovirus 36 seropositivity on the risk of obesity and insulin resistance in a population of children and adolescents from the Región de la Araucanía

La infección previa por el adenovirus-36 (Ad-36) se ha asociado con el proceso adipogénico y el control glicémico en modelos experimentales de cultivos celulares y animales. En humanos, la presencia de anticuerpos contra Ad-36 ha mostrado aumentar el riesgo de obesidad y, paradójicamente, mejorar el control glicémico en diferentes poblaciones. Se evaluó la influencia de la seropositividad contra Ad-36 sobre riesgo de obesidad, el perfil lipídico y glicémico en una población de niños en edad escolar. Métodos: Doscientos ocho individuos de entre 9 y 13 años se agruparon según estado nutricional como normopeso (IMC z-score de -1 a +1), con sobrepeso (IMC z-score de +1 a +2) y con obesidad (IMC z-score > +3). Se evaluaron medidas antropométricas, desarrollo puberal según Tanner y parámetros bioquímicos (perfil lipídico, glucemia e insulina) y la seropositividad contra Ad-36. Se determinó la resistencia a la insulina (RI) según criterio para la población infantil chilena. La seropositividad contra Ad-36 se determinó mediante ELISA. Resultados: Hubo una alta prevalencia de sobrepeso/obesidad en la población de estudio. La seropositividad contra Ad-36 fue del 5,4% en el grupo total, pero no se observó una asociación con el estado nutricional. No se encontró correlación entre la seropositividad contra Ad-36 y los parámetros del perfil lipídico. La insulina y la HOMA-RI fueron significativamente más bajas en el grupo Ad-36 (+) (p<0,001), no habiendo sido reportados casos de RI en el grupo Ad-36 (+) en nuestra población. Conclusiones: Nuestros resultados sugieren que la infección previa por el adenovirus-36 afecta la secreción de insulina y la resistencia a la insulina, como se ha descrito anteriormente, sin embargo, no se observa correlación con el desarrollo de la obesidad infantil en la población pediátrica del sur de Chile.

Previous infection with Adenovirus-36 (Ad-36) has been associated with adipogenic process and glycemic control in experimental models of cell culture and animals. In humans, the presence of antibodies against Ad-36 has been shown to increase the risk of obesity and, paradoxically, improve glycemic control in different populations. The influence of Ad-36 seropositivity on obesity risk, lipid and glycemic profile was evaluated in a population of school-age children. Methods: Two hundred eight individuals aged 9 to 13 years were grouped according to their nutritional status as normal weight (BMI z-score from -1 to +1), overweight (BMI z-score from +1 to +2) or obese (BMI z-score from -1 to +1). z-score > +3). Anthropometric measurements, pubertal development according to Tanner stage, biochemical parameters (lipid profile, glycemia and insulin) and seropositivity against Ad-36 were evaluated. Insulin resistance (IR) was determined according to criteria for the Chilean child population. Seropositivity against Ad-36 was determined by ELISA. Results: There was a high prevalence of overweight/obesity in the study population. Seropositivity against Ad-36 was 5.4% in the total group, but no association with nutritional status was observed. No correlation was found between Ad-36 seropositivity and lipid profile parameters. Insulin and HOMA-RI were significantly lower in the Ad-36 (+) group (p<0.001), and no cases of RI were reported in the Ad-36 (+) group in our population. Conclusions: Our results suggest that previous adenovirus-36 infection affects insulin secretion and insulin resistance, as previously described, however, no correlation is observed with the development of childhood obesity in the pediatric population. from southern Chile.

Trend and correlation of obesity and continued breastfeeding in children from six to 3 months old / Tendência e correlação de obesidade e aleitamento materno continuado em crianças de seis a 23 meses

Abstract Objectives: to analyze the trend and correlation of obesity and the increase in continued breastfeeding in children aged six to 23 months in Brazil, from 2015-2019. Methods: ecological time series study with data from the Sistema de Vigilância Alimentar e Nutricional (Food and Nutritional Surveillance System). The dependent variable was the prevalence of obesity. Prais-Winsten linear regression was used to verify the trend. Spearman's correlation was used to verify the relationship between the prevalence of obesity and the increase in continued breastfeeding. Results: there was a trend towards a reduction in the prevalence of obesity in all regions in Brazil (Annual Percentage Variation [APV]: -4.14; CI95%=-4.50; -3.79). The prevalence of continued breastfeeding showed an upward trend in the North (APV=4.89; CI95%=2.92; 6.90), Southeast (APV=3.36; CI95%=2.32; 4 .41) and South (APV=2.67; CI95%=0.98; 4.38). There was a negative and significant correlation between obesity and continued breastfeeding in the North, Northeast, Southeast and South regions. Conclusion: the reduction in the prevalence of obesity and the increase in continued breastfeeding occurred only in some regions, requiring the implementation of effective strategies to be present throughout the country. Actions to promote, protect and support continued breastfeeding and healthy eating should be more prioritized to promote the child's healthy growth.

Resumo Objetivos: analisar a tendência e a correlação de obesidade e o aumento do aleitamento materno continuado em crianças de seis a 23 meses no Brasil, de 2015-2019. Métodos: estudo ecológico de série temporal com dados do Sistema de Vigilância Alimentar e Nutricional. A variável dependente foi a prevalência de obesidade. A regressão linear de Prais-Winsten foi usada para verificar a tendência. Adotou-se a correlação de Spearman para verificar a relação entre as prevalências de obesidade e o aumento do aleitamento materno continuado. Resultados: verificou-se tendência de redução da prevalência de obesidade em todas as suas regiões do Brasil (Variação Percentual Anual [VPA]: -4,14; IC95%=-4,50; -3,79). A prevalência do aleitamento materno continuado apresentou tendência de aumento nas regiões Norte (VPA=4,89; IC95%=2,92; 6,90), Sudeste (VPA=3,36; IC95%=2,32; 4,41) e Sul (VPA= 2,67; IC95%=0,98; 4,38). Houve correlação negativa e significativa entre obesidade e aleitamento materno continuado nas regiões Norte, Nordeste, Sudeste e Sul. Conclusão: a redução da prevalência da obesidade e o aumento do aleitamento materno continuado ocorreram somente em algumas regiões, requerendo implementação de estratégias eficazes para esteja presente em todo o país. Ações de promoção, proteção e apoio ao aleitamento materno continuado e a alimentação saudável devem ser mais priorizadas para promover o crescimento saudável da criança.

Efecto de una intervención nutricional en el consumo de alimentos en escolares de educación básica de Reynosa, Tamaulipas, México / Effect of a nutritional intervention on food consumption in basic education schoolchildren in Reynosa, Tamaulipas, Mexico

Introducción: en los últimos años se ha incrementado el consumo de alimentos ultraprocesados en escolares y esto se ha relacionado con un aumento en la prevalencia de obesidad infantil. Objetivo: calcular el tamaño del efecto de una intervención nutricional en el consumo alimentario en escolares de educación básica de Reynosa, Tamaulipas, México. Materiales y métodos: estudio longitudinal, con una muestra de 309 escolares de 12 escuelas primarias públicas; se formaron dos grupos: intervención (GI) y control (GC) con seguimiento de un año. Se realizaron mediciones antropométricas. Para evaluar los alimentos incluidos en los refrigerios escolares se utilizó un registro de alimentos antes y después de la intervención y se caracterizaron como recomendables y no recomendables. Se calculó el tamaño del efecto (TE) utilizando el estadístico "g" de Hedges. Resultados: al final del estudio en ambos grupos se incrementó el consumo de agua, sin embargo, él TE fue grande en el GI (TE=0,84), mientras que en el GC fue moderado (TE=0,50). En el GI se encontró una reducción pequeña en el consumo de carnes procesadas (p=0,004; TE=0,28), cereales dulces (p=0,001; TE=0,36) y bebidas no lácteas endulzadas (p=0,001; TE=0,49); mientras que el GC mostró un incremento pequeño en el consumo de comida rápida y antojitos mexicanos (p=0,001; TE=0,46). Conclusiones: en el GI se observó una disminución y un TE pequeño en el consumo de carnes procesadas, cereales dulces y bebidas no lácteas endulzadas. Es necesario diseñar estrategias que promuevan el consumo de alimentos recomendables(AU)

Introduction: In recent years, the consumption of ultraprocessed foods in schoolchildren has increased and this has been linked to an increase in the prevalence of childhood obesity. Objective: To calculate the size of the effect of a nutritional intervention on food consumption in basic education schoolchildren in Reynosa, Tamaulipas, Mexico. Materials and methods: Longitudinal study, with a sample of 309 schoolchildren from 12 public elementary schools; two groups were formed: intervention (IG) and control (CG) with a follow-up of one year. Measurements of weight, height and waist circumference were made. To evaluate the foods included in school lunch, a food registry was used before and after the intervention and they were characterized as recommended and not recommended. The effect size (ES) was calculated using the Hedges'g statistic. Results: At the end of the study in both groups, water consumption increased, however the ES was big in the IG (ES=0.84); while in the CG it was moderate (ES=0.50). In the IG, a small reduction in the consumption of processed meats was observed (p=0.004; ES=0.28), sweet cereals (p=0.001; ES=0.36) and sweetened nondairy beverages decreased (p=0.001; ES=0.49); while the CG showed a small increase in the consumption of fast food and Mexican appetizers (p=0.001; ES=0.46). Conclusions: In the IG showed a TE small decrease in consumption of processed meats, sweet cereals, and sweetened non-dairy beverages. It is necessary to design strategies that promote the consumption of recommended foods(AU)

Prevalencia de malnutrición por exceso en niños, niñas y adolescentes en pandemia, en centro médico de la Escuela de Medicina de la Universidad de Tarapaca / Prevalence of malnutrition due to excess in children, girls and adolescents during pandemic, in a medical center of the School of Medicine of the University of Tarapacá

INTRODUCCIÓN: La malnutrición por exceso afecta aproximadamente a 337 millones de niños, niñas y adolescentes en el mundo. Entre los aspectos multifactoriales asociados a la obesidad, destaca el contexto Pandemia por COVID-19, el cual ha aumentado las cifras de obesidad infantil. Por otro lado, la obesidad es considerada un factor de riesgo para desarrollar de forma grave la enfermedad por COVID-19. Este estudio busca analizar el efecto de la pandemia en los índices de malnutrición por exceso en los niños, niñas y adolescentes atendidos en el centro médico de la carrera de medicina de la Universidad de Tarapacá durante el año 2021 y compararlos con estudios previos realizados en Chile. METODOLOGÍA: La investigación tiene un enfoque analítico, transversal, retrospectivo y observacional. El estudio se basó en la revisión de fichas clínicas de 1094 pacientes entre 2 y 17 años atendidos en el Centro Médico de la Escuela de Medicina de la Universidad de Tarapacá en la ciudad de Arica. Los datos obtenidos fueron almacenados en plantilla Excel para ser ingresados en un programa estadístico. RESULTADOS: Del total de 1094 fichas analizadas, 611 pacientes (55,8%) se encontraron en un estado nutricional concordante con malnutrición por exceso, predominando en el sexo masculino (54,7%) y a mayor edad mayor malnutrición por exceso, encontrando mayor prevalencia de obesidad y obesidad severa en los(las) adolescentes. DISCUSIÓN: La malnutrición por exceso ha adquirido las características de epidemia y es un problema frecuente de los países en vías de desarrollo, convirtiéndose en un problema de salud pública. En este estudio se demuestra un aumento en los niveles de malnutrición por exceso durante el año 2021, comparando los resultados obtenidos en relación a la realidad nacional y regional en los años 2019 y 2020.

INTRODUCTION: Malnutrition due to excess affects approximately 337 million children and adolescents in the world. Among the multifactorial aspects associated with obesity, the COVID-19 Pandemic context stands out, which has warned the figures of childhood obesity. On the other hand, obesity is considered a risk factor for severely developing COVID-19 disease. This study seeks to analyze the effect of the pandemic on the rates of malnutrition due to excess in children and adolescents treated at the medical center of the University of Tarapacá during the year 2021 and compare them with previous studies carried out in Chile. METHODOLOGY: The research has an analytical, cross-sectional, retrospective and observational approach. The study was based on the review of clinical records of 1094 patients between 2 and 17 years of age treated at the Medical Center of the School of Medicine of the University of Tarapacá in the city of Arica. The data obtained was stored in an Excel template to be entered into a statistical program. RESULTS: Of the total of 1094 records analyzed, 611 patients (55.8%) were found to be in a nutritional state consistent with malnutrition due to excess, predominating in males (54.7%) and at older ages, finding a higher prevalence of obesity and severe obesity in adolescents. DISCUSSION: Malnutrition due to excess has acquired the characteristics of an epidemic and is a frequent problem in developing countries, becoming a public health problem. This study demonstrates an increase in the levels of malnutrition by excess during the year 2021, comparing the results obtained in relation to the national and regional reality in the years 2019 and 2020.

Malnutrición en una población de escolares en Santiago, República Dominicana / Malnutrition of an elementary school population in Santiago, Dominican Republic

Introducción: la malnutrición infantil representa uno de los problemas de salud pública más importantes de la República Dominicana (RD) y el mundo. A pesar de esto, actualmente, no existen estudios en la RD que describa el estado nutricional en los niños de la escuela primaria. Material y métodos: este estudio transversal describió las principales variables antropométricas en niños de 1ero a 6to de primaria en Santiago, RD, además de determinar la relación existente entre la antropometría y variables sociodemográficas. Resultados: de los 2,271 estudiantes estudiados, la media del peso fue 33,2 ± 11,4 kg, la talla fue 1,36 ± 0,13 m. La media del percentil fue 65,33 %. El 3.92 % (n=89) estuvo en bajo peso, el 17.57 % (n=399) estuvo en sobrepeso y el 22.94 % (n=521) estuvo en obesidad. Conclusión: el sobrepeso y la obesidad infantil fueron los trastornos más comunes en zonas rurales y urbanas, y tanto en centros privados como públicos

Introduction: Child malnutrition represents one of the most important public health issues in the Dominican Republic (DR) and the whole world. Despite this reality, there are currently no studies in the DR that describe the nutritional status in primary school children. Material and method: This cross-sectional study described the main anthropometric variables in children from elementary schools in Santiago, RD, in addition to determining the relationship between anthropometry status and some sociodemographic variables. Results: 2,271 participants were analyzed; the mean weight was 33.2 ± 11.4 kg, height was 1.36 ± 0.13 m. The mean percentile was 65.33%. 3.92% (n=89) were underweight, 17.57% (n=399) were overweight, and 22.94% (n=521) were obese. Conclusion: Childhood overweight and obesity was the most prevalent disorder, both in rural and urban areas, and both in private and public centers

Association between rapid weight gain and overweight in children aged 0 to 5 years in Latin America / Associação entre ganho rápido de peso e excesso de peso em crianças de 0 a 5 anos de idade na América Latina

Abstract Objectives: to assess the prevalence of rapid weight gain (RWG) in children born with normal weight and its association with overweight (OW) in four Latin America countries. Methods: cross-sectional study in children aged 0 to 5 from the Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher in Brazil and the Encuesta Nacional de Demografía y Salud in Bolivia, Colombia and Peru,using a birth weight ≥2,500g. The outcome variable was OW, the exposure was RWG and breastfeeding (BF) was the adjustment variable. Prevalence, odds ratio and 95% confidence intervalwere estimated using multivariate logistic regression model. Results: there was a greater prevalence of RWG and BF at less than 6 months in Brazil, and a greater prevalence of OW in Brazil and Bolivia. The chances of OW when RWG was present and adjusted for BF were 6.1 times (CI95% = 3.8-9.7) in Brazil, 4.4 times (CI95% = 3.6-5.3) in Bolivia, 6.7 times (CI95% = 5.5-8.2) in Colombia, and 12.2 times in Peru (CI95% = 9.4-15.7) with a p < 0.001 for all countries. Conclusions: RWG in children with normal birth weight was associated with a greater chance of being OW in the four observed Latin America countries.

Resumo Objetivos: avaliar a prevalência do ganho rápido de peso (GRP) em crianças nascidas com peso normal e sua associação com o excesso de peso (EP) em quatro países da América Latina. Métodos: estudo transversal de inquéritos populacionais com crianças de 0 a 5 anos da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher no Brasil e da Encuesta Nacional de Demografía y Salud da Bolívia, Colômbia e Peru, selecionadas pelo peso ao nascer ≥2.500 gramas. A variável desfecho foi o EP; de exposição o GRP; e de ajuste a amamentação. Foram estimadas as prevalências, odds ratio e intervalo de confiança de 95% por regressão logística multivariada. Resultados: observou-se maior prevalência de GRP e tempo de amamentação menor do que 6 meses no Brasil e maior prevalência de EP no Brasil e Bolívia. As chances de EP quando GRP presente e ajustado por amamentação foram de 6,1 vezes (IC95% = 3,8-9,7) no Brasil; 4,4 vezes (IC95% = 3,6-5,3) na Bolívia; 6,7 vezes (IC95% = 5,5-8,2) na Colômbia; 12,2 vezes no Peru (IC95% = 9,4-15,7) e p<0,001 nos quatro países. Conclusões: o GRP em crianças nascidas com peso normal foi associado a maior chance de EP infantil nos quatro países da América Latina.

Overweight/obesity in adolescents with phenylketonuria: protective and predisposing factors

Abstract Objective: To estimate the prevalence and factors associated with overweight/obesity development in adolescents with early diagnosed phenylketonuria treated exclusively by diet. Methodology: In this cross-sectional study anthropometric measurements, serum phenylalanine levels, and 10 metabolites associated with lipid and carbohydrate metabolism were analyzed in 101 adolescents aged 10-20 years. Adolescents were categorized into overweight/obesity and eutrophic/low body mass index groups. These patients were compared using Student's t-test, Pearson's chi-square test, Wald's chi-square test for multivariate analysis. Further, to verify whether the prevalence of overweight/obesity found in the study population was similar to that in the general population, the authors compared the nutritional status of 46 patients aged 13-17 years with that of healthy students of the same age from the National School Health Survey using the chi-square test for adherence. The significance threshold was p < 0.5. Results: The prevalence of overweight/obesity in adolescents was 27.7%. There was no difference in prevalence between sexes. Older age was a protective factor and Increased Homeostasis Model Assessment Insulin Resistance index and high phenylalanine and low-density lipoprotein cholesterol levels were predictive factors for overweight/obesity. The equality hypothesis was not rejected in the comparison of nutritional states of 46 patients aged 13-17 years and healthy students of the same age. Conclusion: The prevalence of overweight/obesity in phenylketonuria adolescents was similar to what is found in healthy adolescents.

Tendência temporal (2008-2018) da prevalência de excesso de peso em lactentes e pré-escolares brasileiros de baixa renda / Time-trend analysis (2008-2018) of overweight prevalence among low-income infant and preschool children

Resumo O objetivo deste estudo foi analisar a tendência temporal da prevalência de excesso de peso (EP) em crianças menores de cinco anos assistidas pelo Programa Bolsa Família (PBF) entre 2008 e 2018. O painel de dados foi baseado nos relatórios de estado nutricional do Sistema de Vigilância Alimentar e Nutricional (SISVAN) (n=30.574.118) e analisado por meio de modelos de regressão joinpoint específicos para idade (lactentes e pré-escolares) e macrorregião. Ainda, calculou-se a cobertura do SISVAN para o PBF e a representatividade nacional, segundo projeção censitária. Na década analisada, o EP em lactentes reduziu de 11,9% (11,8; 12,0 IC95%) para 8,5% (8,4; 8,6 IC95%) (-3,6%/ano [-5,1; -2,0 IC95%]); quanto aos pré-escolares, a prevalência EP aumentou em 3,1%/ano (2,0; 4,2 IC95%) até 2015, seguida por uma retração até 2018 (-6,4%/ano [-10,1; -2,6 IC95%]). Em ambos os grupos etários, a região Norte apresentou a menor prevalência em toda série histórica e a Nordeste o pior desempenho no controle do EP infantil. A cobertura do SISVAN no PBF foi elevada e a representatividade dos dados variou entre 13,9% (Sul) e 42,2% (Nordeste). Apesar da prevalência estar acima do esperado, após 2014, identificou-se redução linear no EP em lactentes e desaceleração na taxa de crescimento nos pré-escolares.

Abstract This study aimed to analyze the overweight (OW) prevalence trends from 2008 to 2018 among under-five-year-old children assisted by the conditional cash transfer program entitled Programa Bolsa Família (PBF). The panel was based on the Food and Nutritional Surveillance System (SISVAN) (n=30,574,118) nutritional status reports. Age- (infants and preschoolers) and region-specific joinpoint regression models were used to analyze OW's prevalence temporal changes. Besides, the coverage of SISVAN for PBF and national representativity were calculated according to census projection. In the decade analyzed, OW in infants decreased from 11.9% (11.8; 12.0 95%CI) to 8.5% (8.4; 8.6 95%CI) (-3.6%/year [-5.1; -2.0 95%CI]); for preschool children, the prevalence of OW increased by 3.1%/year (2.0; 4.2 95%CI) until 2015, followed by a decrease until 2018 (-6.4%/year [-10.1; -2.6 95%CI]). In both age groups, the North region had the lowest prevalence in all time-series, and the Northeast had the worst performance in managing childhood obesity. The SISVAN's coverage in the PBF was high, and the data representativity varied between 13.9% (South) and 42.2% (Northeast). Although the prevalence was higher than expected, after 2014, it was detected a linear reduction in OW in infants and a deceleration in the growth rate in preschoolers.

Maternal and early childhood factors associated with asthma and obesity in children aged 6 to 7 years: a case control study

ABSTRACT Objective To determine the maternal and early childhood factors associated with asthma and obesity in children aged 6 to 7 years. Methods A case-control study conducted with children aged 6 to 7 years. Applications with questions about asthma symptoms in the last 12 months, maternal and childhood data in the first 2 years of life, and anthropometric data were collected. Children who presented asthma symptoms were considered as cases and those without asthma symptoms were considered as controls, later divided into two subgroups that were eutrophic or overweight/obesity. Logistic regression was performed to estimate the association between asthma symptoms (adequate weight and overweight/obesity) and gestational and personal factors, calculating odds ratio and 95% confidence interval (95%CI). Values of p<0.05 were considered significant. Results Two hundred and one children were evaluated, 25.4% had asthma symptoms, 37.2% of them were overweight/obesity. Waist circumference, triceps skinfold, and body mass index were higher in the group with overweight/obesity asthma symptoms compared to no asthma symptoms (p<0.05). Factors significantly associated with asthma and overweight/obesity symptoms included: the maternal history of asthma (odds ratio of 3.73; 95%CI: 1.10-12.6) and hypertension during pregnancy (odds ratio of 3.29; 95%CI: 1.08-9.94). Conclusion Maternal history of asthma and hypertension during pregnancy increased the chances of children, at 6 and 7 years of age, having symptoms of asthma and obesity.

Association between obesity with the diversity and genus of gut microbiota in school-aged children / 中华流行病学杂志

Objective: To analyze the diversity differences of gut microbiota between school-aged obese children and normal-weight children and identify the characteristic flora in obese children to provide some evidence for the subsequent study of the following study-related mechanisms and the prevention and treatment of obesity in school-aged children. Methods: This study was based on a cohort established in a primary school in Jiading district, Shanghai, 2016. Sixty-three children, including 43 boys and 20 girls, who were obese during the three years from 2016 to 2018, were enrolled in the obesity group. Among children who were average weight for three years, a total of 63 were selected as the control group, with matching with the obese ones in a 1 to 1 way according to age, sex and class. The primary characteristics, diet status, breastfeeding, and other information of children were collected by questionnaire. Fecal samples of participants in both groups were collected, and 16S rDNA sequencing was performed. Operable taxon units clustering according to 97% similarity and species annotation were based on the quality-optimized sequences. The difference in the diversity and genius of gut microbiota among children in the obesity and control groups were analyzed. The α diversity indices, including Ace, Chao1, Shannon, and Simpson index, were calculated. The β diversity was presented based on unweighted Unifrac distance and weighted Unifrac space by principal coordinate analysis. The differences in β diversity between the two groups were compared by similarity analysis (ANOSIM).The differences in genus distribution between the two groups were selected by STAMP software. The association of obesity with the α diversity and genus with significant differences were analyzed by the generalized linear model (GLM). Results: The Ace and Chao1 index in the obesity group was significantly lower than those in the control group (The P values were 0.026 and 0.039, respectively). There was no significant difference in Shannon and Simpson index between the two groups (The P values were 0.879 and 0.922, respectively). The results of ANOSIM showed differences in gut microbiota between the two groups (R>0), but the group contribution was not significant (unweighted Unifrac distance: R=0.006, P=0.223; weighted Unifrac distance: R=0.010, P=0.134). Among the obese group, the relative abundance of Prevotella and Sarcina was highest in the endemic genus. The STAMP results showed that the relative lots of 15 genera were significantly different between the two groups (P<0.05). The results of GLM showed that, compared with the control group, the obesity group had a lower level of the relative abundance in Akkermansia muciniphila, while a higher level in Coprococcus_3, Ruminococcus, Agathobacter and Collinsella. After stratification by sex, the Chao1 index was also lower in the obese boys than that in the normal-weight boys. However, the obese girls only had a higher level in Coprococcus_3 than the ordinary weight girls. Conclusions: Compared with children with average weight, obese children had lower α diversity of gut microbiota and lower relative abundance of dominant probiotics but had a higher relative lot of genus associated with metabolic disorders, inflammation promotion, and metabolism rate reduction.

Risk factors of simple obesity in preschool children in nine cities of China / 中华流行病学杂志

Objective: To examine risk factors of simple obesity and their interaction in preschool children in China. Methods: A total of 63 292 preschool children aged 3-7 years selected by cluster random sampling in 9 cities of China, including Beijing, Harbin, Xi'an, Shanghai, Nanjing, Wuhan, Guangzhou, Fuzhou and Kunming, were investigated from June to November in 2016. Based on the BMI-for-age cut off points of overweight and obesity for Chinese children aged 2-18 years, a total of 1 522 obese children (1 006 boys and 516 girls) were screened. By population-based matched case-control design, a normal weight child was randomly selected to match with an obese child by sex, age (difference ≤6 months) and body height (difference ≤5 cm) from the survey area. Conditional logistic regression model was used to analyze association of risk factors with obesity and the interaction of risk factors. Results: ① Univariate conditional logistic regression model showed that 17 risk factors of simple obesity had statistical significance (P<0.001), including high birth weight, cesarean section, gestational diabetes, gestational hypertension, formula feeding in the first 6 months after birth, strong appetite, fast or slow eating speed, low intensity of outdoor activities, daily outdoor activity time <1 hour, daily screen viewing time < 1 hour or ≥2 hours, daily night sleep time <9 hours, mother overweight, father overweight, mother's low educational level, father's low educational level, non-nuclear family structure, and parents not being the primary caregivers of children. ②Multivariate conditional logistic regression model showed that 12 risk factors had statistical significance, including high birth weight (OR=1.83, 95%CI:1.29-2.61, P<0.001), cesarean section (OR=1.22, 95%CI:1.07-1.39, P=0.003), gestational diabetes (OR=4.57, 95%CI:2.13-9.79, P<0.001), mother's low educational level (OR=1.52, 95%CI:1.11-2.07, P=0.008), single parent family (OR=4.79, 95%CI:1.44-15.88, P=0.010), mother overweight (OR=2.58, 95%CI:1.93-3.46, P<0.001), father overweight (OR=2.40, 95%CI:1.86-3.10, P<0.001), strong appetite (OR=7.78, 95%CI:5.38-11.27, P<0.001), fast eating speed (OR=6.59, 95%CI:4.86-8.94, P<0.001), daily outdoor activity time <1 hour (OR=1.42, 95%CI: 1.09-1.85, P=0.009), daily night sleep time <9 hours (OR=1.59, 95%CI: 1.13-2.23, P=0.007), daily screen viewing time ≥2 hours (OR=1.69, 95%CI:1.27-2.24, P<0.001). ③ Interaction of the four groups of risk factors had statistical significance, including interaction between mother overweight and father overweight (OR=5.53, 95%CI: 3.76-8.13, P<0.001), interaction between strong appetite and fast eating speed (OR=54.48, 95%CI: 32.95-90.06, P<0.001), interaction between low intensity of outdoor activity and daily outdoor activity time <1 hour (OR=2.12, 95%CI: 1.29-3.48, P=0.002), interaction between daily night sleep time <9 hours and daily screen viewing time ≥2 hours (OR=2.83, 95%CI: 1.71-4.68, P<0.001). Conclusions: This study identified 12 risk factors of childhood obesity, including high birth weight, cesarean section, gestational diabetes, mother's low educational level, single parent family, mother overweight, father overweight, strong appetite, fast eating speed, daily short outdoor activity time, daily short night sleep time, daily long screen viewing time, and interaction of the four groups of risk factors had statistical significance, including strong interaction between mother overweight and father overweight, interaction between strong appetite and fast eating speed, interaction between low intensity of outdoor activity and daily short outdoor activity time, interaction between daily short night sleep time and daily long screen viewing time.