Maternal and Offspring Fatty Acid Desaturase Variants, Prenatal DHA Supplementation, and Dietary n-6:n-3 Fatty Acid Ratio in Relation to Cardiometabolic Health in Mexican Children.

BACKGROUND: Single-nucleotide polymorphisms (SNPs) in fatty acid desaturase (FADS) genes may modify dietary fatty acid requirements and influence cardiometabolic health (CMH). OBJECTIVES: We evaluated the role of selected variants in maternal and offspring FADS genes on offspring CMH at the age of 11 y and assessed interactions of genotype with diet quality and prenatal docosahexaenoic acid (DHA) supplementation. METHODS: We used data from offspring (n = 203) born to females who participated in a randomized controlled trial of DHA supplementation (400 mg/d) from midgestation to delivery. We generated a metabolic syndrome (MetS) score from body mass index, high-density lipoprotein cholesterol, triglycerides, systolic blood pressure, and fasting glucose and identified 6 distinct haplotypes from 5 offspring FADS SNPs. Dietary n-6 (ω-6):n-3 fatty acid ratios were derived from 24-h recall data (n = 141). We used generalized linear models to test associations of offspring diet and FADS haplotypes with MetS score and interactions of maternal and offspring FADS SNP rs174602 with prenatal treatment group and dietary n-6:n-3 ratio on MetS score. RESULTS: Associations between FADS haplotypes and MetS score were null. Offspring SNP rs174602 did not modify the association of prenatal DHA supplementation with MetS score. Among children with TT or TC genotype for SNP rs174602 (n = 88), those in the highest n-6:n-3 ratio tertile (>8.61) had higher MetS score relative to the lowest tertile [<6.67) (Δ= 0.36; 95% confidence interval (CI): 0.03, 0.69]. Among children with CC genotype (n = 53), those in the highest n-6:n-3 ratio tertile had a lower MetS score relative to the lowest tertile (Δ= -0.23; 95% CI: -0.61, 0.16). CONCLUSIONS: There was evidence of an interaction of offspring FADS SNP rs174602 with current dietary polyunsaturated fatty acid intake, but not with prenatal DHA supplementation, on MetS score. Further studies may help to determine the utility of targeted supplementation strategies and dietary recommendations based on genetic profile.

Effects of prenatal docosahexaenoic acid supplementation on offspring cardiometabolic health at 11 years differs by maternal single nucleotide polymorphism rs174602: follow-up of a randomized controlled trial in Mexico.

BACKGROUND: There is limited evidence regarding long-term effects of prenatal docosahexaenoic acid (DHA) supplementation on offspring cardiometabolic health (CMH). Inconsistent results may be attributable to variants of fatty acid desaturase (FADS) genes. OBJECTIVE: We aimed to evaluate the effect of prenatal DHA supplementation on offspring CMH and investigate effect modification by maternal FADS2 single nucleotide polymorphism (SNP) rs174602. METHODS: We used follow-up data from a double-blind, randomized controlled trial in Mexico in which pregnant females received 400 mg/d of algal DHA or placebo from midgestation until delivery. The study sample included 314 offspring with data at age 11 y and maternal FADS genetic data (DHA: n = 160; Placebo: n = 154). We derived a Metabolic Syndrome (MetS) score from body mass index, HDL, triglycerides, fasting glucose concentrations, and systolic blood pressure. Generalized linear models were used to evaluate the effect of the intervention on offspring MetS score and test interactions between treatment group and genotype, adjusting for maternal, offspring, and household factors. RESULTS: Offspring MetS score did not differ significantly by treatment group. We observed evidence of effect modification by maternal SNP rs174602 (P = 0.001); offspring of maternal TT genotype who received DHA had lower MetS score relative to the placebo group (DHA (mean ± standard error of the mean (SEM)): -0.21 ± 0.11, n = 21; Placebo: 0.05 ± 0.11, n = 23; Δ= -0.26 (95% CI: -0.55, 0.04), P = 0.09); among CC maternal genotype carriers, offspring of mothers who received DHA had higher MetS score (0.18 ± 0.06, n = 62) relative to the placebo group (-0.05 ± 0.06, n = 65, Δ=0.24 (0.06, 0.41), P < 0.01). CONCLUSION: The effect of prenatal DHA supplementation on offspring MetS score differed by maternal FADS SNP rs174602. These findings further support incorporating genetic analysis of FADS polymorphisms in DHA supplementation trials. CLINICAL TRIAL DETAILS: This trial was registered at clinicaltrials.gov as NCT00646360.

Ovarian activity and reproductive responses of lactating Angus cows due to a mineral supplementation throughout a timed AI protocol.

Two experiments were conducted to evaluate the effect of intramuscular administration of minerals during a TAI program on the reproductive responses of lactating Angus cows. All cows (n=353) were subjected to a 9-day TAI program based on CIDR insertion plus injections of estradiol, cloprostenol, and eCG, and then TAI 48 h later. In experiment 1, two groups were randomly created, one control with a placebo injection (CON, n=109), and the second received 10 mL of Fosfosan® (MIN, n=172) on day 0 of the synchronization. Conception rate (66.9 vs. 55%) and estrus percentage (55.8 vs. 44%) were higher (P≤0.05) in MIN than in CON cows. Given these results, a second experiment was conducted randomly assigning the cows to two treatments (n=36 each): a single injection of 10 mL of Fosfosan® (MIN-O) on day 0 or two injections of 10 mL of Fosfosan® (MIN-T) on synchronization days 0 and 7. Four cows of each treatment were randomly selected to be scanned with transrectal ultrasound before and during the synchronization protocol to assess ovarian structures and cyclicity, and at day 39 post-TAI for pregnancy diagnosis. Also, blood samples were obtained for the determination of serum minerals and progesterone (P4) concentrations. The number of mineral injections did not affect conception rate (P≥0.1229) conception rate, serum mineral and P4 concentrations, number, and size of emerging follicles, or follicle size according to 1 to 4 classifications. The MIN-T promoted (P<0.05) earlier follicular wave emergence than MIN-O. However, MIN-O cows had a dominant follicle of 15.12 mm, which is more significant (P<0.05) than that in MIN-T cows (13.5 mm). In conclusion, providing a single mineral injection of Fosfosan® at the start of a TAI program is an excellent reproductive strategy in lactating Angus cows to improve the dominant follicle growth, estrus response, and conception rate.

Enteral Multiple Micronutrient Supplementation in Preterm and Low Birth Weight Infants: A Systematic Review and Meta-analysis.

OBJECTIVES: To assess effects of supplementation with 3 or more micronutrients (multiple micronutrients; MMN) compared to no MMN in human milk-fed preterm and low birth weight (LBW) infants. RESULTS: Data on a subgroup of 414 preterm or LBW infants from 2 randomized controlled trials (4 reports) were included. The certainty of evidence ranged from low to very low. For growth outcomes in the MMN compared to the non-MMN group, there was a small increase in weight-for-age (2 trials, 383 participants) and height-for-age z-scores (2 trials, 372 participants); a small decrease in wasting (2 trials, 398 participants); small increases in stunting (2 trials, 399 participants); and an increase in underweight (2 trials, 396 participants). For neurodevelopment outcomes at 78 weeks, we found small increases in Bayley Scales of Infant Development, Version III (BISD-III), scores (cognition, receptive language, expressive language, fine motor, gross motor) in the MMN compared to the non-MMN group (1 trial, 27 participants). There were no studies examining dose or timing of supplementation. CONCLUSIONS: Evidence is insufficient to determine whether enteral MMN supplementation to preterm or LBW infants who are fed mother's own milk is associated with benefit or harm. More trials are needed to generate evidence on mortality, morbidity, growth, and neurodevelopment.

Consumption of Micronutrient Powder, Syrup or Fortified Food Significantly Improves Zinc and Iron Status in Young Mexican Children: A Cluster Randomized Trial.

The objective of this study was to compare the effect of three micronutrient products on biomarkers of iron and zinc status of Mexican children 6−12 months of age. As part of research to improve the impact of a national program, 54 communities were randomly assigned to receive: (1) fortified food (FF), provided by the program at the time, or (2) micronutrient powders (MNP) or (3) syrup. Each product contained 10 mg each of zinc and iron, plus other micronutrients. Children consumed the product 6 days/week for four months. Primary outcomes were changes in serum zinc, ferritin, soluble transferrin receptor, hemoglobin concentrations, and their deficiencies. Zinc concentration increased significantly from baseline to follow-up in all groups, with the largest change in the syrup group (geometric mean difference: +4.4 µmol/L; 95%CI: 3.2, 5.5), followed by MNP (+2.9 µmol/L; 95%CI: 2.1, 3.6) and FF (+0.9 µmol/L; 95%CI: 0.3, 1.6). There was a significant increase in hemoglobin concentration (+5.5 g/L; 2.5, 8.4) and a significant reduction in anemia prevalence (44.2% to 26.8%, p < 0.01) only in the MNP group. Compliance differed significantly among groups (MNP vs. FF, p = 0.04; MNP vs. syrup, p = 0.04), but may not fully explain the greater improvement in zinc and iron status in the syrup and MNP groups. The food matrix may influence nutrient utilization from supplements.

Tiempo de cuidado familiar en la carga de trabajo doméstico y sus efectos en la salud del niño / Family Care Time within Domestic Workloads and its Effects on Child Health

Introducción: El bienestar de los niños depende de un cuidado integral. Es la madre junto a la familia quienes desempeñan un rol importante en el cuidado integral de sus hijos, por lo que el tiempo que le dedican es fundamental. Objetivo: Identificar los efectos del tiempo de cuidado familiar en la carga de trabajo doméstico sobre la salud del niño. Métodos: Estudio cuantitativo, observacional, transversal con diseño ex post facto, realizado en Acomayo, Distrito Chinchao, Provincia Huánuco, Perú, durante enero-diciembre del 2019. Población de 180 madres, muestra de 54 sujetos seleccionados con muestreo aleatorio simple. Se aplicaron: cuestionario de características generales de la madre, ficha de evaluación del estado nutricional del niño, ficha de tamizaje de hemoglobina y ficha de análisis documental de los episodios de enfermedades de los niños, validados y fiabilizados. Se utilizaron frecuencias absolutas y porcentajes, las hipótesis se comprobaron mediante la prueba chi cuadrado para p 0,05. Resultados: Del total de la muestra, 55,55 por ciento disponía de tiempo insuficiente para el cuidado familiar, 42,59 por ciento tenía un tiempo ajustado. Hubo desnutrición aguda en 48,14 por ciento y anemia leve en 46,29 por ciento. Se identificó presencia de al menos un episodio de enfermedad diarreica aguda en 37,03 por ciento, infección respiratoria aguda en 38,88 por ciento y parasitosis en 35,18 por ciento. Conclusiones: El tiempo insuficiente para el cuidado familiar en las cargas de trabajo doméstico tiene efectos desfavorables en la salud infantil, evidenciado con la presencia de desnutrición aguda, anemia, enfermedades diarreicas agudas, infecciones respiratorias agudas. y parasitosis en los niños estudiados (p ≤ 0,05)(AU)

Introduction: The well-being of children depends on comprehensive care. It is the mother, together with the family, who plays an important role in the comprehensive care of their children; therefore, the time they dedicate to such task is essential. Objective: To identify the effects of family care time within domestic workloads on child health. Methods: Quantitative, observational and cross-sectional study, with ex post facto design, carried out, from January to December 2019, in Acomayo, Chinchao District, Huánuco Province, Peru. The population was 180 mothers, while the sample was 54 subjects chosen with simple random sampling. The following instruments, validated and made reliable, were applied: a questionnaire on the mother's general characteristics, an assessing card for the child's nutritional status, a hemoglobin screening card, document analysis card for the children's illness episodes. Absolute frequencies and percentages were used < the hypotheses were verified using the chi-square test for P ≤ 0.05. Results: Of the whole sample, 55.55 percent had insufficient time for family care, while 42.59 percent had an adjusted time. There was acute malnutrition in 48.14 percent and mild anemia in 46.29 percent. The presence of at least one episode of acute diarrheal disease was identified in 37.03 percent; for acute respiratory infection, in 38.88 percent; and for parasitosis, in 35.18 percent. Conclusions: Insufficient family care time within the domestic workloads has unfavorable effects on child health, evidenced by the presence of acute malnutrition, anemia, acute diarrheal diseases, acute respiratory infections and parasitosis in the children studied (P ≤ 0.05)(AU)

Progesterone supplementation in Holstein heifers subjected to cooling and timed AI during summer: physiological and reproductive variables and thyroid hormone concentrations.

Our aim was to evaluate the effects of progesterone supplementation after fixed-time artificial insemination (FTAI) on physiological and reproductive variables and serum thyroid hormone concentrations of cooled Holstein heifers during a hot summer season. Sixty-nine Holstein heifers were randomly assigned to three treatments: (1) heifers under visual estrus detection and inseminated according to AM-PM rule (n = 23; control (C)), (2) heifers subjected to FTAI after estrus synchronization using a CIDR insert (n = 24; FTAI group), and (3) heifers treated as the FTAI group plus progesterone supplementation between the day 4 and 14 post-insemination with a reused CIDR device (n = 22; FTAI+SP4 group). All heifers were cooled daily with misting and fans. Physiological variables were measured; likewise, blood samples were collected to determine serum progesterone, thyroxine, and triiodothyronine concentrations. Both respiration rate and rectal temperature were similar among treatments. Conception rate was greater (P < 0.05) in C (65.2%) and FTAI+SP4 (59.1%) heifers than in FTAI heifers (33.3%). Serum triiodothyronine and progesterone concentrations of FTAI+SP4 heifers were similar to those of C heifers but greater (P < 0.05) than those of FTAI heifers. In conclusion, progesterone supplementation post-insemination increased conception rate and serum progesterone concentrations without affecting thermoregulation capacity in Holstein heifers subjected to FTAI and cooling during a hot summer season.

Predicting obesity reduction after implementing warning labels in Mexico: A modeling study.

BACKGROUND: In October 2019, Mexico approved a law to establish that nonalcoholic beverages and packaged foods that exceed a threshold for added calories, sugars, fats, trans fat, or sodium should have an "excess of" warning label. We aimed to estimate the expected reduction in the obesity prevalence and obesity costs in Mexico by introducing warning labels, over 5 years, among adults under 60 years of age. METHODS AND FINDINGS: Baseline intakes of beverages and snacks were obtained from the 2016 Mexican National Health and Nutrition Survey. The expected impact of labels on caloric intake was obtained from an experimental study, with a 10.5% caloric reduction for beverages and 3.0% caloric reduction for snacks. The caloric reduction was introduced into a dynamic model to estimate weight change. The model output was then used to estimate the expected changes in the prevalence of obesity and overweight. To predict obesity costs, we used the Health Ministry report of the impact of overweight and obesity in Mexico 1999-2023. We estimated a mean caloric reduction of 36.8 kcal/day/person (23.2 kcal/day from beverages and 13.6 kcal/day from snacks). Five years after implementation, this caloric reduction could reduce 1.68 kg and 4.98 percentage points (pp) in obesity (14.7%, with respect to baseline), which translates into a reduction of 1.3 million cases of obesity and a reduction of US$1.8 billion in direct and indirect costs. Our estimate is based on experimental evidence derived from warning labels as proposed in Canada, which include a single label and less restrictive limits to sugar, sodium, and saturated fats. Our estimates depend on various assumptions, such as the transportability of effect estimates from the experimental study to the Mexican population and that other factors that could influence weight and food and beverage consumption remain unchanged. Our results will need to be corroborated by future observational studies through the analysis of changes in sales, consumption, and body weight. CONCLUSIONS: In this study, we estimated that warning labels may effectively reduce obesity and obesity-related costs. Mexico is following Chile, Peru, and Uruguay in implementing warning labels to processed foods, but other countries could benefit from this intervention.

Behavior of Calcium, Phosphorus, and Parathormone Before Transplantation and in Months 1, 3, 6, 9, and 12 After Transplantation.

BACKGROUND: Bone mineral disease after transplantation persists and is an issue that must be addressed owing to the cardiovascular impact it presents. The objective of this study is to present the behavior of calcium, phosphorus, and parathormone (PTH) before renal transplantation (RT) and throughout the 12 months after transplant surgery. METHODS: A longitudinal observational study of RT patients was performed from 2013 to 2017 in 2 renal transplant units in Mexico. In total, 1009 records of patients with RT were analyzed. Calcium, phosphorus, and PTH levels were studied before transplantation and for 12 months after. Central tendency and dispersion were measured, the difference of means was established with chi square or student t tests, and the significant value of P was set at <.05. We also used the SPSS statistical package, version 25. RESULTS: Phosphorus had a median pre-RT of 5.73, which decreased to 2.8 in the first month post-transplant and then increased to 3.41 at 12 months post-RT. The median PTH, on the other hand, started at 420.60 and decreased to 67.45. Calcium began at 9.04 and hit a plateau of 9.58 during month 12 after the surgical event. CONCLUSIONS: Of the 3 biochemical parameters evaluated, phosphorus was the one that most corrected itself after transplantation. Despite a tendency toward hypophosphatemia in the first month after transplantation, it began to normalize from month 6 on. Meanwhile, calcium was the biochemical value that changed the least after transplantation.

Vitamin D and other environmental risk factors in Colombian patients with multiple sclerosis.

OBJECTIVE: The aim of this study was to explore the association between MS and vitamin D levels, as well as Epstein-Barr virus (EBV) seropositivity and smoking history in a Colombian population. METHODS: We conducted a cross-sectional study between 2017 and 2018. We measured vitamin D levels and EBV antibody titers and administered a questionnaire to assess dietary habits, smoking, second-hand smoking and duration of smoking, sunlight exposure, physical activity, and personal and family history in individuals with and without multiple sclerosis during adolescence. A multivariable logistic regression model was then performed to explore the association between vitamin D status and MS. RESULTS: A total of 87 individuals with MS (mean age 40.9 years; 65.52% females) and 87 without MS (mean age 55 years; 65.52% females) were included in the analysis. In the multivariable analysis, after controlling for supplementation vitamin D levels did not differ between both groups and no difference was found regarding tobacco smoke exposure. The proportion of individuals who tested positive for anti-EBV nuclear antigen was significantly higher in individuals with MS (95.4% vs 82.76%, p = 0.028) CONCLUSION: : We did not find a statistically significant association between MS and vitamin D levels while anti-EBV nuclear antigen titers behaved as previously described in the literature. This study provides new evidence of the association between MS and different risk factors in our country, reinforcing the hypothesis that the pathogenesis of MS is multifactorial. Further studies are needed to better define the association between environmental factors and the development of MS in low prevalence areas.

Análisis factorial confirmatorio de la escala de espiritualidad personal en adultos puertorriqueños / Confirmatory Factorial Analysis of the Personal Spirituality Scale in Puerto Ricans Adults

La espiritualidad se define como la capacidad multidimensional de búsqueda de sentido y conexión en las relaciones con uno mismo, con las demás personas, con la naturaleza o lo sagrado. El objetivo de este estudio fue examinar la fiabilidad y la estructura factorial de la versión revisada de la Escala de Espiritualidad Personal (EEP-R) en adultos puertorriqueños. Un total de 577 puertorriqueños participaron en este estudio de carácter confirmatorio y psicométrico. Los resultados confirmaron que la escala posee una estructura multidimensional. Estas dimensiones son Conexión Intrapersonal, Conexión Interpersonal y Conexión Transpersonal. Los doce ítems de la escala cumplieron con los criterios de discriminación y los índices de confiabilidad obtenidos para la escala fluctuaron entre .81 y .95. En síntesis, la EEP-R cuenta con las propiedades psicométricas adecuadas para seguir con estudios de validación, así como para implementarla en diversas líneas de trabajo, tanto teóricas como aplicadas.

Spirituality is defined as the multidimensional capacity of search for meaning and connection in relationships with oneself, other people, nature or the sacred. The aim of this study was to analyze the reliability and factor structure of Personal Spirituality Scale (PSS-R) in a sample of Puerto Ricans adults. A total of 577 Puerto Ricans participated in this psychometric study. The results confirmed that the PSS has a multidimensional structure. These dimensions were Intrapersonal Spirituality, Interpersonal Spirituality and Transpersonal Spirituality. The twelve items complied with the criteria of discrimination. The reliability index obtained fluctuated between .81 to .95. The PSS-R has appropriate psychometric properties useful for validation studies. It can be used in different lines of research, theoretical as well as applied.

Yogurt consumption during pregnancy and preterm delivery in Mexican women: A prospective analysis of interaction with maternal overweight status.

Preterm delivery is an important cause of perinatal morbidity and mortality, often precipitated by maternal infection or inflammation. Probiotic-containing foods, such as yogurt, may reduce systemic inflammatory responses. We sought to evaluate whether yogurt consumption during pregnancy is associated with decreased preterm delivery. We studied 965 women enrolled at midpregnancy into a clinical trial of prenatal docosahexaenoic acid supplementation in Mexico. Yogurt consumption during the previous 3 months was categorized as ≥5, 2-4, or <2 cups per week. Preterm delivery was defined as delivery of a live infant before 37 weeks gestation. We used logistic regression to evaluate the association between prenatal yogurt consumption and preterm delivery and examined interaction with maternal overweight status. In this population, 25.4%, 34.2%, and 40.4% of women reported consuming ≥5, 2-4, and <2 cups of yogurt per week, respectively. The prevalence of preterm delivery was 8.9%. Differences in preterm delivery were non-significant across maternal yogurt consumption groups; compared with women reporting <2 cups of yogurt per week, those reporting 2-4 cups of yogurt per week had adjusted odds ratio (aOR) for preterm delivery of 0.81 (95% confidence interval, CI [.46, 1.41]), and those reporting ≥5 cups of yogurt per week had aOR of 0.94 (95% CI [.51, 1.72]). The association between maternal yogurt consumption and preterm delivery differed significantly for nonoverweight women compared with overweight women (p for interaction = .01). Compared with nonoverweight women who consumed <2 cups of yogurt per week, nonoverweight women who consumed ≥5 cups of yogurt per week had aOR for preterm delivery of 0.24 (95% CI [.07, .89]). Among overweight women, there was no significant association. In this population, there was no overall association between prenatal yogurt consumption and preterm delivery. However, there was significant interaction with maternal overweight status; among nonoverweight women, higher prenatal yogurt consumption was associated with reduced preterm delivery.

Modifiers of the effect of maternal multiple micronutrient supplementation on stillbirth, birth outcomes, and infant mortality: a meta-analysis of individual patient data from 17 randomised trials in low-income and middle-income countries.

BACKGROUND: Micronutrient deficiencies are common among women in low-income and middle-income countries. Data from randomised trials suggest that maternal multiple micronutrient supplementation decreases the risk of low birthweight and potentially improves other infant health outcomes. However, heterogeneity across studies suggests influence from effect modifiers. We aimed to identify individual-level modifiers of the effect of multiple micronutrient supplements on stillbirth, birth outcomes, and infant mortality in low-income and middle-income countries. METHODS: This two-stage meta-analysis of individual patient included data from 17 randomised controlled trials done in 14 low-income and middle-income countries, which compared multiple micronutrient supplements containing iron-folic acid versus iron-folic acid alone in 112 953 pregnant women. We generated study-specific estimates and pooled subgroup estimates using fixed-effects models and assessed heterogeneity between subgroups with the χ2 test for heterogeneity. We did sensitivity analyses using random-effects models, stratifying by iron-folic acid dose, and exploring individual study effect. FINDINGS: Multiple micronutrient supplements containing iron-folic acid provided significantly greater reductions in neonatal mortality for female neonates compared with male neonates than did iron-folic acid supplementation alone (RR 0·85, 95% CI 0·75-0·96 vs 1·06, 0·95-1·17; p value for interaction 0·007). Multiple micronutrient supplements resulted in greater reductions in low birthweight (RR 0·81, 95% CI 0·74-0·89; p value for interaction 0·049), small-for-gestational-age births (0·92, 0·87-0·97; p=0·03), and 6-month mortality (0·71, 0·60-0·86; p=0·04) in anaemic pregnant women (haemoglobin <110g/L) as compared with non-anaemic pregnant women. Multiple micronutrient supplements also had a greater effect on preterm births among underweight pregnant women (BMI <18·5 kg/m2; RR 0·84, 95% CI 0·78-0·91; p=0·01). Initiation of multiple micronutrient supplements before 20 weeks gestation provided greater reductions in preterm birth (RR 0·89, 95% CI 0·85-0·93; p=0·03). Generally, the survival and birth outcome effects of multiple micronutrient supplementation were greater with high adherence (≥95%) to supplementation. Multiple micronutrient supplements did not significantly increase the risk of stillbirth or neonatal, 6-month, or infant mortality, neither overall or in any of the 26 examined subgroups. INTERPRETATION: Antenatal multiple micronutrient supplements improved survival for female neonates and provided greater birth-outcome benefits for infants born to undernourished and anaemic pregnant women. Early initiation in pregnancy and high adherence to multiple micronutrient supplements also provided greater overall benefits. Studies should now aim to elucidate the mechanisms accounting for differences in the effect of antenatal multiple micronutrient supplements on infant health by maternal nutrition status and sex. FUNDING: None.

Prenatal Docosahexaenoic Acid Supplementation Does Not Affect Nonfasting Serum Lipid and Glucose Concentrations of Offspring at 4 Years of Age in a Follow-Up of a Randomized Controlled Clinical Trial in Mexico.

BACKGROUND: Docosahexaenoic acid (DHA) has regulatory effects on lipid and glucose metabolism. Differences in DHA availability during specific developmental windows may program metabolic changes. OBJECTIVE: We investigated the effects of maternal DHA supplementation during pregnancy on the nonfasting serum lipid and glucose concentrations of offspring at 4 y of age. METHODS: We used data from the Prenatal Omega-3 Fatty Acid Supplementation, Growth, and Development trial, a double-blind randomized controlled trial conducted in Mexico. Pregnant women were supplemented daily with 400 mg DHA or placebo from 18-22 wk of gestation to delivery. The primary outcomes of the trial were offspring growth and neurological development. Nonfasting blood samples were obtained from the offspring at 4 y of age. We analyzed serum total, HDL, non-HDL, and LDL cholesterol; the total-to-HDL cholesterol ratio; apolipoprotein B (apoB); triglycerides; glucose; and insulin as secondary outcomes and compared their concentrations between treatment groups. RESULTS: Data from 524 offspring were available. The women were compliant with the intervention based on pill counts and changes in cord blood and breast milk DHA concentrations. None of the between-group differences (DHA compared with placebo), adjusted for maternal height and time since last food intake, were significant (P range 0.27-0.83). Means (95% CIs) were as follows: total cholesterol (TC), 1.73 mg/dL (-2.63, 6.09 mg/dL); HDL cholesterol, 0.66 mg/dL (-1.07, 2.39 mg/dL); non-HDL cholesterol, 1.77 mg/dL (-1.83, 5.37 mg/dL); LDL cholesterol, 1.62 mg/dL (-2.21, 5.45 mg/dL); TC:HDL ratio, 0.01 (-0.09, 0.11); apoB, -0.15 mg/dL (-2.78, 2.48 mg/dL); triglycerides, 0.21 mg/dL (-10.93, 10.52 mg/dL); glucose, -0.67 mg/dL (-2.46, 1.11 mg/dL); and insulin, 0.62 µU/mL (-0.88, 2.11 µU/mL). CONCLUSION: Prenatal DHA supplementation does not affect nonfasting serum lipid and glucose concentrations of offspring at 4 y of age. This trial was registered at clinicaltrials.gov as NCT00646360.

Prenatal supplementation with DHA improves attention at 5 y of age: a randomized controlled trial.

BACKGROUND: Docosahexanoic acid (DHA) is an important constituent of the brain. Evidence from well-designed intervention trials of the long-term benefits of increasing DHA intake during pregnancy has been sparse. OBJECTIVE: We evaluated global cognition, behavior, and attention at age 5 y in the offspring of Mexican women who participated in a randomized controlled trial of prenatal DHA supplementation. DESIGN: A total of 1094 women were randomly assigned to receive 400 mg of either DHA or placebo/d from 18 to 22 wk of pregnancy until delivery. We assessed cognitive development and behavioral and executive functioning, including attention, in 797 offspring at age 5 y (82% of 973 live births) with the use of the McCarthy Scales of Children's Abilities (MSCA), the parental scale of the Behavioral Assessment System for Children, Second Edition (BASC-2), and the Conners' Kiddie Continuous Performance Test (K-CPT). We compared the groups on raw scores, T-scores, and standardized scores, as appropriate. We examined heterogeneity by the quality of the home environment, maternal intelligence, and socioeconomic status. RESULTS: There were no group differences for MSCA scores (P > 0.05), but the positive effect of the home environment at 12 mo on general cognitive abilities was attenuated in the DHA group compared with in the placebo group (P-interaction < 0.05). There were no differences between groups on the BASC-2. On the K-CPT, offspring in the DHA group showed improved mean ± SD T-scores compared with those of the placebo group for omissions (DHA: 47.6 ± 10.3; placebo: 49.6 ± 11.2; P < 0.01) with no differences (P > 0.05) for the other K-CPT scores or of the proportion who were clinically at risk of attention deficit hyperactivity disorders after Bonferroni correction for multiple comparisons. CONCLUSION: Prenatal exposure to DHA may contribute to improved sustained attention in preschool children. This trial was registered at clinicaltrials.gov as NCT00646360.

Mexican Children under 2 Years of Age Consume Food Groups High in Energy and Low in Micronutrients.

BACKGROUND: Mexico faces malnutrition problems in the child population. Analysis of food consumption in small children allows us to identify and propose strategies focused on feeding to improve their nutritional status. OBJECTIVE: We described the consumption of beverages and food groups in Mexican children <24 mo of age. METHODS: A cross-sectional study was carried out in 926 children aged <24 mo participating in the 2012 ENSANUT (National Health and Nutrition Study). Dietary information was obtained through 24-h recalls. The foods and beverages consumed were divided into 17 groups. Consumption was estimated in grams or milliliters, kilocalories per day, and percentage of energy (PE) per day. The percentage of consumers was calculated for each food group and stratified by age (<6, 6-11, and 12-23 mo) and by breastfeeding status (breastfed or not breastfed). Differences in the consumption of food groups were analyzed by breastfeeding status, area of residence (urban or rural), and socioeconomic status (SES) by using linear regression adjusted for age, breastfeeding status, and survey design. RESULTS: Only 35% of the children consumed breast milk. Infant formula was consumed by 48% in children aged <6 mo and by 33% in children 6-11 mo old. More than 35% of the children aged 6-11 and 12-23 mo and 12% of children <6 mo old consumed nondairy sugar-sweetened beverages. Legumes and seeds and maize-based preparations contributed a higher PE in rural areas (3.4% and 1.9%, respectively) than in urban areas (11.1% and 6.4%, respectively) (P < 0.05). Children from the lowest SES category consumed less PE from cereals other than maize (2.4%) and more from maize-based preparations (10.2%) than did the middle (4.9% from other cereals and 8.0% from maize) and high (6.0% from other cereals and 4.5% from maize) SES categories (P < 0.05). CONCLUSION: Mexican children <24 mo of age do not consume a diet that meets recommendations, which is consistent with the high prevalence of malnutrition in Mexico.

Overview of the Dietary Intakes of the Mexican Population: Results from the National Health and Nutrition Survey 2012.

BACKGROUND: Mexico is facing the double burden of malnutrition: stunting and micronutrient deficiencies in young children, iron deficiency in pregnant women, and widespread obesity across age groups. OBJECTIVE: The aim was to summarize and discuss findings published in this supplement on dietary intakes and the eating habits of the Mexican population. METHODS: A 24-h recall questionnaire that used the multiple-pass method with a repeated measure in a fraction of the sample was applied in a nationally representative sample. We estimated mean intakes and percentages of inadequacy for macronutrients and micronutrients; mean intakes and percentages of the population who adhere to dietary recommendations for food groups; sources of added sugars; intakes of discretionary foods by mealtime, place, and activity; and mean dietary intakes in children <2 y old. RESULTS: Infant formula was consumed by almost half of infants aged <6 mo and sugar-sweetened beverages were consumed by two-thirds of children aged 12-23 mo. In the different age groups, a high proportion of the population had excessive intakes of added sugars (58-85%) and saturated fats (54-92%), whereas a high prevalence of insufficient intakes was found for fiber (65-87%), vitamin A (8-70%), folates (13-69%), calcium (26-88%), and iron (46-89%). Discretionary foods (nonbasic foods high in saturated fats and/or added sugars) contributed 26% of the population's total energy intake, whereas only 1-23% met recommendations for legumes, seafood, fruit, vegetables, and dairy foods. CONCLUSIONS: High proportions of Mexicans consume diets that do not meet recommendations. Breastfeeding and complementary feeding diverged from recommendations, intakes of discretionary foods were high, and the prevalence of nutrient inadequacies and age groups not meeting intake recommendations of basic food groups were also high. The results are consistent with the high prevalence of the double burden of malnutrition and are useful to design food and nutrition policies.

A Food Transfer Program without a Formal Education Component Modifies Complementary Feeding Practices in Poor Rural Mexican Communities.

BACKGROUND: Inadequate complementary feeding partially explains micronutrient deficiencies in the first 2 y of life. To prevent malnutrition, the Mexican government implemented the Programa de Apoyo Alimentario (PAL), which transferred either food baskets containing micronutrient-fortified milk and animal food products or cash to beneficiary families along with educational sessions. OBJECTIVE: This study evaluated the impact of PAL on 2 indicators of complementary feeding: minimum dietary diversity and consumption of iron-rich or iron-fortified foods in children aged 6-23 mo. METHODS: A secondary analysis of the original PAL evaluation design was conducted through a randomized community trial implemented with 3 intervention groups (food basket with education, food basket without education, and cash transfer with education) and a control. The impact of PAL after 14 mo of exposure was estimated in 2 cross-sectional groups of children aged 6-23 mo at baseline and at follow-up in a panel of 145 communities by using difference-in-difference models. Only children who lived in households and communities that were similar between treatment groups at baseline were included in the analysis. These children were identified by using a propensity score. RESULTS: Of the 3 intervention groups, when compared with the control, only the food basket without education group component increased the consumption of iron-rich or iron-fortified foods by 31.2 percentage points (PP) (P < 0.01) and the prevalence of minimum dietary diversity by 21.6 PP (P < 0.01). CONCLUSION: These findings suggest that in order to improve dietary quality in children, food baskets that include fortified complementary foods may be more effective than cash transfers. The fact that the 2 food basket groups differed in the observed impact does not allow for more convincing conclusions to be made about the education component of the program. This trial was registered at clinicaltrials.gov as NCT01304888.

Prenatal Docosahexaenoic Acid Supplementation and Offspring Development at 18 Months: Randomized Controlled Trial.

OBJECTIVE: We evaluated the effects of prenatal docosahexaenoic acid (DHA) supplementation on offspring development at 18 months of age. DESIGN: Randomized placebo double-blind controlled trial. SETTINGS: Cuernavaca, Mexico. PARTICIPANTS AND METHODS: We followed up offspring (n = 730; 75% of the birth cohort) of women in Mexico who participated in a trial of DHA supplementation during the latter half of pregnancy. We assessed the effect of the intervention on child development and the potential modifying effects of gravidity, gender, SES, and quality of the home environment. INTERVENTIONS OR MAIN EXPOSURES: 400 mg/day of algal DHA. OUTCOME MEASURES: Child development at 18 months of age measured using the Spanish version of the Bayley Scales of Infant Development-II. We calculated standardized psychomotor and mental development indices, and behavior rating scale scores. RESULTS: Intent-to-treat differences (DHA-control) were: Psychomotor Developmental Index -0.90 (95% CI: -2.35, 0.56), Mental Developmental Index -0.26 (95% CI: -1.63, 1.10) and Behavior Rating Scale -0.01 (95% CI: -0.95, 0.94). Prenatal DHA intake attenuated the positive association between home environment and psychomotor development index observed in the control group (p for interaction = 0.03) suggesting potential benefits for children living in home environments characterized by reduced caregiver interactions and opportunities for early childhood stimulation. CONCLUSIONS: Prenatal DHA supplementation in a population with low intakes of DHA had no effects on offspring development at 18 months of age although there may be some benefit for infants from poor quality home environments. TRIAL REGISTRATION: Clinicaltrials.gov NCT00646360.

Prenatal Supplementation with Docosahexaenoic Acid Has No Effect on Growth through 60 Months of Age.

BACKGROUND: Prenatal supplementation with docosahexaenoic acid (DHA) has been shown to increase birth size, but it is unclear whether these differences translate into improved postnatal growth. OBJECTIVE: We assessed the effect of prenatal supplementation with DHA on offspring weight, length, and body mass index (BMI) through 60 mo of age. METHODS: We examined growth patterns (height, weight, and BMI) in a cohort of 802 Mexican children whose mothers participated in a randomized, controlled trial of daily supplementation with 400 mg/d of DHA or a placebo from week 18-22 of gestation through delivery, with the use of a longitudinal multilevel model of growth. RESULTS: Overall, means ± SDs of height-, weight-, and BMI-for-age z scores relative to WHO growth standards at 60 mo were -0.49 ± 0.91, -1.15 ± 1.07 and 0.13 ± 1.11, respectively. There were no significant differences by treatment group (all P > 0.05) for height, weight, or BMI at any age through 60 mo. Similarly, DHA did not affect the average growth or the trajectories for these measures through 60 mo. CONCLUSION: Prenatal DHA supplementation did not affect height, weight, or BMI through 60 mo of age. This trial was registered at clinicaltrials.gov as NCT00646360.