The Intuitive Eating Scale-2 Adapted for Mexican Pregnant Women: Psychometric Properties and Influence of Sociodemographic Variables.

A weight-inclusive approach to health involves the promotion of intuitive eating, i.e., the individual's ability to be aware of their physiological hunger and satiety cues to determine when and how much to eat, while paying attention to how certain foods affect their body. The second version of the Intuitive Eating Scale (IES-2) evaluates four interrelated traits of intuitive eating: Unconditional Permission to Eat (UPE), Eating for Physical rather than emotional Reasons (EPR), Reliance on internal Hunger/Satiety Cues (RHSC), and Body-Food Choice Congruence (BFCC). In this study, our aim was to evaluate the psychometric properties of a Mexican Spanish adaptation of the IES-2 for pregnant women and examine the relationship between intuitive eating traits and maternal sociodemographic characteristics. A sample of 514 pregnant women answered our IES-2 adaptation and a sociodemographic questionnaire. We determined the quality, validity, and reliability of our adaptation through descriptive measures, frequency distributions, intra-class correlations, and extreme answer group comparison for each item, eliminating those with weak technical properties. We then performed an exploratory principal component analysis and a confirmatory factor analysis. Last, we analyzed the association between intuitive eating and maternal sociodemographic and reproductive variables through correlation tests and multivariable linear regressions. Psychometric tests confirmed the validity and reliability of our IES-2 adaptation, which comprised 18 out of the 23 original items. Notably, both the exploratory and confirmatory factor analyses yielded not four but five factors, due to the EPR subscale splitting in two (the "emotional" and "physical" components of EPR). We attribute this novel finding to the emotional manifestations that naturally accompany pregnancy, which may incline pregnant women to base their eating behaviors more on the emotional than the physical component that would otherwise dominate their EPR trait. Further research is also needed about the UPE subscale during pregnancy, due to item removal and subtle changes in meaning. Finally, the influence of sociodemographic variables on the IES-2 score was extremely low, suggesting that other variables, possibly of a psychological nature, may have greater influence on a pregnant woman's intuitive eating.

A Mexican Spanish Adaptation of the Dutch Eating Behavior Questionnaire: Psychometric Properties and Influence of Sociodemographic Variables in Pregnant Women.

Eating behaviors are complex phenomena, entangling physiological signals of hunger and satiety, food choices, emotional states, and social factors and expectations, as well as food availability and sensory appearance. Evaluating eating behaviors is challenging and must cover different motives. One instrument for such evaluation is the Dutch Eating Behavior Questionnaire (DEBQ), composed of three subscales for exploring emotional eating, external eating, and restrained eating. In this article, we aimed to (1) evaluate the psychometric properties of a Mexican Spanish adaptation of the DEBQ; and (2) explore the associations between the three adapted DEBQ scales and the influence of sociodemographic factors on each of the three eating behaviors in Mexican pregnant women. A sample of 514 pregnant women responded to our adapted version of the DEBQ and a questionnaire about sociodemographic information. We performed an exploratory factor analysis using a principal component analysis with varimax rotation; based on this analysis, we removed items that loaded on two factors and then performed a confirmatory factor analysis. The final version of the adapted DEBQ has 26 items, clearly divided into a three-factor structure and satisfactorily reliable (Cronbach's ⍺ = 0.903). We then performed Spearman bivariate correlations and multivariate linear regression with backward variable selection to test the associations and influence of sociodemographic factors on each of the three eating behaviors evaluated with the DEBQ. In pregnant women, emotional eating (EmoE) had a medium-high correlation with external eating (ExtE) and a low correlation with restrained eating (RestE), while ExtE and RestE showed no association. The three eating behaviors are associated with maternal sociodemographic and reproductive variables, which partly explain their variation, most notably maternal schooling. Our adapted version of the DEBQ is suitable for use with Mexican Spanish-speaking pregnant women. Maternal sociodemographic and reproductive factors have an influence on the variance of eating behaviors during pregnancy.

Infant Feeding Practices That Substitute Exclusive Breastfeeding in a Semi-Rural Mexican Community: Types, Moments, and Associated Factors.

International organizations recommend mothers practice exclusive breastfeeding (EBF) during the first six months of their infant's life and introduce complementary feeding (CF) thereafter while continuing breastfeeding. However, the earlier introduction of liquids and foods is common worldwide and may have negative effects on breastfeeding practice, nutrition, and health. In this formative cross-sectional study, we interviewed 143 mothers from semi-rural communities in Tabasco, Mexico, whose infants were 4-6 months old. We explored (1) which feeding practices substituted EBF and (2) which factors were associated with each practice. During the first month of life, 42.7% of infants received formula milk (FM); this proportion increased to 74.5% by the sixth month. Adjusted Poisson regression analyses showed that giving FM was positively related to working away from home (PR 1.27; 95% CI 1.06, 1.54) and the perception that FM is an important food to accompany breast milk (PR 1.38; 95% CI 1.19, 1.70). Giving FM was negatively associated with not being sure the infant is full after breastfeeding (PR 0.75; 95% CI 0.61, 0.92). Regarding CF, less than half (47.5%) of infants had not received it by the fifth month. Factors positively associated with timely CF introduction were: the mother was told during prenatal care visits the optimal age to start CF is 6 months (PR 1.17, 95% CI 1.06, 1.29); she is convinced that giving only breast milk is best for her baby (PR 1.15, 95% CI 1.03, 1.29), and a higher infant weight-for-length (PR 1.04, 95% CI 1.00, 1.08) and length for age (PR 1.04, 95% CI 1.00, 1.09) z-scores at the study visit; conversely, it was negatively associated to the idea that if the infant is not full, she/he should receive formula milk or some other food (PR 0.87, 95% CI 0.78, 0.96). In these communities, EBF is lost to the use of FM and early CF. The factors associated with these inadequate feeding practices are related to returning to work, information received during prenatal visits, and the mother's beliefs and thoughts. This work will guide the design of an intervention on infant feeding practices for these communities and other similar ones.

Exclusive Breastfeeding and Factors Influencing Its Abandonment During the 1st Month Postpartum Among Women From Semi-rural Communities in Southeast Mexico.

INTRODUCTION: In this study we describe breastfeeding practices among women from semi-rural communities in southeast Mexico, and explore which factors, modifiable or not, are associated with such practices. MATERIALS AND METHODS: This was a formative cross-sectional study that included 143 mothers with infants 4-6 months old, from semi-rural communities in Tabasco, Mexico. We collected data on two categories of factors: (1) women's sociodemographic characteristics, and (2) maternal / infant factors. We first analyzed the frequency of various breastfeeding practices. Then, we classified participants into the up to 1 month of exclusive breastfeeding group ( ≤ 1 m-EBF) and the beyond 1 month EBF group (>1 m-EBF), if they practiced EBF for less or more than 1 month, respectively. We compared the two categories of factors between groups and then, using logistic regression models, explored which factors were associated with practicing >1 m-EBF. RESULTS: By the end of the 1st month postpartum, 51.7% of participants had abandoned EBF, introduced milk formula (35%), other food (9.1%), non-nutritive liquids (7.7%), or had stopped breastfeeding completely. In the next months, EBF practice fell sharply and mixed feeding grew importantly.Logistic regression models showed that women were more likely to be in the >1 m-EBF group if they lived with the baby's father, had complications during pregnancy, delivered vaginally and attended a health center at least three times postpartum. To the contrary, women were less likely to be practice >1 m-EBF if they gave infants other liquids during their hospital stay; experienced pain or discomfort in breasts/nipples, or used a pacifier after hospitalization; had larger bodies (i.e., higher BMI); and believed that you should give the infant powdered milk or some other food when the baby is not full. CONCLUSION: Many factors associated with abandoning EBF, particularly in the early postpartum period, are modifiable and can be altered through timely interventions that include giving correct information and ensuring its comprehension; assertive personal counseling and accompaniment must be provided to mothers; and reinforcement during the early postpartum at health facilities and other settings.

Association of Pregestational BMI and Gestational Weight Gain with Maternal and Neonatal Outcomes in Adolescents and Adults from Mexico City.

During pregnancy, adolescents experience physiological changes different from adults because they have not concluded their physical growth. Therefore, maternal and neonatal outcomes may not be the same. This paper aimed to analyze the association between pregestational BMI (pBMI) and gestational weight gain (GWG) with maternal and neonatal outcomes in adolescent and adult pregnant women. The authors performed an observational study that included 1112 women, where 52.6% (n = 585) were adolescents. Sociodemographic information, pBMI, GWG, neonatal anthropometric measures, and maternal and neonatal outcomes were obtained. Adolescent women had a mean lower (21.4 vs. 26.2, p ≤ 0.001) pBMI than adults and a higher gestational weight gain (12.3 vs. 10.7 kg, p ≤ 0.001). According to Poisson regression models, gestational diabetes is positively associated with insufficient GWG and with pregestational obesity. Furthermore, the probability of developing pregnancy-induced hypertension increased with pBMI of obesity compared to normal weight. Preeclampsia, anemia, and preterm birth were not associated with GWG. Insufficient GWG was a risk factor, and being overweight was a protective factor for low birth weight and small for gestational age. We conclude that pBMI, GWG, and age group were associated only with gestational diabetes and low birth weight.

Erythropoiesis and Red Cell Indices Undergo Adjustments during Pregnancy in Response to Maternal Body Size but not Inflammation.

During human pregnancy, iron requirements gradually increase, leading to higher amounts of erythropoietin (EPO) and reticulocytes, and changes in erythrocyte size and density. Women with pregestational obesity experience "obesity hypoferremia" during pregnancy, which alters iron homeostasis. In this study we aimed to describe the relationship between EPO and iron nutrition status during nonanemic pregnancy, and to explore whether obesity and inflammation influence erythropoiesis and red cell indices. We conducted a secondary analysis of a cohort followed throughout pregnancy. Participants were nonanemic women assigned to two study groups based on pregestational body mass index (pgBMI): adequate weight (AW, n = 53) or obesity (Ob, n = 40). All received a multivitamin supplement. At gestational ages (GA) 13, 21, 28 and 34, we measured hemoglobin and red cell indices with an ACT-5DIFF hematology counter, and reticulocyte percentage by manual cell counting. EPO, interleukin (IL-6) and markers of iron status, i.e., hepcidin, serum transferrin receptor (sTfr) and ferritin, were measured by ELISA. Bivariate correlations showed that EPO was positively associated with pgBMI, GA, sTfr and IL-6, but negatively associated with hepcidin, ferritin and hemoglobin, and unrelated to iron intake. Generalized linear models adjusted for confounding factors showed that EPO and erythrocyte concentrations were significantly higher in women in the Ob group, while mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and red cell distribution width (RDW) were lower; reticulocytes and mean corpuscular hemoglobin concentration (MCHC) were not different. Differences were not altered when controlling for inflammation (IL-6). These changes suggest that, in addition to altering iron metabolism, a larger maternal body size during pregnancy results in higher erythropoiesis without increasing hemoglobin, which is exhibited in the latter being distributed among more and smaller erythrocytes.

Obesity Is Associated with Changes in Iron Nutrition Status and Its Homeostatic Regulation in Pregnancy.

The influence of obesity on maternal iron homeostasis and nutrition status during pregnancy remains only partially clarified. Our study objectives were (1) to describe how obesity influences broad iron nutrition spectrum biomarkers such as available or circulating iron (serum transferrin receptor (sTfr) and serum iron), iron reserves (ferritin), and functional iron (hemoglobin); and (2) to depict the regulating role of hepcidin. The above was carried out while considering influential factors such as initial iron nutrition status, iron intake, and the presence of inflammation. Ninety three non-anemic pregnant adult women were included, 40 with obesity (Ob) and 53 with adequate weight (AW); all took ≈30 mg/day of supplementary iron. Information on iron intake and blood samples were obtained at gestational weeks 13, 20, 27, and 35. A series of repeated measure analyses were performed using General Linear Models to discern the effect of obesity on each iron indicator; iron intake, hepcidin, and C-reactive protein were successively introduced as covariates. Available and circulating iron was lower in obese women: sTfr was higher (p = 0.07) and serum iron was lower (p = 0.01); and ferritin and hemoglobin were not different between groups. Hepcidin was higher in the Ob group (p = 0.01) and was a significant predictor variable for all biomarkers. Obesity during pregnancy dysregulates iron homeostasis, resembling "obesity hypoferremia".

[Pregnancy and breastfeeding]. / Embarazo y lactancia.

During pregnancy and breastfeeding the demand for nutrients that promote the growth and development of the fetus, maternal tissues and breastmilk production is increased. Milk and dairy products provide energy, proteins, fatty acids, carbohydrates, calcium, phosphorus, vitamins D and B12, therefore their importance during pregnancy and breastfeeding. The energy through food supply allows the development and growth from the conception; protein promotes the rapid growth of the maternal and fetal tissues: fatty acids stimulate the development of the fetus central nervous system; carbohydrates are essential to support fetal brain growth; calcium is essential for the formation and mineralization of the fetus skeleton, while vitamin D promotes calcium absorption and the development of the nervous and immune systems. Multiple studies refer a positive association between the consumption of dairy products and birth weight. Regarding height, some papers show an increase in the femur length and in the total height (head-ankle) with regard to the intake of dairy products. Few studies report an association between a specific dairy product and the presence of allergic diseases. Therefore, more research is mandatory.

[Young children, toddlers and school age children]. / Niño pequeño, preescolar y escolar.

Cow´s milk represents a very important source of proteins of high biological value and calcium in the child´s diet. The aim of this article is to review the available evidences of its role in nutrition of young children and school age children. Its main benefits are related with effects in linear growth, bone health and oral health, as protein source in early severe malnutrition, and it does not appears to influence metabolic syndrome risk and autism. High protein content in cow´s milk and increased protein consumption by children during the complementary feeding period is associated to the risk of developing a high body mass index and obesity in school-age children; therefore, milk consumption should be mildly restricted during the second year of life and to 480-720 ml/day during the first years of life. Its relationship with some diseases has not been confirmed, and milk consumption is associated with iron deficiency. The use of low-fat cow's milk instead of regular milk in young children remains controversial and its introduction is not advised before 2 to 4 years of age.

Longitudinal Analysis of the Interaction Between Obesity and Pregnancy on Iron Homeostasis: Role of Hepcidin.

BACKGROUND AND AIMS: When pregnancy occurs in obese women, two opposite mechanisms for iron homeostasis concur: increased need for available iron to support erythropoiesis and decreased iron mobilization from diets and stores due to obesity-related inflammation linked to overexpressed hepcidin. Few studies have examined the role of hepcidin on maternal iron homeostasis in the context of obese pregnancy. The aim of the study was to evaluate the combined effect of maternal obesity and pregnancy on hepcidin and maternal iron status while accounting for inflammation and iron supplementation. METHODS: We conducted a secondary analysis of a cohort of pregnant women recruited from a referral obstetric hospital in Mexico City. Circulating biomarkers of iron status (hepcidin, ferritin [SF], transferrin receptor [sTfR], erythropoietin [EPO]), and inflammation (C-reactive protein [CRP], tumor necrosis factor-[TNF]α, and interleukin-[IL]6) were determined monthly throughout pregnancy. Repeated measures ANOVA and logistic regression models were used for statistics. RESULTS: Twenty-three obese (Ob) and 25 lean (Lc) women were studied. SF and hepcidin declined, and EPO and sTfR increased throughout pregnancy in both groups. sTfR increased more in Ob than in Lc (p = 0.024). The smallest hepcidin decline occurred in iron-supplemented Ob women compared to non-supplemented Lc women (p = 0.022). The risk for iron deficiency at the end of pregnancy was higher for Ob than for Lc (OR = 4.45, 95% CI = 2.07-9.58) after adjusting for iron supplementation and hepcidin concentration. CONCLUSION: Pre-gestational obesity increases the risk of maternal iron deficiency despite iron supplementation. Overexpressed hepcidin appears to be a potential mechanism.

[Promoting factors for breastfeeding: the role of health professionals]. / Factores que promueven la lactancia materna exitosa: el papel del profesional de la salud.

By the end of their first year of life, infants are ready to sit at the dinner table, to eat the same food as their family and to accept a variety of foods in sufficient quantity to maintain adequate nutritional status. In this context, breastfeeding contributes through different mechanisms such as: self-regulation in milk consumption and exposure to different flavors to assure a good nutrition and to create adequate feeding habits. However, breastfeeding is one of several options available to feed a newborn and a behavior that women need to learn. Today, the responsibility to counsel and guide women and their families in breastfeeding falls upon health professionals, specifically the general practitioner. This paper discusses the characteristics and functioning of the mammary gland as well as anatomical and physiological bases of suction exerted by the baby on the breast, so the health professional can recognize the factors that promote successful breastfeeding and to solve the problems or difficulties that could arise. Also are discussed here the main elements of a practice and proper technique, which are essential to provide breastfeeding counseling.

Risk for postpartum depression, breastfeeding practices, and mammary gland permeability.

In a cross-sectional study, 163 breastfeeding women completed the Edinburgh Postnatal Depression Scale (EPDS), a questionnaire on demographics and infant feeding and hand-expressed breast milk for Na and K quantification, between 2 and 12 weeks postpartum. Forty women (24.5%) had an EPDS score compatible with the risk of a depressive episode, and 63 (41%) did not feel confident about breastfeeding. These 2 variables were significantly correlated to each other and individually correlated to breastfeeding exclusiveness. Weeks postpartum was correlated to breastfeeding exclusiveness and Na:K in milk (all P < .001). A logistic regression model showed that supplementation increased the risk of high Na:K in milk by 209%, whereas a longer time postpartum lowered the risk for mammary gland permeability. This study suggests that postpartum depression and low breastfeeding confidence, which may be present concomitantly, are associated with increased mammary gland permeability, only to the extent in which depression dissuades the mother from exclusive breastfeeding.

Gestational weight gain as predicted by pregestational body mass index and gestational age in Mexican women.

OBJECTIVE: To develop a reference pattern to evaluate gestational weight according to pregestational body mass index (BMI) and gestational age, using current longitudinal information from healthy pregnant women. SUBJECTS AND METHODS: We followed 438 women with singleton pregnancies between weeks 16 and 36 of pregnancy Women were excluded if they developed pathologic conditions during gestation, delivered malformed or dead fetuses, or delivered babies with a birthweight of less than 2500 or more than 4200 g or with a gestational age of less than 37 or more than 41 weeks. Weight, biochemical indicators, and clinical indicators were recorded every 4 weeks throughout the pregnancy. Data were analyzed by sequential regressions. RESULTS: Four equations for maternal predicted weight across categories of pregestational BMI (underweight, normal, overweight, and obese) and gestational ages were developed and synthesized in a table of reference values. CONCLUSIONS: Optimal weight and weight gain during pregnancy can be estimated with our equations, which are corrected for pregestational BMI and gestational age.