Aplicación móvil para el seguimiento del crecimiento y cuidado nutricional del bebé en hogares colombianos

Introducción: El predominio y asequibilidad actual de los teléfonos móviles inteligentes han permitido una amplia difusión de variedad de aplicaciones a nivel mundial para el monitoreo del crecimiento y del estado nutricional de los lactantes. No obstante, la mayoría de estos recursos no son lo suficientemente completos para proveer una interfaz amigable de seguimiento del crecimiento, combinada con una adecuada educación parental en materia de nutrición y alimentación complementaria. Objetivos: Este trabajo pretende presentar el desarrollo y evaluación de la aplicación propuesta "Baby Home", con el fin de estudiar su potencial como herramienta digital de apoyo a padres y cuidadores en el cuidado nutricional de sus niños desde el hogar. Materiales y métodos: Baby Home integra una interfaz de seguimiento interactivo del crecimiento del bebé con una serie de contenidos educativos alimentarios, posibilitando al usuario consultar las prácticas recomendadas según el estado nutricional estimado de su bebé. Un conjunto de 7 jueces expertos fue reunido para evaluar la validez de estos contenidos consignados en la aplicación. Posteriormente, se llevó a cabo un estudio de prueba piloto con 8 madres participantes, las cuales aportaron en las fortalezas y debilidades de las funcionalidades propuestas. Resultados: la aplicación desarrollada muestra una aprobación positiva por los especialistas consultados y una aceptación satisfactoria entre las madres participantes gracias a su diseño amigable y funcionalidades de fácil uso. Los recursos visuales implementados prueban ser adecuados para la apropiación de los contenidos alimentarios y el empoderamiento del usuario en torno a los cuidados nutricionales que requieren sus niños. Conclusiones: Baby Home se ubica como un soporte práctico y accesible para el cuidado nutricional del lactante, otorgando seguridad y confianza al usuario en la alimentación de su niño y disponiendo la posibilidad de detectar oportunamente problemas de crecimiento.

Introduction: The current prevalence and affordability of smartphones have enabled a broad diffusion of a variety of mobile applications worldwide for monitoring infant's growth and nutritional status. However, most of these resources are not comprehensive enough to provide a user-friendly interface for growth tracking combined with proper parental education on nutrition and complementary feeding. Objectives: This work aims to present the development and evaluation of the proposed application "Baby Home", in order to study its potential as a digital tool for supporting parents and caregivers in the nutritional care of their children from home. Materials and methods: Baby Home integrates an interactive baby growth monitoring interface with a collection of educational content on infant feeding, allowing the user to check the recommended practices based on the estimated nutritional status of their baby. A panel of seven expert judges was assembled to evaluate the validity of these contents included in the application. Subsequently, a pilot study was carried out with eight participating mothers who contributed to the strengths and weaknesses of the proposed functionalities. Results: The developed application received positive feedback by the consulted specialists and a satisfactory acceptance within the participating mothers thanks to its friendly design and easy-to-use functionalities. The implemented visual resources proved to be well suited for the user's appropriation of feeding contents and their empowerment regarding the nutritional care required by their children. Conclusions: Baby Home is positioned as a practical and accessible support for the nutritional care of infants, providing safeness and confidence to the user in their child's feeding and the possibility of timely detection of growth problems.

Experiencias de cuidadores frente a un programa integral en salud para niños con cardiopatías congénitas

Las enfermedades congénitas complejas son un grave problema de salud pública que afecta a millones de niños y sus cuidadores en el mundo, razón por la cual es necesario generar programas de apoyo formal para favorecer el seguimiento en casa de estos menores y así, incrementar la adherencia al tratamiento y reducir la mortalidad interestadio. El presente estudio tuvo como objetivo describir la percepción de los cuidadores frente a un programa integral en salud, planeado sobre la educación y el uso extenso de las herramientas de telecomunicación para el seguimiento en casa de niños con cardiopatías congénitas complejas, en el marco del proyecto Promesa de la Fundación Cardiovascular de Colombia, a partir de un enfoque cualitativo de diseño fenomenológico. La muestra seleccionada estuvo compuesta por 12 cuidadores con quienes se realizó entrevista a profundidad y grupo focal. Los datos fueron analizados a través del software para el análisis de estudios cualitativos Atlas.ti, estableciendo las siguientes categorías: Valoración del proyecto y del programa integral, Experiencias con el uso de dispositivos médicos, tecnologías de la información y de la comunicación, Comunicación y relación con profesionales, Apoyo institucional y Redes de cuidadores. Se concluye que implementar las Tic en el tratamiento de cardiopatías congénitas complejas es una estrategia novedosa y aceptada por los cuidadores, que se ajusta a las condiciones del sistema de salud colombiano y a las necesidades de los usuarios.

Congenital heart disease are a serious public health problem that affects millions of children and their caregivers around the world, which is why it is necessary to generate formal support programs to promote follow-up at home for these minors and thus increase adherence to treatment and reduce interstage mortality. The objective of this study was to describe the perception of caregivers regarding a comprehensive health program, planned on education and the extensive use of telecommunication tools for home monitoring of children with complex congenital heart disease, within the framework of the project Promise of the Cardiovascular Foundation of Colombia, based on a qualitative approach of phenomenological design. The selected sample consisted of 12 caregivers with whom an in-depth interview and focus group were conducted. The data was analyzed through the software for the analysis of qualitative studies Atlas.ti, establishing the following categories: Assessment of the project and the comprehensive program, Experiences with the use of medical devices, information and communication technologies, Communication and relationship with professionals, institutional support and networks of caregivers. It is concluded that implementing ICTs in the treatment of complex congenital heart diseases is a novel strategy accepted by caregivers, which is adjusted to the conditions of the Colombian health system and the needs of users.

Design of a mobile application for home monitoring of babies with complex congenital heart disease / Diseño de una aplicación móvil para la monitorización domiciliaria de bebés con cardiopatías congénitas complejas / Projeto de um aplicativo móvel para monitoramento domiciliar de bebês com cardiopatias congênitas complexas

Introduction: Congenital heart diseases are related to heart defects that develop during pregnancy and are present at birth. Children must regularly attend specialized clinical centers for treatment, which includes medical check-ups, hemodynamic procedures, and surgery. Nevertheless, the success of interventions largely depends on the education of parents and caregivers about the symptoms and warning signs that babies with complex congenital heart disease may present during the period between stages. Likewise, it is necessary for caregivers to have tools to face the barriers of the health system, such as, obstacles or delays in obtaining healthcare services. This facilitates timely health care for patients and avoids fatal outcomes or deterioration in quality of life. Materials and Methods: This document presents a system that provides support to patients with complex congenital heart disease in follow-up by a home monitoring program. The system consists of a mobile application that allows parents/caregivers to monitor physiological variables of the patients (weight, intake, and oximetry). The information registered in the application is sent for real-time evaluation by the medical team. Results:The application provides an effective means for sending data and communicating with the medical control center, in addition to offering educational and informative material. In this way, parents/caregivers get constant help and feedback about their baby's condition. Conclusions: The mobile application could help mitigate the costs of medical care and overcome the limitations of follow-up at home, giving doctors the possibility to see the patient's evolution and give timely recommendations.

Introducción: Las cardiopatías congénitas están relacionadas con defectos cardíacos que se desarrollan durante el embarazo y están presentes al nacer. El éxito de las intervenciones depende en gran medida de la educación de los padres/cuidadores sobre los signos y síntomas de alerta. Los cuidadores necesitan tener herramientas para hacer frente a las barreras del sistema de salud. Objetivo: crear un sistema como herramienta de seguimiento para los bebés con cardiopatías congénitas complejas que ayude a los padres/cuidadores y a los profesionales médicos a observar las variables fisiológicas del paciente y a brindar una retroalimentación oportuna y profesional a los padres/cuidadores desde la atención domiciliaria. Materiales y métodos:se presenta un sistema que proporciona apoyo a los pacientes que necesitan seguimiento de cardiopatías congénitas complejas mediante un programa de monitoreo en casa. El sistema consiste en una aplicación móvil que permite a los padres/cuidadores controlar las variables fisiológicas del paciente (peso, ingesta de alimento y oximetría). La información registrada en la aplicación se envía para ser evaluada en tiempo real por el equipo médico. Resultados: la aplicación proporciona un medio eficaz para enviar datos y comunicarse con el centro de control médico, además de ofrecer material educativo e informativo. De este modo, los padres/cuidadores reciben constantemente ayuda e información acerca del estado de su bebé. Conclusiones: la aplicación móvil podría ayudar a minimizar los costos de la atención médica y superar las limitaciones del seguimiento domiciliario, dando a los médicos la posibilidad de ver la evolución del paciente y dar recomendaciones oportunas.

Introdução: as doenças cardíacas congênitas estão relacionadas a defeitos cardíacos que se desenvolvem durante a gravidez e estão presentes no nascimento. O sucesso das intervenções depende em grande parte da educação dos pais/responsáveis sobre os sinais e sintomas de alerta. Os cuidadores precisam ter ferramentas para lidar com as barreiras do sistema de saúde. Objetivo: Criar uma ferramenta de sistema de monitoramento para bebês com doenças cardíacas congênitas complexas, que ajude pais/cuidadores e profissionais médicos a observar as variáveis fisiológicas do paciente e manter um feedback profissional e oportuno para os pais/cuidadores dos cuidados domiciliares. Materiais e Métodos: é apresentado um sistema que fornece suporte aos pacientes com cardiopatias congênitas complexas em acompanhamento através de um programa de monitoramento domiciliar. O sistema consiste em uma aplicação móvel que permite aos pais/responsáveis pelo acompanhamento das variáveis fisiológicas do paciente (peso, ingestão e oximetria). As informações registradas no aplicativo são enviadas para serem avaliadas em tempo real pela equipe médica. Resultados: a aplicação fornece um meio eficiente para enviar dados e se comunicar com o centro de controle médico, além de oferecer material educativo e informativo. Desta forma, os pais/responsáveis recebem ajuda constante e feedback sobre a condição de seu bebê. Conclusões: a aplicação móvel pode ajudar a minimizar os custos do atendimento médico e superar as limitações do acompanhamento domiciliar, dando aos médicos a possibilidade de ver a evolução do paciente e dar recomendações oportunas.

Effect of Antioxidants in the Treatment of COPD Patients: Scoping Review.

Chronic obstructive pulmonary disease (COPD) is a common, preventable, treatable lung disease characterized by persistent respiratory symptoms and airflow limitation and multiorgan impact. This affects the nutritional status of patients and requires multidimensional interventions including nutritional interventions according to individual metabolic needs. Our scoping review determined the effects of antioxidants in the treatment of COPD patients and their role in the decrease in the probability of exacerbations, hospital readmissions, and changes in lung function. The sources MEDLINE, LILACS, and Google Scholar were consulted and 19 studies were selected. The most indicated antioxidants are N-Acetylcysteine, vitamins E and D, and Zinc. Other antioxidants from plants or fruits extracts are also being investigated. The beneficial effect of antioxidants in stable or exacerbated patients is not clear, but theoretical and biological arguments of benefit justify lines of research that specify the impact on reducing oxidative stress and negative effects in COPD.

Perception of COVID-19 Vaccination Amongst Physicians in Colombia.

Introduction: The SARS-CoV-2/COVID-19 pandemic has triggered the need to develop rapidly effective and safe vaccines to prevent infection, particularly in those at-risk populations such as medical personnel. This study's objective was to assess the perception of COVID-19 vaccination amongst Colombian physicians featuring two different scenarios of COVID-19 vaccination. Methods: A cross-sectional analytical study was carried out through an online survey directed at medical staff in several cities in Colombia. The percentage of physicians who have a positive perception to be vaccinated and the associated factors that determine that decision were determined. A binomial regression analysis adjusted for age and sex was carried out, taking as a dependent variable the acceptance of free vaccination with an effectiveness of 60 and 80%. The most significant factors were determined in the non-acceptance of vaccination. Results: Between 77.0% and 90.7% of physicians in Colombia accept COVID-19 vaccination, according to the scenario evaluated where the vaccine's effectiveness was 60 or 80%, respectively. Medical specialty, having never paid for a vaccine, recommending the administration of the vaccine to their parents or people over 70 years, and dispensing the vaccine to their children, were the factors to consider to be vaccinated for free with an effectiveness of 60% and 80%. Conclusions: There is a high perception of the intention to vaccinate physicians in Colombia against COVID-19, and this is very similar to that of the general population.

Efficacy of oral Vitamin D supplementation in reducing body mass index and lipid profile in adolescents and young adults in Colombia: A pilot clinical trial protocol nested in the SIMBA cohort.

BACKGROUND: In recent years, the role of vitamin D (VD) as a protective factor in cardiovascular disease has been recognized. Thus, there is a need to study the effect of vitamin D supplementation in the control of different cardiovascular risk factors and metabolic syndrome, especially in young populations where few studies have been conducted. METHODS: Pilot study of a randomized, parallel two-arm, triple-blind clinical controlled trial in 150 adolescents and young adults in the city of Bucaramanga-Colombia. The intervention group will receive 1000 IU of VD and the control group 200 IU of VD daily for 15 weeks. The main outcomes are: serum calcifediol levels (25(OH) D), body mass index and lipid profile; secondary outcomes are complementary to the previous ones (skin folds, waist-hip ratio). Other variables will be analyzed such as assessment of dietary intake, physical activity, sun exposure, cigarette and tobacco consumption and compliance with VD supplementation. DISCUSSION: This study is innovative since there is little evidence from clinical trials in adolescents and young adults; similar studies are not known in our context. The results of this study may facilitate the recommendation of oral vitamin D supplementation in the population of interest. In addition, it is a low-cost and easy-to-apply intervention that could contribute to the formulation and implementation of health policies. TRIAL REGISTRATION: NCT04377386.

Family history of pre-eclampsia and cardiovascular disease as risk factors for pre-eclampsia: the GenPE case-control study.

Objective: To determine whether family history of pre-eclampsia and cardiovascular disease is consistently associated with the occurrence of pre-eclampsia sub-phenotypes and fetal growth restriction (FGR).Material and Methods: We conducted a case-control study in which cases of pre-eclampsia and healthy pregnant controls were recruited at the time of delivery from eight Colombian cities between 2000 and 2012. Odds of pre-eclampsia among women with a positive family history of pre-eclampsia or cardiovascular disease were compared to women without affected relatives (logistic regression modeling and multinomial logistic regression model [Ajusted]).Results: A total of 3510 pre-eclampsia cases and 4512 controls with data on family history of pre-eclampsia were included in analyses. A subsample of 3086 cases and 3888 controls also provided information on family history of cardiovascular disease. Women whose mothers had pre-eclampsia had 3.38 (95% CI 2.89, 3.96) higher odds than those who did not, and having an affected sister increased pre-eclampsia odds by 2.43 (95% CI 2.02, 2.93). The effect of having both mother and sister affected with pre-eclampsia was stronger than the two independent risk factors (OR 4.17 [95% CI 2.60, 6.69]). Women with parental history of cardiovascular disease also had an increased risk of pre-eclampsia (OR 1.58 [95% CI 1.24, 2.01]).Conclusions: Family history of pre-eclampsia increased the risk of PE. The impact of family history of cardiovascular disease on pre-eclampsia was more conservative, but serves to support the hypothesis that pre-eclampsia may reflect the premature exposure of underlying cardiovascular dysfunction, precipitated by the stress test of pregnancy.

Ácido úrico y su asociación con los componentes del síndrome metabólico en adolescentes colombianos / Uric acid and its association with the components of the metabolic syndrome in Colombian adolescents

Introducción: la relación del ácido úrico y el desarrollo de enfermedades cardiometabólicas se ha estudiado en los últimos años. No obstante, continúa la controversia en considerar este hallazgo como un factor de riesgo independiente para enfermedad cardiovascular en edades tempranas. El objetivo fue establecer la prevalencia de niveles séricos de ácido úrico alterados y su asociación con los componentes del síndrome metabólico en adolescentes de Bucaramanga, Colombia. Metodología: estudio de corte transversal analítico, anidado en una cohorte poblacional, con una muestra de 494 adolescentes recontactados del estudio original. Las variables dependientes fueron: síndrome metabólico y criterios que lo componen. La variable independiente principal fueron los valores de ácido úrico, clasificados en dos categorías: ácido úrico a riesgo (valores mayores a 5,5 mg/dl) y ácido úrico elevado (mayores de 6,5 mg/dl). Se usaron modelos de regresión logística, ajustados por sexo, edad e índice de masa corporal para determinar la asociación entre las variables de interés. Resultados: la prevalencia de ácido úrico a riesgo fue del 37,25% (IC 95%, 32,9-41,5) y la proporción de ácido úrico elevado fue del 18,42% (IC 95%, 14,9-21,8), significativamente mayor en hombres que en mujeres (p < 0,0001). Los adolescentes con niveles elevados de ácido úrico mostraron mayor probabilidad de presentar obesidad abdominal (OR: 3,03; IC 95% 1,38-6,64), presión arterial alta (OR: 1,11; IC 95% 1,05-2,07), hipertrigliceridemia (OR: 4,94; IC 95%, 2,98-8,19) y glucemia en ayuno alterada (OR: 5,15; IC 95%, 3,42-11,05). Conclusiones: los resultados sugieren la existencia de una relación positiva entre la presencia de niveles de ácido úrico elevados y los factores de riesgo cardiometabólico

Background: the relationship of uric acid and the development of cardiometabolic diseases has been studied in recent years. However, the controversy continues to consider this finding as an independent risk factor for cardiovascular disease at early ages. The objective was to establish the prevalence of serum levels of altered uric acid and its association with the metabolic syndrome components in adolescents from Bucaramanga, Colombia. Methods: an analytical cross-sectional study, nested in a population cohort, with a sample of 494 re-contacted adolescents from the original study. The dependent variables were metabolic syndrome and its component criteria. The main independent variable was uric acid values, classified into two categories: uric acid at risk (values greater than 5.5 mg/dl) and high uric acid (greater than 6.5 mg/dl). Logistic regression models were used, adjusted for sex, age and body mass index to determine the association between the variables of interest. Results: the prevalence of uric acid at risk was 37.25% (CI 95%, 32.9-41.5) and the proportion of high uric acid was 18.42% (CI 95%, 14.9-21, 8), significantly higher in men than in women (p < 0.0001). Adolescents with high levels of uric acid were more likely to have abdominal obesity (OR: 3.03, CI 95% 1.38-6.64), high blood pressure (OR: 1.11, CI 95%, 1.05-2.07), hypertriglyceridemia (OR: 4.94, CI 95%, 2.98-8.19) and altered fasting glycemia (OR: 5.15, CI 95%, 3.42-11.05). Conclusions: the results suggest the existence of a positive relationship between the presence of high levels of uric acid and metabolic cardio-risk factors

Food Changes and Geography: Dietary Transition in Colombia.

BACKGROUND: The food transition can no longer be studied in developed countries because the so-called Western diet now predominates in these areas. However, in developing countries, it is still possible to study the food transition. It is a novel concept that complements other transitions such as the demographic, economic, nutritional and epidemiological transitions. OBJECTIVES: The objectives of this study were to a) estimate the average departmental adherence to the three pre-established food patterns, b) assess adherence patterns based on the Global Spatial Analysis, c) evaluate whether the Local Spatial Variations in the adherence to food patterns are random or follow defined patterns (cluster) and d) generate 2D maps to graphically locate the food patterns that compose the phenomenon of the food transition occurring in Colombia. METHODS: The National Survey of the Nutritional Situation in Colombia, 2010 was analyzed. Based on factor analysis, three consumption patterns were established; Protein/Fiber, Snack and Snack and Traditional/Starch and the average departmental adhesion was estimated. The global and local spatial variation was calculated with the Moran indexes. FINDINGS: the average adherence to the traditional consumption/starch pattern was -0.00 (95% CI: -0.12 to 0.12). The mean adherence to the protein/fiber intake pattern was -0.07 (95% CI: -0.16 to 0.03). The average adherence to the pattern of snack consumption was -0.03 (95% CI: -0.11 to 0.05). The three patterns of food consumption values for the Global Total Moran Index, for men and women were positive and statistically significant. CONCLUSIONS: The food transition experienced by Colombia is not homogeneous and there are well defined clusters for adherence in the three predefined food patterns. Within the clusters there are differences by sex. In regions where the traditional pattern/starch predominates, the presence of the snack pattern is very weak.

[Uric acid and its association with the components of the metabolic syndrome in Colombian adolescents]. / Ácido úrico y su asociación con los componentes del síndrome metabólico en adolescentes colombianos.

INTRODUCTION: Background: the relationship of uric acid and the development of cardiometabolic diseases has been studied in recent years. However, the controversy continues to consider this finding as an independent risk factor for cardiovascular disease at early ages. The objective was to establish the prevalence of serum levels of altered uric acid and its association with the metabolic syndrome components in adolescents from Bucaramanga, Colombia. Methods: an analytical cross-sectional study, nested in a population cohort, with a sample of 494 re-contacted adolescents from the original study. The dependent variables were metabolic syndrome and its component criteria. The main independent variable was uric acid values, classified into two categories: uric acid at risk (values greater than 5.5 mg/dl) and high uric acid (greater than 6.5 mg/dl). Logistic regression models were used, adjusted for sex, age and body mass index to determine the association between the variables of interest. Results: the prevalence of uric acid at risk was 37.25% (CI 95%, 32.9-41.5) and the proportion of high uric acid was 18.42% (CI 95%, 14.9-21, 8), significantly higher in men than in women (p < 0.0001). Adolescents with high levels of uric acid were more likely to have abdominal obesity (OR: 3.03, CI 95% 1.38-6.64), high blood pressure (OR: 1.11, CI 95%, 1.05-2.07), hypertriglyceridemia (OR: 4.94, CI 95%, 2.98-8.19) and altered fasting glycemia (OR: 5.15, CI 95%, 3.42-11.05). Conclusions: the results suggest the existence of a positive relationship between the presence of high levels of uric acid and metabolic cardio-risk factors.

INTRODUCCIÓN: Introducción: la relación del ácido úrico y el desarrollo de enfermedades cardiometabólicas se ha estudiado en los últimos años. No obstante, continúa la controversia en considerar este hallazgo como un factor de riesgo independiente para enfermedad cardiovascular en edades tempranas. El objetivo fue establecer la prevalencia de niveles séricos de ácido úrico alterados y su asociación con los componentes del síndrome metabólico en adolescentes de Bucaramanga, Colombia. Metodología: estudio de corte transversal analítico, anidado en una cohorte poblacional, con una muestra de 494 adolescentes recontactados del estudio original. Las variables dependientes fueron: síndrome metabólico y criterios que lo componen. La variable independiente principal fueron los valores de ácido úrico, clasificados en dos categorías: ácido úrico a riesgo (valores mayores a 5,5 mg/dl) y ácido úrico elevado (mayores de 6,5 mg/dl). Se usaron modelos de regresión logística, ajustados por sexo, edad e índice de masa corporal para determinar la asociación entre las variables de interés. Resultados: la prevalencia de ácido úrico a riesgo fue del 37,25% (IC 95%, 32,9-41,5) y la proporción de ácido úrico elevado fue del 18,42% (IC 95%, 14,9-21,8), significativamente mayor en hombres que en mujeres (p < 0,0001). Los adolescentes con niveles elevados de ácido úrico mostraron mayor probabilidad de presentar obesidad abdominal (OR: 3,03; IC 95% 1,38-6,64), presión arterial alta (OR: 1,11; IC 95% 1,05-2,07), hipertrigliceridemia (OR: 4,94; IC 95%, 2,98-8,19) y glucemia en ayuno alterada (OR: 5,15; IC 95%, 3,42-11,05). Conclusiones: los resultados sugieren la existencia de una relación positiva entre la presencia de niveles de ácido úrico elevados y los factores de riesgo cardiometabólico.

Association between body fat mass and cardiometabolic risk in children and adolescents in Bucaramanga, Colombia.

BACKGROUND: Obesity is common among children and teenagers and is associated with cardiometabolic risk factors in the adult age. The objective of this paper was to evaluate the association between the percentage of body fat and cardiometabolic risk factors in children and adolescents in the city of Bucaramanga, Colombia. MATERIAL AND METHODS: About 494 children and adolescents aged 10-20 years were studied. Laboratory tests were made for analyzing cardiovascular risk factors and anthropometric measurements. Percentage body fat was determined with Slaughter equation. Lineal regression analyses were conducted to evaluate the association between cardiometabolic risk factors and the percentage body fat. RESULTS: Prevalence of percentage body fat (>26%) was 46.1%. Variables associated with percentage body fat were HOMA-IR - insulin resistance, HDL, LDL, triglycerides, and total cholesterol levels, and high blood pressure. CONCLUSIONS: Increase in percentage body fat is significantly associated with cardiometabolic risk factors in children and adolescents in Bucaramanga. Early identification and intervention of this population at risk is fundamental.

Early evaluation of the metabolic syndrome in Bucaramanga, Colombia.

BACKGROUND: Metabolic syndrome (MS) is one of the conditions that increase the risk of developing cardiovascular diseases (CVD) and type-2 diabetes in the early future if it appears during childhood or adolescence. The purpose of the study to compare the MS prevalence of MS estimated in a representative sample of school-age population in Bucaramanga, Colombia, and the MS prevalence estimated in a subsample from the same population in the adolescent stage. METHODS: An analytical cross-sectional survey (in the adolescent stage) (n=494) was carried out, nested in a population-based cohort assembled when children were of school age (n=1,282). Selection employed a bi-stage randomized sampling per neighborhoods and houses across the city. Sociodemographic and anthropometric variables, as well as cardiometabolic factors were analyzed in accordance with their distribution, and statistical significance tests were applied according to each case. MS was determined using the Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) criteria. RESULTS: Estimated MS prevalence in school age according to the ATP III criteria was 9.5% (95% CI: 8.0-11.3%) and according to the IDF criteria it was 8.0% (95% CI: 6.6-9.7%). At the time of follow up the prevalence of MS was 13.2% and 14.8% according to the ATP III and IDF criteria, respectively. CONCLUSIONS: MS prevalence of MS increased in 4% from the school age (9.5%) to the adolescence (13.1%).

Association of pre-eclampsia risk with maternal levels of folate, homocysteine and vitamin B12 in Colombia: A case-control study.

BACKGROUND: Maternal serum concentrations of folate, homocysteine, and vitamin B12 have been associated with pre-eclampsia. Nevertheless, reported studies involve limited number of cases to reliably assess the nature of these associations. Our aim was to examine the relation of these three biomarkers with pre-eclampsia risk in a large Colombian population. MATERIALS AND METHODS: Design: A case-control study. Setting: Cases of pre-eclampsia and healthy pregnant controls were recruited at the time of delivery from eight different Colombian cities between 2000 and 2012. Population or Sample: 2978 cases and 4096 controls were studied. Maternal serum concentrations of folate, homocysteine, and vitamin B12 were determined in 1148 (43.6%) cases and 1300 (31.7%) controls. Also, self-reported folic acid supplementation was recorded for 2563 (84%) cases and 3155 (84%) controls. Analysis: Adjusted odds ratios (OR) for pre-eclampsia were estimated for one standard deviation (1SD) increase in log-transformed biomarkers. Furthermore, we conducted analyses to compare women that reported taking folic acid supplementation for different periods during pregnancy. Main Outcomes Measures: Odds ratio for pre-eclampsia. RESULTS: After adjusting for potential confounders in logistic regression models, the OR for pre-eclampsia was 0.80 (95% CI: 0.72, 0.90) for 1SD increase in log-folate, 1.16 (95%CI: 1.05, 1.27) for 1SD increase in log-homocysteine, and 1.10 (95%CI: 0.99, 1.22) for 1SD increase in log-vitamin B12. No interactions among the biomarkers were identified. Women who self-reported consumption of folic acid (1 mg/day) throughout their pregnancy had an adjusted OR for pre-eclampsia of 0.86 (95%CI: 0.67, 1.09) compared to women that reported no consumption of folic acid at any point during pregnancy. CONCLUSIONS: Maternal serum concentrations of folate were associated as a protective factor for pre-eclampsia while concentrations of homocysteine were associated as a risk factor. No association between maternal vitamin B12 concentrations and preeclampsia was found.

Percepción de diversos sectores sociales de Colombia sobre los biobancos con fines de investigación / The perception of different social agents in Colombia regarding biobanks for research purposes

Introducción. Los biobancos con fines de investigación son un bien público que necesita de la participación activa de todas las partes interesadas, por lo cual es importante conocer la percepción que tiene el público general en Colombia sobre su intervención en un biobanco. Objetivo. Indagar en diferentes sectores sociales colombianos sobre su percepción en torno a la donación de material biológico humano para ser almacenado en biobancos con fines de investigación. Materiales y métodos. Se hizo un estudio exploratorio tanto cuantitativo como cualitativo, entre personas sanas de diferentes sectores del país mediante una encuesta anónima sobre su conocimiento y actitudes con respecto a los biobancos. Resultado. La encuesta fue respondida por 368 personas, que incluían investigadores en salud, abogados y miembros de comités de ética de la investigación. El 96 % de los sujetos expresó su voluntad de donar material biológico, aunque el 60 % manifestó tener desconfianza en que sus muestras fueran usadas en algunos tipos de investigación, especialmente en clonación humana. Cerca de la mitad de los participantes refirieron saber qué era un biobanco, sin embargo, menos del 3 % tenía claridad suficiente sobre el concepto. Conclusión. Los participantes expresaron su disposición a donar y almacenar material biológico con fines de investigación, así como su opinión sobre algunos aspectos de la gestión de los biobancos. Las opiniones del público general se deben tener en cuenta en el desarrollo de políticas que regulen la actividad de los biobancos con fines de investigación en Colombia.

Introduction: Biobanks for research purposes are public assets that require active participation from all interested parties; therefore, it is important to discern and investigate the perception that the general public in Colombia has with regards to their participation in a biobank. Objective: To question different healthy Colombian social agents about the perception they have on donating human biological material to be stored in a biobank for future research purposes. Materials and methods: We conducted an exploratory quantitative and qualitative research by means of an anonymous survey on healthy members of the Colombian community in order to evaluate their knowledge and stances related to biobanks. Results: Three hundred sixty-eight (368) individuals completed the survey, including health-care researchers, lawyers and members of research ethics committees. Ninety-six percent (96%) of the subjects stated their willingness to donate biological material to biobanks, although 60% expressed distress about their samples being used for certain research activities, mainly human cloning. Even though about half of the participants reported knowing what a biobank is, less than 3% of the individuals had a clear concept of them. Conclusion: Participants showed their willingness to donate and store their biological material for research purposes. Similarly, they expressed their opinion about issues related to the management of biobanks. It is necessary to take into account the opinions of the general public in the development of policies that regulate biobanks for research purposes in Colombia.

[Relationship between exclusive breastfeeding the first six months of life and development of insulin resistance in children and adolescents in Bucaramanga, Colombia]. / Relación entre la lactancia materna exclusiva los primeros seis meses de vida y el desarrollo de resistencia a la insulina en niños y adolescentes de Bucaramanga, Colombia.

INTRODUCTION: exclusive breastfeeding (EB) is a protective factor against the development of insulin resistance (IR) as mainstay of the metabolic syndrome. OBJECTIVE: the objective of the study was to evaluate the relationship between EB during the first six months of life and the development of IR through the Homeostasis Model Assessment (HOMA-IR) and Quantitative Insulin Sensitivity Check Index (QUICKI) indexes. MATERIAL AND METHODS: a population-based cohort study included 494 adolescent participants, from whom socio-demographic, anthropometric, and cardiometabolic variables were assessed using the HOMA-IR and QUICKI indexes to determine the degree of association between EB and the development IR. The results were expressed in medians. RESULTS: the prevalence of EB was 42%. The results suggest a protective effect of EB on IR, in such a way that for each extra month of EB, the HOMA-IR index decreases in 0.32 (p = 0.005) and the index QUICKI increases in 0.70 (p = 0.008). Regarding waist circumference, body mass index and waist size index, this relationship was not significant. CONCLUSION: the bivariate and multivariate analyses indicate an epidemiologically significant relationship that demonstrates a protective effect of EB on the HOMA-IR and QUICKI indexes.

INTRODUCCIÓN: la lactancia materna exclusiva (LME) es un factor protector contra el desarrollo de resistencia a la insulina (RI) como causa del síndrome metabólico. OBJETIVO: el objetivo del estudio fue evaluar la relación entre la LME los  primeros seis meses de vida y el desarrollo de RI, mediante los índicesHomeostasis Model Assessment (HOMA-IR) y Quantitative Insulin Sensitivity Check Index (QUICKI). MATERIAL Y MÉTODOS: estudio de cohorte de tipo poblacional; se incluyeron 494 participantes adolescentes, de los cuales se evaluaron variables sociodemográficas, antropométricas y factores cardiometabólicos mediante los índices HOMA-IR y QUICKI para determinar el grado de asociación entre la LME y el desarrollo de RI. Los resultados fueron expresados en medianas. RESULTADOS: la prevalencia de LME fue del 42%. Los resultados sugieren un efecto protector de la LME sobre la resistencia a la insulina, de tal manera que por cada mes más de duración de LME, disminuye en 0,32 (p = 0,005) el índice HOMA-IR y aumenta en 0,70 (p = 0,008) el índice QUICKI. Para la circunferencia de cintura, el índice de masa corporal (IMC) y el índice-cintura talla (ICT) esta relación no fue significativa. CONCLUSIÓN: los análisis bivariados y multivariados, indican una relación epidemiológicamente significativa que demuestra un efecto protector de la Lactancia Materna Exclusiva sobre el índice HOMA-IR y el QUICKI.

Relación entre la lactancia materna exclusiva los primeros seis meses de vida y el desarrollo de resistencia a la insulina en niños y adolescentes de bucaramanga, colombia / Relationship between exclusive breastfeeding the first six months of life and development of insulin resistance in children and adolescents in Bucaramanga, Colombia

Introducción: la lactancia materna exclusiva (LME) es un factor protector contra el desarrollo de resistencia a la insulina (RI) como causa del síndrome metabólico. Objetivo: el objetivo del estudio fue evaluar la relación entre la LME los primeros seis meses de vida y el desarrollo de RI, mediante los índices Homeostasis Model Assessment (HOMA-IR) y Quantitative Insulin Sensitivity Check Index (QUICKI).Material y métodos: estudio de cohorte de tipo poblacional; se incluyeron 494 participantes adolescentes, de los cuales se evaluaron variables sociodemográficas, antropométricas y factores cardiometabólicos mediante los índices HOMA-IR y QUICKI para determinar el grado de asociación entre la LME y el desarrollo de RI. Los resultados fueron expresados en medianas. Resultados: la prevalencia de LME fue del 42%. Los resultados sugieren un efecto protector de la LME sobre la resistencia a la insulina, de tal manera que por cada mes más de duración de LME, disminuye en 0,32 (p = 0,005) el índice HOMA-IR y aumenta en 0,70 (p = 0,008) el índice QUICKI. Para la circunferencia de cintura, el índice de masa corporal (IMC) y el índice-cintura talla (ICT) esta relación no fue significativa. Conclusión: los análisis bivariados y multivariados, indican una relación epidemiológicamente significativa que demuestra un efecto protector de la Lactancia Materna Exclusiva sobre el índice HOMA-IR y el QUICKI

Introduction: exclusive breastfeeding (EB) is a protective factor against the development of insulin resistance (IR) as mainstay of the metabolic syndrome. Objective: the objective of the study was to evaluate the relationship between EB during the fi rst six months of life and the development of IR through the Homeostasis Model Assessment (HOMA-IR) and Quantitative Insulin Sensitivity Check Index (QUICKI) indexes. Material and methods: a population-based cohort study included 494 adolescent participants, from whom socio-demographic, anthropometric, and cardiometabolic variables were assessed using the HOMA-IR and QUICKI indexes to determine the degree of association between EB and the development IR. The results were expressed in medians. Results: the prevalence of EB was 42%. The results suggest a protective effect of EB on IR, in such a way that for each extra month of EB, the HOMA-IR index decreases in 0.32 (p = 0.005) and the index QUICKI increases in 0.70 (p = 0.008). Regarding waist circumference, body mass index and waist size index, this relationship was not significant. Conclusion: the bivariate and multivariate analyses indicate an epidemiologically signifi cant relationship that demonstrates a protective effect of EB on the HOMA-IR and QUICKI indexes

Vitamin D and risk of preeclampsia: A systematic review and meta-analysis.

Introduction: Human vitamin D levels have been increasingly related to a wide range of clinical outcomes. There is a large amount of reports on its associations, especially with obstetric complications, including preeclampsia and gestational diabetes. These results are scarcely consistent and there is still a lack of quality intervention studies to confirm the role of vitamin D in those outcomes. Objective: To review the available scientific evidence on the role of maternal vitamin D in the development of preeclampsia. Materials and methods: The methodology used followed the recommendations of the Cochrane guide for the preparation of systematic reviews, and for metaanalysis, the Guide of the Metaanalysis of Observational Studies in Epidemiology group (MOOSE). The search included both observational studies and controlled clinical trials. Results: Low vitamin D levels, measured by the 25-hydroxyvitamin D test, are common in pregnancy. The results of this systematic review and metaanalysis suggest an inverse ratio between vitamin D levels and the development of preeclampsia. There was heterogeneity among the studies with regard to the design, population, geographic location, definitions of exposure, and the outcome. We excluded randomized controlled trials from this meta-analysis. Conclusion: The inverse association we found suggests that the higher the levels of vitamin D the lesser the probability of developing preeclampsia, in spite of the heterogeneity of the global measurement in this type of analysis.

Introducción: Cada vez son más los hallazgos sobre la relación entre las concentraciones de vitamina D en el ser humano y diversas condiciones clínicas. Hay una gran cantidad de estudios que informan sobre dicha asociación, especialmente con complicaciones obstétricas, incluidas la preeclampsia y la diabetes mellitus de la gestación, entre otras, pero sus resultados todavía no son definitivos, por lo que se requieren estudios de intervención de calidad que confirmen la relación de la vitamina D con dichos resultados. Objetivo: Revisar la información plasmada en estudios en torno al papel de la vitamina D materna y el desarrollo de la preeclampsia. Materiales y métodos: La metodología usada siguió las recomendaciones de la guía Cochrane para la elaboración de revisiones sistemáticas y de la guía del grupo Meta-analysis of Observational Studies in Epidemiology (MOOSE) para los metaanálisis. La búsqueda incluyó estudios observacionales y ensayos clínicos controlados. Resultados: Los niveles bajos de vitamina D, medida con el examen de 25-hidroxivitamina D, son comunes en el embarazo. Los resultados de esta revisión sistemática y del metaanálisis sugieren una asociación inversa entre los niveles de vitamina D y el desarrollo de preeclampsia. Hubo heterogeneidad en los estudios en cuanto a su diseño, población y ubicación geográfica, así como a las definiciones de exposición y resultado. Los ensayos clínicos controlados aleatorizados se excluyeron del metaanálisis. Conclusión: Se encontró una asociación inversa que sugiere que, a mayores concentraciones de vitamina D, menor es la probabilidad de desarrollar preclampsia, a pesar de la heterogeneidad de la medida global en este tipo de análisis.

Lipid profile, plasma apolipoproteins, and pre-eclampsia risk in the GenPE case-control study.

BACKGROUND AND AIMS: Pre-eclampsia constitutes a leading cause of maternal and perinatal morbidity and mortality. Pre-eclampsia susceptibility is believed to be associated with altered lipid profiles and abnormal lipid metabolism via lipid peroxidation that leads to endothelial dysfunction. The goal of this study was to evaluate the association of maternal blood lipid and apolipoprotein levels with pre-eclampsia in a large-scale study. METHODS: Using data from a large case-control study (1366 cases of pre-eclampsia and 1741 normotensive controls), the association between the distributions of eight lipid fractions and pre-eclampsia risk was evaluated using adjusted logistic regression models. Pre-eclampsia was defined as blood pressure ≥140/90 mmHg and proteinuria ≥300 mg/24 h (>1 + dipstick). Sub-group analyses were conducted for early (<34 weeks) and late (≥37 weeks) pre-eclampsia, estimating the effect of 1 standard deviation increase in log-transformed lipid fraction levels in adjusted multinomial regression models. RESULTS: After adjustment for potential confounders, concentrations of triglycerides, apolipoprotein E (ApoE) and the relationship between apolipoprotein B and A1 (ApoB/ApoA1) showed the strongest associations with pre-eclampsia, particularly for those cases with an early onset. CONCLUSIONS: Higher levels of triglycerides, ApoE and the ApoB/ApoA1 ratio are associated with an increased risk of pre-eclampsia. Further studies that allow for a causal inference are needed to confirm or refute the aetiological role of blood lipids in pre-eclampsia.

Vitamina D y riesgo de preeclampsia: revisión sistemática y metaanálisis / Vitamin D and risk of preeclampsia: A systematic review and meta-analysis

Resumen Introducción. Cada vez son más los hallazgos sobre la relación entre las concentraciones de vitamina D en el ser humano y diversas condiciones clínicas. Hay una gran cantidad de estudios que informan sobre dicha asociación, especialmente con complicaciones obstétricas, incluidas la preeclampsia y la diabetes mellitus de la gestación, entre otras, pero sus resultados todavía no son definitivos, por lo que se requieren estudios de intervención de calidad que confirmen la relación de la vitamina D con dichos resultados. Objetivo. Revisar la información plasmada en estudios en torno al papel de la vitamina D materna y el desarrollo de la preeclampsia. Materiales y métodos. La metodología usada siguió las recomendaciones de la guía Cochrane para la elaboración de revisiones sistemáticas y de la guía del grupo Meta-analysis of Observational Studies in Epidemiology (MOOSE) para los metaanálisis. La búsqueda incluyó estudios observacionales y ensayos clínicos controlados. Resultados. Los niveles bajos de vitamina D, medida con el examen de 25-hidroxivitamina D, son comunes en el embarazo. Los resultados de esta revisión sistemática y del metaanálisis sugieren una asociación inversa entre los niveles de vitamina D y el desarrollo de preeclampsia. Hubo heterogeneidad en los estudios en cuanto a su diseño, población y ubicación geográfica, así como a las definiciones de exposición y resultado. Los ensayos clínicos controlados aleatorizados se excluyeron del metaanálisis. Conclusión. Se encontró una asociación inversa que sugiere que, a mayores concentraciones de vitamina D, menor es la probabilidad de desarrollar preclampsia, a pesar de la heterogeneidad de la medida global en este tipo de análisis.

Abstract Introduction: Human vitamin D levels have been increasingly related to a wide range of clinical outcomes. There is a large amount of reports on its associations, especially with obstetric complications, including preeclampsia and gestational diabetes. These results are scarcely consistent and there is still a lack of quality intervention studies to confirm the role of vitamin D in those outcomes. Objective: To review the available scientific evidence on the role of maternal vitamin D in the development of preeclampsia. Materials and methods: The methodology used followed the recommendations of the Cochrane guide for the preparation of systematic reviews, and for metaanalysis, the Guide of the Metaanalysis of Observational Studies in Epidemiology group (MOOSE). The search included both observational studies and controlled clinical trials. Results: Low vitamin D levels, measured by the 25-hydroxyvitamin D test, are common in pregnancy. The results of this systematic review and metaanalysis suggest an inverse ratio between vitamin D levels and the development of preeclampsia. There was heterogeneity among the studies with regard to the design, population, geographic location, definitions of exposure, and the outcome. We excluded randomized controlled trials from this meta-analysis. Conclusion: The inverse association we found suggests that the higher the levels of vitamin D the lesser the probability of developing preeclampsia, in spite of the heterogeneity of the global measurement in this type of analysis.

The perception of different social agents in Colombia regarding biobanks for research purposes / Percepción de diversos sectores sociales de Colombia sobre los biobancos con fines de investigación

Introduction: Biobanks for research purposes are public assets that require active participation from all interested parties; therefore, it is important to discern and investigate the perception that the general public in Colombia has with regards to their participation in a biobank. Objective: To question different healthy Colombian social agents about the perception they have on donating human biological material to be stored in a biobank for future research purposes. Materials and methods: We conducted an exploratory quantitative and qualitative research by means of an anonymous survey on healthy members of the Colombian community in order to evaluate their knowledge and stances related to biobanks. Results: Three hundred sixty-eight (368) individuals completed the survey, including health-care researchers, lawyers and members of research ethics committees. Ninety-six percent (96%) of the subjects stated their willingness to donate biological material to biobanks, although 60% expressed distress about their samples being used for certain research activities, mainly human cloning. Even though about half of the participants reported knowing what a biobank is, less than 3% of the individuals had a clear concept of them. Conclusion: Participants showed their willingness to donate and store their biological material for research purposes. Similarly, they expressed their opinion about issues related to the management of biobanks. It is necessary to take into account the opinions of the general public in the development of policies that regulate biobanks for research purposes in Colombia.

Introducción. Los biobancos con fines de investigación son un bien público que necesita de la participación activa de todas las partes interesadas, por lo cual es importante conocer la percepción que tiene el público general en Colombia sobre su intervención en un biobanco.Objetivo. Indagar en diferentes sectores sociales colombianos sobre su percepción en torno a la donación de material biológico humano para ser almacenado en biobancos con fines de investigación.Materiales y métodos. Se hizo un estudio exploratorio tanto cuantitativo como cualitativo, entre personas sanas de diferentes sectores del país mediante una encuesta anónima sobre su conocimiento y actitudes con respecto a los biobancos.Resultado. La encuesta fue respondida por 368 personas, que incluían investigadores en salud, abogados y miembros de comités de ética de la investigación. El 96 % de los sujetos expresó su voluntad de donar material biológico, aunque el 60 % manifestó tener desconfianza en que sus muestras fueran usadas en algunos tipos de investigación, especialmente en clonación humana. Cerca de la mitad de los participantes refirieron saber qué era un biobanco, sin embargo, menos del 3 % tenía claridad suficiente sobre el concepto.Conclusión. Los participantes expresaron su disposición a donar y almacenar material biológico con fines de investigación, así como su opinión sobre algunos aspectos de la gestión de los biobancos. Las opiniones del público general se deben tener en cuenta en el desarrollo de políticas que regulen la actividad de los biobancos con fines de investigación en Colombia.