A Clustering Study of Dietary Patterns and Physical Activity among Workers of the Uruguayan State Electrical Company.

Recent studies have shown that certain nutrients, specific food groups, or general dietary patterns (DPs) can promote health and prevent noncommunicable chronic diseases (NCCDs). Both developed and developing countries experience a high prevalence of NCCDs due to poor lifestyle habits, DPs, and low physical activity levels. This study aims to examine the dietary, physical activity, sociodemographic, and lifestyle patterns of Uruguayan State Electrical Company workers (the IN-UTE study). A total of 2194 workers participated in the study, providing information about their sociodemographics, lifestyles, and dietary habits through different questionnaires. To identify DPs from 16 food groups, principal component analysis (PCA) was performed. A hierarchical cluster algorithm was used to combine food groups and sociodemographic/lifestyle variables. Four DPs were extracted from the data; the first DP was related to the intake of energy-dense foods, the second DP to the characteristics of the job, the third DP to a Mediterranean-style diet, and the fourth DP to age and body mass index. In addition, cluster analysis involving a larger number of lifestyle variables produced similar results to the PCA. Lifestyle and sociodemographic factors, including night work, working outside, and moderate and intense PA, were significantly correlated with the dietary clusters, suggesting that working conditions, socioeconomic status, and PA may play an important role in determining DPs to some extent. Accordingly, these findings should be used to design lifestyle interventions to reverse the appearance of unhealthy DPs in the UTE population.

Gestational weight gain charts for Latin American adolescents.

Monitoring gestational weight gain (GWG) throughout pregnancy among adolescents is important for detecting individuals at risk and timely intervention. However, there are no specific tools or guidelines for GWG monitoring of this group. We aimed to construct GWG charts for pregnant adolescents (10-19 years old) according to pre-pregnancy body mass index (BMI) using a pooled dataset from nine Latin American countries. Datasets from Argentina, Brazil, Chile, Colombia, Mexico, Panama, Paraguay, Peru, and Uruguay collected between 2003 and 2021 were combined after data cleaning and harmonization. Adolescents free of diseases that could affect GWG and who gave birth to newborns weighing between 2,500-4,000 g and free of congenital malformations were included. Multiple imputation techniques were applied to increase the sample size available for underweight and obesity categories. Generalized Additive Models for Location, Scale, and Shape were used to construct the charts of GWG according to gestational age. Internal and external validation procedures were performed to ensure that models were not over-adjusted to the data. The cohort included 6,414 individuals and 29,414 measurements to construct the charts and 1,684 individuals and 8,879 measurements for external validation. The medians (and interquartile ranges) for GWG at 40 weeks according to pre-pregnancy BMI were: underweight, 14.9 (11.9-18.6); normal weight, 14.0 (10.6-17.7); overweight, 11.6 (7.7-15.6); obesity, 10.6 kg (6.7-14.3). Internal and external validation showed that the percentages above/below selected percentiles were close to those expected, except for underweight adolescents. These charts describe the GWG throughout pregnancy among Latin American adolescents and represent a significant contribution to the prenatal care of this group. GWG cut-offs based on values associated with lower risks of unfavorable outcomes for the mother-child binomial should be determined before implementing the charts in clinical practice.

Duración de lactancia materna y consumo de productos ultraprocesados y bebidas azucaradas en niños uruguayos menores de 4 años

RESUMEN Se ha descrito que una mayor duración de lactancia materna, parece estar asociada a hábitos alimentarios saludables en la primera infancia. Nuestro objetivo fue determinar la asociación entre duración de lactancia materna y consumo de productos ultra-procesados (PUP) y bebidas azucaradas (BA) en menores de 4 años, considerando seguridad alimentaria y contexto educativo. Adicionalmente se analizó ingesta de otros alimentos. Se analizaron transversalmente 3.077 niños de la Primera Encuesta Nacional de Salud, Nutrición y Desarrollo Infantil de Uruguay. Se aplicaron cuestionarios a la madre u otro adulto responsable. Se realizaron modelos de regresión logística crudos y ajustados por: edad materna, índice de masa corporal materna al momento de la entrevista, seguridad alimentaria y asistencia a centro educativo. Se consideraron significativos valores de p<0.05. En modelos ajustados no se encontró asociación entre duración de lactancia materna y PUP, ni BA (p≥0.31) en ningún grupo etario. En el total de niños ≥6 meses se encontró asociación significativa directa entre inseguridad alimentaria y consumo de PUP y BA (p<0.046). En niños ≥24 meses, se observó asociación inversa entre asistencia a centro educativo y BA (p= 0.002). Los ≥24 meses en la categoría menos saludable (BA SI+0-4 alimentos saludables), nunca recibieron lactancia (p= 0.001); y en la más saludable (BA NO+4-8 alimentos saludables) el 72.4% había tenido lactancia ≥6 meses (p= 0.001). En conclusión, queda en evidencia que la inseguridad alimentaria explica en gran medida el consumo tanto de alimentos ultra-procesados como de bebidas azucaradas.

ABSTRACT Longer duration of breastfeeding seems to be associated with healthier eating habits in children. The aim of this study was to determine the association between breastfeeding duration and the consumption of ultra-processed products and sweetened beverages (SB) among Uruguayan children under 4, considering food security and educational context. Additionally, the intake of other foods was analyzed. Data used in this cross-sectional study were obtained in the First National Survey of Child Health, Nutrition and Development of Uruguay (n=3,077). Adult participants answered a qualitative survey. Crude regression models were tested, and adjusted for maternal age, maternal body mass index, food security and school attendance; p-value 0.046). In children ≥24 months, an inverse association was observed between school attendance and SB (p= 0.002). Those ≥24 months in the less healthy category (SB yes +0-4 healthy foods), never received breastfeeding (p= 0.001); and in the healthiest one (SB no + 4-8 healthy foods), 72.4% had been breastfeeding for 6 months or more (p= 0.001). In conclusion, food insecurity could explain ultra-processed foods and sweetened beverages consumption.

Study of Food Intake and Physical Activity Patterns in the Working Population of the Uruguayan State Electrical Company (UTE): Design, Protocol and Methodology.

Noncommunicable diseases are the main cause of death globally, and most are potentially preventable; they are long term diseases and generally evolve slowly. In Uruguay 64.9% of the population between 25 and 64 years of age are either overweight or obese. The available scientific data show that workplaces are good for developing food-intake interventions for a healthier life. The present study aims to report the design, protocol and methodology for the evaluation of the food intake and physical activity patterns of the Uruguayan State Electrical Company (UTE) workers, as it is distributed across the whole country, and has established associations with overweight and obesity in order to establish institutional strategies to improve the situation. This study uses a population and a cross-sectional, randomized, representative sample of UTE workers with a precision of 3% and a confidence level of 95%. The considered anthropometric variables are weight, height, waist circumference, percentage of fat mass and percentage of visceral fat. A questionnaire on frequency of consumption of different foods and two 24-h dietary recalls (24-h DR) will be performed to evaluate the food intake. Accelerometry will be used to evaluate physical activity, and the International physical activity questionnaire (IPAQ) will be applied. Clinical data will be obtained from the UTE clinical charts. This is the first study of its kind that will be undertaken in Uruguay. It is registered under ClinicalTrials.gov Identifier nº NCT04509908.

Prevalence of malnutrition among children and women of reproductive age in Uruguay by socio-economic status and educational level.

OBJECTIVE: To describe the magnitude and distribution of malnutrition in all forms (stunting, wasting, overweight and obesity) by level of education and socio-economic status (SES). DESIGN: Representative data from three national surveys were used: the socio-economic characteristics of Uruguayan households the 2012-2013; the Survey of Child Health, Nutrition and Development and the Survey of Chronic Disease Risks. We defined overweight, obesity, wasting/underweight and stunting/short stature according to WHO criteria. We conducted a comparison between malnutrition prevalence values per SES and education level. SETTING: In total, 1 183 177 households were surveyed, including 2265 children's and 752 women's households, forming a nationally representative sample in urban areas with more than 5000 habitants. PARTICIPANTS: A total of 3079 children aged <4 years from the National Survey of Child Health, Nutrition and Development 2013 and 752 women aged 20-49 years from the National Survey of Chronic Disease Risks 2013 were included. RESULTS: Among children aged <4 years, stunting and overweight disproportionately affected low-wealth groups, with 5·45 % of children in the lower income tertile and 3·44 % in the upper tertile presenting stunting (P < 0·05). Overweight and obesity were higher in the third tertile of income. Among the women, 54·8 % (95 % CI 48·0, 61·6) had excess weight (overweight and obesity) and significant differences were found between those with the lowest and highest levels of SES. Regarding excess weight with respect to educational level, significant differences were also found between the low and high levels and between the medium and high levels. CONCLUSIONS: In Uruguay, there are slight differences in the prevalence of all forms of malnutrition according to SES and education levels in the populations considered. Excess weight in children and women poses the greatest public health nutritional challenge at all levels of SES and education. The fact that more educated mothers are more overweight differs from the findings in other countries and should be studied in more detail. Stunting in children is also important, requiring more focused interventions. Notably, excess weight is higher in more educated mothers, a fact that differs from other countries. Further analysis is important to understand this discrepancy.

Arterial Structural and Functional Characteristics at End of Early Childhood and Beginning of Adulthood: Impact of Body Size Gain during Early, Intermediate, Late and Global Growth.

An association between nutritional characteristics in theearlylife stages and the state of the cardiovascular (CV) system in early childhood itself and/or at the beginning of adulthood has been postulated. It is still controversial whether changes in weight, height and/or body mass index (BMI) during childhood or adolescence are independently associated with hemodynamics and/or arterial properties in early childhood and adulthood. AIMS: First, to evaluate and compare the strength of association between CVproperties (at 6 and 18 years (y)) and (a) anthropometric data at specific growth stages (e.g., birth, 6 y, 18 y) and (b) anthropometric changes during early (0-2 y), intermediate (0-6 y), late (6-18 y) and global (0-18 y) growth. Second, to determine whether the associations between CVproperties and growth-related body changes depend on size at birth and/or at the time of CVstudy. Third, to analyze the capacity of growth-related body size changes to explain hemodynamic and arterial properties in early childhood and adulthood before and after adjusting for exposure to CV risk factors. Anthropometric, hemodynamic (central, peripheral) and arterial parameters (structural, functional; elastic, transitional and muscular arteries) were assessed in two cohorts (children, n = 682; adolescents, n = 340). Data wereobtained and analyzed following identical protocols. RESULTS: Body-size changes in infancy (0-2 y) and childhood (0-6 y) showed similar strength of association with CV properties at 6 y. Conversely, 0-6, 6-18 or 0-18 ychanges were not associated with CV parameters at 18 y. The association between CV properties at 6 yand body-size changes during growth showed: equal or greater strength than the observed for body-size at birth, and lower strength compared to that obtained for current z-BMI. Conversely, only z-BMI at 18 y showed associations with CV z-scores at 18 y. Body size at birth showed almost no association with CVproperties at 6 or 18 y. CONCLUSION: current z-BMI showed the greatest capacity to explain variations in CV properties at 6 and 18 y. Variations in some CV parameters were mainly explained by growth-related anthropometric changes and/or by their interaction with current z-BMI. Body size at birth showed almost no association with arterial properties at 6 or 18 y.

Double burden of undernutrition and obesity in Uruguay.

BACKGROUND: Uruguay is at an advanced stage of the epidemiologic transition; like other Latin American countries, it bears a nutritional double burden composed of undernutrition and overweight or obesity. OBJECTIVES: The aim was to estimate whether a double burden of nutritional problems exists in Uruguay and to identify if governmental programs and policies for nutrition take this double burden into account. DESIGN: Existing studies were reviewed, and other data were processed specifically for the purpose of this article. Several data sources were used to include a broad, comprehensive population range. RESULTS: The prevalence of stunting in children aged <2 y is 10.9%. There is a high frequency of obesity, which increases with age (9.5% in children <2 y old, 18.8% in those aged 6 y, 20.4% in those aged 11 y, 26.6% in those aged 13-15 y, and 35.3% in adults). In addition, 13.8% of women start pregnancy underweight and the rate of obesity increases during pregnancy from 36.7% at the beginning to 46.5% at the end. Anemia is very frequent in the selected population we examined, as follows: 31% of children <2 y old and 20.9% of pregnant women in their third trimester. An obese mother with a stunted child are present in 6.3% of households; 1.9% of stunted children are obese at age 6 y and 3.1% are obese at the age of 11. Multiple logistic analysis applied to children <2 y showed an association between stunting and obesity (OR: 2.0; 95% CI: 1.2, 3.6). CONCLUSIONS: The data suggest that there is a nutritional double burden in Uruguay. This nutritional burden is similar to that of other countries in the region. This important public issue should be tackled, and it should be addressed in early infancy.

Zinc in plasma and breast milk in adolescents and adults in pregnancy and pospartum: a cohort study in Uruguay.

OBJECTIVE: To assess if age is a risk factor for low zinc nutritional status in pregnancy, postpartum and in breast milk concentration, and the association between mother zinc plasma level with zinc milk concentration. DESIGN: Cohort study comparing adolescents with adult women, with < 14 weeks of gestation at first prenatal care. Socio demographic and plasma zinc data were collected at that moment and at postpartum time (4 + 1 month). Milk zinc concentrations were also measured at 4 th month postpartum. SETTING: Women were recruited from 16 public primary health care services in Uruguay Subjects: 151 adolescents and 161 adult women. RESULTS: Adolescent average plasma zinc at < 14 weeks of gestation was 84.4 ± 3.6 ug /dl and did not differ significantly from that for adult women (85.2 ± 13.6 ug/dl). Prevalence of hypozincemia was relatively low with but with no difference by age (14.6% in adolescents and 12.3% in adults). Zinc concentrations in breast milk were similar for adolescents, 1.24 mg. /L (CI 1.06 to 1.44) and adult women, 1.27 mg./L (CI .1.0-1.46). There was no correlation between plasma zinc and breast milk zinc concentrations in adults and a weak correlation in adolescents (- 0.27, P <0.05). CONCLUSIONS: Prevalence of hypozincemia in pregnancy was relatively low but similar in adolescents and adult women. Neither pregnancy nor age had negative consequences over postpartum plasma zinc, nor over breast milk zinc concentrations. No correlation was found between mother s plasma zinc and breast milk levels.

Objetivo: Evaluar la edad como factor de riego para el déficit nutricional de zinc en el embarazo y en el posparto y la correlación entre la concentración de zinc plasmático y de la leche materna. Diseño: Estudio de cohorte de 151 embarazadas adolescentes y 161 adultas con < 14 semanas de gestación al primer control prenatal, seleccionadas en 16 centros públicos de salud de primer nivel de atención de Uruguay. Se obtuvieron datos socio demográficos y se determinó zinc plasmático al primer control prenatal y 4 meses posparto (± 1 mes). En el último control se midió también la concentración de zinc en la leche materna. Resultados: La media de concentración de zinc plasmático a las 14 semanas de gestación fue 84.4 ± 3.6 ug. /dl sin diferencias significativas con las adultas (85.2 ± 13.6 ug/dl). La prevalencia de hipozincemia fue relativamente baja, sin diferencias entre los grupos (14.6% en adolescentes y 12.3% en adultas). La concentración de zinc en la leche materna fue similar en adolescentes y adultas (1.2 CI 1.1-1.4 mg. /L en el grupo total). No se encontró correlación entre el nivel plasmático de zinc materno y la concentración en la leche en adultas y una débil correlación en el grupo de adolescentes (-0.27, P <0.05). Conclusión: La prevalencia de hipozincemia en el embarazo es relativamente baja y similar entre adultas y adolescentes. No se observó relación entre la edad materna y los niveles plasmáticos de zinc post parto en la madre ni en la leche materna. La concentración de zinc plasmático materno no se correlacionó con el zinc en la leche materna.

Zinc in plasma and breast milk in adolescents and adults in pregnancy and pospartum: a cohort study in Uruguay / Zinc en el plasma y leche materna en embarazadas adolescentes y adultas y en el postparto; estudio de cohorte en Uruguay

Objective: To assess if age is a risk factor for low zinc nutritional status in pregnancy, postpartum and in breast milk concentration, and the association between mother zinc plasma level with zinc milk concentration. Design: Cohort study comparing adolescents with adult women, with < 14 weeks of gestation at first prenatal care. Socio demographic and plasma zinc data were collected at that moment and at postpartum time (4 + 1 month). Milk zinc concentrations were also measured at 4th month postpartum. Setting: Women were recruited from 16 public primary health care services in Uruguay Subjects: 151 adolescents and 161 adult women Results: Adolescent average plasma zinc at < 14 weeks of gestation was 84.4 ± 3.6 ìg /dl and did not differ significantly from that for adult women (85.2 ± 13.6 ug/dl). Prevalence of hypozincemia was relatively low with but with no difference by age (14.6% in adolescents and 12.3% in adults). Zinc concentrations in breast milk were similar for adolescents, 1.24 mg. /L (CI 1.06 to 1.44) and adult women, 1.27 mg./L (CI .1.0-1.46). There was no correlation between plasma zinc and breast milk zinc concentrations in adults and a weak correlation in adolescents (-0.27, p <0.05).Conclusions: Prevalence of hypozincemia in pregnancy was relatively low but similar in adolescents and adult women. Neither pregnancy nor age had negative consequences over postpartum plasma zinc, nor over breast milk zinc concentrations. No correlation was found between mother s plasma zinc and breast milk levels (AU)

Objetivo: Evaluar la edad como factor de riego para el déficit nutricional de zinc en el embarazo y en el posparto y la correlación entre la concentración de zinc plasmático y de la leche materna. Diseño: Estudio de cohorte de 151 embarazadas adolescentes y 161 adultas con < 14 semanas de gestación al primer control prenatal, seleccionadas en 16 centros públicos de salud de primer nivel de atención de Uruguay. Se obtuvieron datos socio demográficos y se determinó zinc plasmático al primer control prenatal y 4 meses posparto (± 1 mes). En el último control se midió también la concentración de zinc en la leche materna. Resultados: La media de concentración de zinc plasmático a las 14 semanas de gestación fue 84.4 ± 3.6 ug. /dl sin diferencias significativas con las adultas (85.2 ± 13.6 ug/dl). La prevalencia de hipozincemia fue relativamente baja, sin diferencias entre los grupos (14.6% en adolescentes y 12.3% en adultas). La concentración de zinc en la leche materna fue similar en adolescentes y adultas (1.2 CI 1.1-1.4 mg. /L en el grupo total). No se encontró correlación entre el nivel plasmático de zinc materno y la concentración en la leche en adultas y una débil correlación en el grupo de adolescentes (-0.27, p <0.05). Conclusión: La prevalencia de hipozincemia en el embarazo es relativamente baja y similar entre adultas y adolescentes. No se observó relación entre la edad materna y los niveles plasmáticos de zinc post parto en la madre ni en la leche materna. La concentración de zinc plasmático materno no se correlacionó con el zinc en la leche materna (AU)

Nutrición de la embarazada diabética / Nutrition of the pregnant diabetic patient

La Diabetes gestacional (D.G.) se define como una alteración del metabolismo de los hidratos de carbono, de severidad variable, que comienza o se reconoce por primera vez durante el embarazo. Se aplica independientemente de si se requiere o no insulina, o si la alteración persiste después del embarazo. El tratamiento de la paciente con Diabetes Gestacional se basa en cuatro pilares básicos: educación nutricional, plan de alimentación, insulinoterapia y actividad física. Sin educación diabetológica sería imposible atender correctamente a la mujer con Diabetes Gestacional. El plan de alimentación tiene como objetivos: asegurar el correcto estado de nutrición, aportar energía y nutrientes necesarios para la salud materno-fetal, evitar la hiperglucemia posprandial, prevenir la hipoglucemia, evitar la descompensación cetoacidósica, evitar la cetosis de ayuno y favorecer la lactancia. Los requerimientos de la mujer embarazada con Diabetes Gestacional son iguales a los de la embarazada no diabética. El plan de alimentación debe reverse y ajustarse durante su transcurso, resaltando la importancia de los horarios de comidas y colaciones, respetando en lo posible hábitos y situación socioeconómica.