Genetic biomarkers related to hemarthrosis, inflammation, and cartilage structure in pediatric patients with hemophilic arthropathy.

BACKGROUND: The pathophysiology of hemophilic arthropathy is complex and not completely understood. In this study, we aimed to identify biomarkers that can affect the hemophilic arthropathy severity. METHODS: Fifty patients were analyzed for biomarker frequencies; in 37 patients, articular symptoms were evaluated based on the physical joint examination score, and in 18, it was based on magnetic resonance imaging. Eight polymorphisms, namely FV 1691G>A, FII 20210G>A, MTHFR 677C>T and 1298A>C, TNFα-308G>A and -238G>A, ACAN VNTR, and IL1RN*2-VNTR were identified. RESULTS: Patients with the MTHFR 677TT genotype showed a higher number of affected joints (1.83 ± 0.9 vs. 0.55 ± 0.7 for CC; p = .023), whereas those with the MTHFR 1298AC genotype exhibited higher effusion according to two radiologists (0.90 ± 0.31/1.20 ± 0.63 vs. 0.38 ± 0.52/0.50 ± 0.53 for AA genotype; p = .043/0.036, respectively). In addition, patients with the TNFα-308GA genotype had more subchondral cysts (0.75 ± 0.95 vs. 0.07 ± 0.26 for GG genotype; p = .041). CONCLUSIONS: The distribution of risk genotypes for MTHFR and TNFα-308GA suggests their association with clinical parameters of hemophilic arthropathy. Cohort studies are essential to verify these associations.

Nutritional support strategies in pediatric cancer patients in Mexico / Estrategias de soporte nutricio en pacientes pediátricos con cáncer en México

Background: Meeting the nutritional needs of pediatric patients on oncology services in low budget public hospitals of Mexico is a continuous challenge, due to its financial resources. Objective: To evaluate the effectiveness of a nutritional strategy for children and adolescents with cancer in a public hospital of Mexico, based on a complacency diet. Methods: Across-sectional study included 58 children and adolescents (1-18 years old). An assessment of nutritional status was applied and a dietary diary was elaborated for 24 hours with the double weight method. Results: 43 patients (74.4%) had an adequate nutritional status. The average energy intake was 72.8% and average protein intake 168.3% of the requirements. The hospital meals accounted for 67.5% of the energy intake, 28.5% resulted from snacks and 3.9% from oral nutritional supplements or polymeric smoothies. Conclusion: The nutritional strategy based on offering a menu at the request supported by smoothies or oral nutritional supplements and the permission to introduce snacks to the hospital offers convenience and flexibility for meal times and favors the energy intake in hospitalized pediatric oncology patients.

Introducción: debido a la escasez de recursos económicos, los hospitales públicos de México tienen un reto continuo para satisfacer las necesidades nutricionales de niños en los servicios de oncología pediátrica. Objetivo: evaluar la eficacia de una estrategia nutricional en niños y adolescentes con cáncer, de un hospital público de México, basada en una dieta a complacencia. Métodos: se llevó a cabo un estudio transversal en el que se incluyeron 58 niños y adolescentes (1-18 años de edad). Se realizó una evaluación antropométrica del estado nutricio y se elaboró un diario dietético durante 24 horas con el método de doble pesada. Resultados: 43 pacientes (74.4%) tenían un estado nutricio adecuado. El consumo promedio de energía fue 72.8% y de proteínas 168.3% del requerimiento. Del total de las calorías consumidas 67.5% provenían del menú hospitalario, 28.5% de refrigerios y 3.9% de suplementos alimenticios o licuados artesanales. Conclusión: la estrategia nutricional basada en una dieta a complacencia apoyada por licuados y suplementos alimenticios más un permiso para la introducción de refrigerios al hospital, favoreció la ingestión calórica, ofreció comodidad y flexibilidad durante las horas de comida a los pacientes oncológicos pediátricos hospitalizados.

Energy expenditure is associated with age, anthropometric indicators and body composition in children with spastic cerebral palsy.

INTRODUCTION: proper estimation of energy requirements in children with cerebral palsy (CP) is essential in ensuring that their energy needs are optimally met. OBJECTIVE: therefore, the purpose of this study was to demonstrate that resting energy expenditure (REE) and total energy expenditure (TEE) are associated with age, anthropometric indicators and body composition in children with spastic cerebral palsy. METHODS: a cross-sectional study included 79 participants with spastic CP from 24 months to 16 years nine months. Weight and height (estimated by lower leg length) were obtained; body composition and energy expenditure were estimated by bioelectrical impedance analysis. ANOVA, post hoc tests, the Pearson correlation and determination coefficients (R2) were performed. RESULTS: significant gradual increases according to age in REE and TEE (both in kcal/d) were observed. There were highly significant positive correlations between REE and TEE (kcal/d, kcal/cm/d) with fat-free mass (FFM) and fat mass (FM), but negative correlations between REE (kcal/ kg/d) with body composition and energy indicators. FFM and total body water, and to a lesser extent FM, explained a high percentage of the direct variability of REE and TEE in kcal/d and the inverse in kcal/kg/d. CONCLUSIONS: as age increased, energy expenditure also increased. The estimated energy expenditure in kcal/cm/d did not differ with age and sex. The estimated energy expenditure, based on height, would be a practical and reliable method for estimating energy expenditure and ensuring adequate nutritional status.

Energy expenditure is associated with age, anthropometric indicators and body composition in children with spastic cerebral palsy / El gasto energético se asocia con la edad, los indicadores antropométricos y la composición corporal en niños con parálisis cerebral espástica

Introduction: proper estimation of energy requirements in children with cerebral palsy (CP) is essential in ensuring that their energy needs are optimally met. Objective: therefore, the purpose of this study was to demonstrate that resting energy expenditure (REE) and total energy expenditure (TEE) are associated with age, anthropometric indicators and body composition in children with spastic cerebral palsy. Methods: a cross-sectional study included 79 participants with spastic CP from 24 months to 16 years nine months. Weight and height (estimated by lower leg length) were obtained; body composition and energy expenditure were estimated by bioelectrical impedance analysis. ANOVA, post hoc tests, the Pearson correlation and determination coefficients (R2) were performed. Results: significant gradual increases according to age in REE and TEE (both in kcal/d) were observed. There were highly significant positive correlations between REE and TEE (kcal/d, kcal/cm/d) with fat-free mass (FFM) and fat mass (FM), but negative correlations between REE (kcal/ kg/d) with body composition and energy indicators. FFM and total body water, and to a lesser extent FM, explained a high percentage of the direct variability of REE and TEE in kcal/d and the inverse in kcal/kg/d. Conclusions: as age increased, energy expenditure also increased. The estimated energy expenditure in kcal/cm/d did not differ with age and sex. The estimated energy expenditure, based on height, would be a practical and reliable method for estimating energy expenditure and ensuring adequate nutritional status

Introducción: la estimación adecuada de los requerimientos de energía en niños con parálisis cerebral (PC) es indispensable para garantizar que sus necesidades energéticas se cumplan de manera optima. Objetivo: demostrar que el gasto de energía en reposo (GER) y el gasto energético total (GET) se asocian con la edad y los indicadores antropométricos y de composición corporal en niños con parálisis cerebral (PC) espástica. Métodos: un estudio transversal incluyo 79 participantes con PC espástica de 24 meses a 16 años y nueve meses de edad. Se obtuvieron el peso y la talla (estimados por la longitud de la pierna inferior); la composición corporal y el gasto de energía se estimaron mediante análisis de impedancia bioelectrica. Se realizaron ANOVA, pruebas post hoc, los coeficientes de correlación y determinación de Pearson (R2). Resultados: se observaron incrementos graduales significativos según la edad en GER y GET (ambos en kcal/d). Hubo correlaciones positivas altamente significativas entre GER y GET (kcal/d, kcal/cm/d) con masa libre de grasa (MLG) y masa grasa (MG) y correlaciones negativas entre GER (kcal/kg/d) con la composición corporal e indicadores de energía. La MLG y el agua corporal total, y en menor grado la MG, explicaron un porcentaje elevado de la variabilidad de GER y GET en kcal/d y en kcal/kg/d Conclusiones: conforme aumento la edad, aumento también el gasto de energía. El gasto energético estimado en kcal/cm/d no difirió con la edad y el sexo. Por tanto, el gasto energético basado en la talla seria un método practico y confiable para garantizar un estado nutricio adecuado

Public and Private Hospital Care Disparities of Ischemic Stroke in Mexico: Results from the Primer Registro Mexicano de Isquemia Cerebral (PREMIER) Study.

BACKGROUND AND AIMS: Mortality and bad outcome by stroke are higher in developing countries than in industrialized countries. Health-care system efficiency could explain these disparities. Our objective was to identify the impact on short- and middle-term outcomes of patients with acute ischemic stroke (AIS) among public and private Mexican medical care. METHODS: We analyzed data from patients with AIS included in the Primer Registro Mexicano de Isquemia Cerebral (PREMIER) study. Transient ischemic attacks (TIAs) and ambulatory patients were excluded. Mortality and good outcome were assessed by the modified Rankin Scale (mRS) and analyzed at 1, 3, and 12 months of follow-up. RESULTS: From 1246 patients with AIS included in the registry, 1123 were hospitalized, either in public (n = 881) or in private (n = 242) hospitals. There were no significant differences regarding age and gender. In private settings, patients had a higher educational level, a major frequency of dyslipidemia, a previous stroke and TIA, less overweight and obesity, a sedentary lifestyle, and diabetes; stroke severity, the rate of systemic complications, the length of stay, and in-hospital mortality were also lower; a major frequency of thrombolysis was observed when compared with public hospitals. Our study showed a better outcome (mRS score ≤2) in private scenarios and a higher mortality in patients treated in public hospitals at short- and middle-term follow-ups. CONCLUSIONS: A polarized medical practice was observed in the AIS care in this large multicenter cohort of Mexico. There is evidence of an advantage for private scenarios, possibly related with an optimal infrastructure or with a strong patient's economic status.

Patient-Generated Subjective Global Assessment of nutritional status in pediatric patients with recent cancer diagnosis.

BACKGROUND: The subjective global assessment (SGA) is a simple, sensitive tool used to identify nutritional risk. It is widely used in the adult population, but there is little evidence on its effectiveness in children with cancer. OBJECTIVE: This cross-sectional study was undertaken to demonstrate significant correlation between a simplified version of the Patient-Generated SGA (PG-SGA) and anthropometric assessment to identify nutritional status in children recently diagnosed with cancer. METHODS: The nutritional status of 70 pediatric cancer patients was assessed with the PG-SGA and anthropometric measurements. The relation between the assessments was tested with ANOVA, independent samples t-test, Kappa statistic, and non-parametric Spearman and Kendall correlation coefficient. The PG-SGA divided the patients into four groups: well nourished, mildly, moderately and severely malnourished. RESULTS: The prevalence of malnutrition according to the PG-SGA was 21.4%. The correlations (r ≥ 0.300, p < 0.001) and the concordance (k ≥ 0.327, p < 0.001) between the PG-SGA and anthropometric indicators were moderate and significant. CONCLUSIONS: The results indicate that the PG-SGA is a valid tool for assessing nutritional status in hospitalized children recently diagnosed with cancer. It is important to emphasize that the subjective assessment does not detect growth retardation, overweight or obesity.

Patient-Generated Subjective Global Assessment of nutritional status in pediatric patients with recent cancer diagnosis / Estado nutricio en pacientes pediátricos con reciente diagnóstico de cáncer mediante la Evaluación Global Subjetiva Generada por el Paciente

Background: The subjective global assessment (SGA) is a simple, sensitive tool used to identify nutritional risk. It is widely used in the adult population, but there is little evidence on its effectiveness in children with cancer. Objective: This cross-sectional study was undertaken to demonstrate significant correlation between a simplified version of the Patient-Generated SGA (PG-SGA) and anthropometric assessment to identify nutritional status in children recently diagnosed with cancer. Methods: The nutritional status of 70 pediatric cancer patients was assessed with the PG-SGA and anthropometric measurements. The relation between the assessments was tested with ANOVA, independent samples t-test, Kappa statistic, and non-parametric Spearman and Kendall correlation coefficient. The PG-SGA divided the patients into four groups: well nourished, mildly, moderately and severely malnourished. Results: The prevalence of malnutrition according to the PG-SGA was 21.4%. The correlations (r ≥ 0.300, p < 0.001) and the concordance (k ≥ 0.327, p < 0.001) between the PG-SGA and anthropometric indicators were moderate and significant. Conclusions: The results indicate that the PG-SGA is a valid tool for assessing nutritional status in hospitalized children recently diagnosed with cancer. It is important to emphasize that the subjective assessment does not detect growth retardation, overweight or obesity (AU)

Introducción: la evaluación global subjetiva (EGS) es una herramienta sensible y simple que se utiliza para identificar el riesgo nutricional. Es ampliamente utilizada en la población adulta, pero hay poca evidencia sobre su efectividad en niños con cáncer. Objetivo: este estudio transversal fue realizado para demostrar una correlación significativa entre una versión simplificada de la EGS generada por el paciente (EGS-GP) y la evaluación antropométrica para identificar el estado nutricio en niños con reciente diagnóstico de cáncer. Métodos: el estado nutricio de 70 pacientes pediátricos con cáncer fue evaluado con la EGS-GP y las mediciones antropométricas. La relación entre las evaluaciones fue examinada con ANOVA, t de Student para muestras independientes, concordancia de Kappa, coeficientes de correlación no-paramétricas de Spearman y Kendall. La EGS-GP dividió a los pacientes en cuatro grupos: bien nutrido, levemente, moderadamente y gravemente desnutrido. Resultados: la prevalencia de desnutrición de acuerdo a la EGS-GP fue 21.4%. Las correlaciones (r ≥ 0,300, p < 0,001) y la concordancia (k ≥ 0,327, p < 0,001) entre la EGS-GP y los indicadores antropométricos fueron moderadas y significativas. Conclusiones: los resultados indican que la EGS-GP es una herramienta válida para la evaluación del estado nutricio en niños hospitalizados con reciente diagnóstico de cáncer. Es importante enfatizar que la evaluación subjetiva no detecta retraso en el crecimiento, sobrepeso u obesidad (AU)

Diferencias entre conductas alimentarias de preescolares que recibieron lactancia materna completa y preescolares que recibieron sucedáneos de la leche humana / Eating behaviors of preschoolers who were exclusively breastfed, and preschoolers who received human milk substitutes

El propósito fue demostrar diferencias en las conductas alimentarias entre preescolares que recibieron lactancia materna completa (LMC: exclusiva o predominante) y preescolares que recibieron sucedáneos de la leche humana (SLH), que acuden a jardín de niños de la zona metropolitana de Guadalajara. En estudio trasversal analítico por conveniencia, se seleccionaron a 177 preescolares de tres a cinco años de edad, sanos, nacidos a término, peso normal al nacer, con antecedentes de alimentación con LME o SLH que acudían a tres jardines de niños. Se aplicó un cuestionario validado de conductas alimentarias que consta de ocho escalas. Se obtuvieron variables socioeconómicas y demográficas de las familias e indicadores antropométricos de los participantes. Se aplicaron pruebas t de Student, U de Mann-Whitney, Chi cuadrado, razón de momios, coeficiente de correlación de Pearson y regresión logística. Hubo 2.8 veces mayor probabilidad de puntaje elevado en la escala comer menos por emociones en el grupo de SLH [RM=2.8 (1.0, 8.3), p=0.037]. Se observaron 15 correlaciones significativas entre las diferentes escalas del cuestionario en el grupo de LMC (62.5%) y nueve en el grupo de SLH (37.5%). Hubo siete correlaciones significativas entre las escalas en el grupo LMC que no fueron significativas en el grupo de SLH. En preescolares que recibieron LMC, a mayor lentitud para comer hubo menor irritabilidad hacia los alimentos (r=-0.325, p=0.01). Los preescolares con antecedentes de LMC tendrían menor probabilidad de alteraciones de conducta alimentaria y mostraron mayor número de correlaciones significativas entre las escalas que los preescolares que recibieron SLH(AU)

The purpose was to demonstrate differences in eating behaviors among preschool children who received full breastfeeding (FBF: exclusive or predominant) and preschool children who received human milk substitutes (HMS), who attend kindergarten in the metropolitan area of Guadalajara, Mexico. In analytical cross-sectional study by convenience, 177 preschoolers, three to five years old, healthy, term infants with normal weight at birth and feeding history of FBF or HMS attending three kindergartens were selected. A validated questionnaire of eating behaviors consisting of eight scales was applied. Socioeconomic and demographic variables of families and anthropometric indicators of participants were obtained. Student's t test, U Mann-Whitney, chi-square, odds ratio, Pearson correlation coefficient and logistic regression tests were applied. There were 2.8 times more likely to score high on the scale eat less by emotions in HMS group [OR = 2.8 (1.0, 8.3), p = 0.037]. Fifteen significant correlations between different scales of the questionnaire in the FBF group (62.5%) and nine in the HMS group (37.5%) were observed. There were seven significant correlations among the scales in FBF group, but not significant in the HMS group. In preschoolers receiving FBF, more frequency of eating slowly was related to less irritability to food (r=-0.325, p=0.01).Preschoolers with a history of FBF would be less likely to have alterations in eating behavior and showed more significant correlations between the scales that preschoolers who received HMS(AU)

Assessment of anthropometric indicators in children with cerebral palsy according to the type of motor dysfunction and reference standard.

AIM: The study aimed to demonstrate that the assessment of the anthropomorphic measurements of children with cerebral palsy (CP) varies according to the type of motor dysfunction and references standard used for comparison. METHOD: In a cross-sectional design, 108 children 2 to 16 years were classified according to the type of motor dysfunction by gender and age group. Weight, mid-upper-arm-circumference (MUAC), and alternative measures for height were performed. Height/age and weight/age indexes and BMI were evaluated with percentiles and/or Z-scores with reference to a number of previously published references of growth, including those of the World Health Organization (WHO). RESULTS: Fifty-three (49.1%) were females and 55 (50.9%) males. Spastic type was predominant (73.1%) and 26.9% were other types of dysfunction. Most of the children were located on level IV (14.6%) and level V (73.1%) of the Gross Motor Function Classification System (GMFCS). Significant differences were found, suggesting that weight (p = 0.002), height (p = 0.001), and MUAC (p = 0.05) are higher in the spastic group than in other groups. CONCLUSIONS: The anthropometric indicators were significantly higher in the spastic group than in other groups. Upper-arm length (UAL) seemed less appropriate than knee height (KH) and lower-leg length (LLL) for measuring height. The WHO reference standard was not useful to evaluate the majority of anthropometric indexes in children with CP, other references as the growth charts of Day and Brooks have been more suitable.

Assessment of anthropometric indicators in children with cerebral palsy according to the type of motor dysfunction and reference standard / Evaluación de indicadores antropométricos en niños con parálisis cerebral de acuerdo con el tipo de disfunción motora y estándar de referencia

Aim: The study aimed to demonstrate that the assessment of the anthropomorphic measurements of children with cerebral palsy (CP) varies according to the type of motor dysfunction and references standard used for comparison. Method: In a cross-sectional design, 108 children 2 to 16 years were classified according to the type of motor dysfunction by gender and age group. Weight, mid-upper-arm-circumference (MUAC), and alternative measures for height were performed. Height/age and weight/age indexes and BMI were evaluated with percentiles and/or Z-scores with reference to a number of previously published references of growth, including those of the World Health Organization (WHO). Results: Fifty-three (49.1%) were females and 55 (50.9%) males. Spastic type was predominant (73.1%) and 26.9% were other types of dysfunction. Most of the children were located on level IV (14.6%) and level V (73.1%) of the Gross Motor Function Classification System (GMFCS). Significant differences were found, suggesting that weight (p = 0.002), height (p = 0.001), and MUAC (p = 0.05) are higher in the spastic group than in other groups. Conclusions: The anthropometric indicators were significantly higher in the spastic group than in other groups. Upper-arm length (UAL) seemed less appropriate than knee height (KH) and lower-leg length (LLL) for measuring height. The WHO reference standard was not useful to evaluate the majority of anthropometric indexes in children with CP, other references as the growth charts of Day and Brooks have been more suitable (AU)

Objetivo: demostrar que la evaluación de las mediciones antropomórficas de los niños con parálisis cerebral (PC) varía según el tipo de disfunción motora y la referencia estándar utilizada. Método: en un diseño transversal se incluyeron 108 niños de 2 a 16 años clasificados de acuerdo con el tipo de disfunción motora por sexo y grupos de edad. Se obtuvieron el peso, circunferencia media de brazo y mediciones alternas para la talla. Los índices talla/edad, peso/edad y el IMC fueron evaluados con los percentiles y/o puntuaciones Z con referencia a estándares de crecimiento previamente publicados, incluyendo los de la Organización Mundial de la Salud (OMS). Resultados: cincuenta y tres (49.1%) eran mujeres y 55 (50.9 %) hombres. Predominó la PC tipo espástico (73.1%) y 26.9% otros tipos de disfunción. La mayoría de los niños se encontraron en el nivel IV (14.6%) y en el nivel V (73.1 %) de la Gross Motor Function Classification System (GMFCS). Se encontraron diferencias significativas, lo que sugiere que el peso (p = 0,002), talla (p = 0,001), y la circunferencia media del brazo CMB (p = 0,05) son mayores en el grupo espástico que en otros grupos. Conclusiones: los indicadores antropométricos fueron mayores en el grupo espástico. La longitud del brazo pareció menos apropiada que la altura de la rodilla y la longitud de la pierna para la medición de la talla. El estándar de crecimiento de la OMS no resultó útil para evaluar los índices antropométricos en niños con parálisis cerebral; otras referencias como las tablas de crecimiento de Day y Brooks fueron más adecuadas (AU)

Risk of malnutrition of hospitalized children in a university public hospital.

OBJECTIVE: The study aimed to demonstrate that the duration of hospitalization has a significant effect on the nutritional status of children treated in a university hospital. METHODS: A longitudinal study was conducted during 2014, with a non-random sampling site concentration in children from birth to 19 years who were admitted to the hospital in the past 24 hours and who met the inclusion criteria and had signed informed consent. Upon entering, at 7 days, and at discharge, anthropometric indices, including weight/age, height/age, weight/height, BMI/age, head circumference/age, triceps and subscapular skin folds, and fat percentage, were obtained. Student's t-test, U Mann-Whitney, ANOVA, chi square, Wilcoxon, and odds ratios were used to analyze the data. RESULTS: In total, 206 patients were included: 40% infants, 25% preschoolers, 15% schoolchildren, and 20% teenagers. Infants had a significant improvement from admission to discharge in the indices weight/length (p = 0.042) and BMI (p = 0.002); adolescents showed decreased BMI from admission to discharge from the hospital (p = 0.05). Patients with longer hospitalization (more than 10 days) had an increased deficit in anthropometric indices at admission (p < 0.05). Infants had a higher risk of deficit in the BMI index and height/age than preschoolers, schoolchildren, and adolescents between admission and discharge. CONCLUSION: When the nutritional condition of a child was critical at admission, the child remained hospitalized significantly longer. Infants come under the age group most vulnerable to malnutrition and require greater monitoring of nutritional status during hospitalization.

Risk of malnutrition of hospitalized children in a university public hospital / Riesgo de desnutrición en niños hospitalizados en un hospital público universitario

Objective: The study aimed to demonstrate that the duration of hospitalization has a significant effect on the nutritional status of children treated in a university hospital. Methods: A longitudinal study was conducted during 2014, with a non-random sampling site concentration in children from birth to 19 years who were admitted to the hospital in the past 24 hours and who met the inclusion criteria and had signed informed consent. Upon entering, at 7 days, and at discharge, anthropometric indices, including weight/age, height/age, weight/height, BMI/age, head circumference/age, triceps and subscapular skin folds, and fat percentage, were obtained. Student’s t-test, U Mann-Whitney, ANOVA, chi square, Wilcoxon, and odds ratios were used to analyze the data. Results: In total, 206 patients were included: 40% infants, 25% preschoolers, 15% schoolchildren, and 20% teenagers. Infants had a significant improvement from admission to discharge in the indices weight/length (p = 0.042) and BMI (p = 0.002); adolescents showed decreased BMI from admission to discharge from the hospital (p = 0.05). Patients with longer hospitalization (more than 10 days) had an increased deficit in anthropometric indices at admission (p < 0.05). Infants had a higher risk of deficit in the BMI index and height/age than preschoolers, schoolchildren, and adolescents between admission and discharge. Conclusion: When the nutritional condition of a child was critical at admission, the child remained hospitalized significantly longer. Infants come under the age group most vulnerable to malnutrition and require greater monitoring of nutritional status during hospitalization (AU)

Objetivo: demostrar que la duración de la hospitalización tiene un efecto significativo sobre el estado nutricional de niños internados en un hospital para población general. Métodos: estudio longitudinal llevado a cabo durante 2014 en niños con edades comprendidas desde el nacimiento hasta los 19 años, ingresados en un hospital público en las últimas 24 horas. Al ingreso, a los 7 días y al alta hospitalaria se obtuvieron los índices antropométricos peso/edad, talla/edad, peso/talla, IMC/edad, circunferencia cefálica/edad, pliegues cutáneos tricipital y subescapular y el porcentaje de grasa. Para el análisis de datos se utilizaron las pruebas t de Student, U Mann-Whitney, ANOVA, Chi-cuadrado, Wilcoxon y razón de momios. Resultados: se incluyeron 206 pacientes: 40% lactantes, 25% preescolares, 15% escolares y 20% adolescentes. Los lactantes tuvieron una mejoría significativa desde el ingreso al alta en los índices peso/talla (p = 0,042) y el IMC (p = 0,002); los adolescentes mostraron una disminución del IMC desde el ingreso hasta el alta del hospital (p = 0,05). Hubo mayor déficit en los índices antropométricos al ingreso en pacientes con una hospitalización superior a 10 días (p < 0,05). Entre el ingreso y el alta, los lactantes tuvieron un riesgo mayor de déficit en el índice talla/edad y en el IMC que los niños preescolares, escolares y adolescentes. Conclusión: cuando la condición nutricia del niño fue crítica al ingreso, permaneció hospitalizado por un periodo significativamente más largo. Los lactantes fueron el grupo etario más vulnerable a la desnutrición y requieren de mayor vigilancia del estado nutricio y la alimentación durante la hospitalización (AU)

Hábitos de alimentación en adolescentes embarazadas de acuerdo a su estado civil.

Objetivo: identificar los hábitos alimentarios de adolescentes embarazadas en cuatro estados civiles diferentes: casada, cohabita con una pareja, soltera sin pareja y soltera con una pareja. Métodos: en estudio transversal, se incluyeron 321 adolescentes embarazadas de 13-19 años que acudieron al Hospital Civil de Guadalajara Dr. Juan I Menchaca, Guadalajara (Jalisco, México). Se encontraban sanas, en cualquier trimestre del embarazo y pertenecían a un nivel socioe-conómico bajo o medio-bajo. El estado civil se estratificó en: casadas; en unión libre; soltera con una pareja y soltera sin pareja. Se incluyeron datos socio-demográficos, económicos y de hábitos de alimentación. Se utilizaron pruebas de ANOVA, pruebas post-hoc para Chi 2 , razón de momios y modelos de regresión logística. Resultados: la frecuencia de las adolescentes casadas fue de 9,3%, 59,8% en unión libre, 15,3% eran solteras sin pareja y 15,6% solteras con pareja. La baja escolaridad (RM 2,6 [1,5-4,4]) y la ocupación en el hogar (RM 4,47 [1,99-10,0]) predominaron entre las adolescentes en unión libre; la ocupación en el hogar (RM 0,28 [0,127-0,61]) y cenar sin compañía (RM 4,12 [1,62-10,8]) fueron significativamente más frecuentes en adolescentes sin pareja. El consumo de verduras fue menor en las adolescentes casadas y en quienes cohabitaban con pareja; el consumo de frijoles y pan dulce fue menor en adolescentes embarazadas casadas. Conclusión: debido a que ciertas variables y hábitos de alimentación mostraron diferencias entre los grupos es pertinente analizar las adolescentes embarazadas de acuerdo a su estado civil.

Food habits in Mexican pregnant adolescents according to their civil status / Hábitos de alimentación en adolescentes embarazadas de acuerdo a su estado civil

Objective: To identify the feeding habits of pregnant adolescents in four different civil status: married, cohabiting with a partner, single with no partner and single with a partner. Methods: In a cross-sectional study, 321 pregnant adolescents aged 13 to 19 years old who attended the Hospital Civil de Guadalajara Dr. Juan I Menchaca, Guadalajara (Jalisco, Mexico) were included. They were healthy, in any trimester of pregnancy and had either a low or medium-low socioeconomic status. The civil status of adolescents was stratified into: a) married, b) cohabiting with a partner, c) single with a partner and d) single without a partner. Socio-demographic, economic and feeding habits data were included. ANOVA, post-hoc tests for Chi2 , odds ratio and logistic regression models were used. Results: The frequency of married adolescents was 9.3%; 59.8% of the adolescents were cohabiting, 15.3% of the adolescents were single without a partner and 15.6% of the adolescents were single with a partner. Low schooling (OR 2.6 [1.5-4.4]) and occupation in housework (OR 4.47 [1.99-10.0]) predominated among adolescents in cohabitating with a partner; an occupation at home (OR 0.28 [0.127 to 0.61]) and unaccompanied dining (OR 4.12 [1.62-10.8]) were the factors with the most epidemiological significance in single without a partner adolescents. The consumption of vegetables was significantly lower in married adolescents and cohabiting-with-partner adolescents; consumption of beans and sweet bread was significantly lower in pregnant married adolescents. Conclusion: Because some variables and eating habits depended on civil status, it is pertinent to analyze them in each group of pregnant teenagers separately (AU)

Objetivo: identificar los hábitos alimentarios de adolescentes embarazadas en cuatro estados civiles diferentes: casada, cohabita con una pareja, soltera sin pareja y soltera con una pareja. Métodos: en estudio transversal, se incluyeron 321 adolescentes embarazadas de 13-19 años que acudieron al Hospital Civil de Guadalajara Dr. Juan I Menchaca, Guadalajara (Jalisco, México). Se encontraban sanas, en cualquier trimestre del embarazo y pertenecían a un nivel socioeconómico bajo o medio-bajo. El estado civil se estratificó en: casadas; en unión libre; soltera con una pareja y soltera sin pareja. Se incluyeron datos socio-demográficos, económicos y de hábitos de alimentación. Se utilizaron pruebas de ANOVA, pruebas post-hoc para Chi2 , razón de momios y modelos de regresión logística. Resultados: la frecuencia de las adolescentes casadas fue de 9,3%, 59,8% en unión libre, 15,3% eran solteras sin pareja y 15,6% solteras con pareja. La baja escolaridad (RM 2,6 [1,5-4,4]) y la ocupación en el hogar (RM 4,47 [1,99-10,0]) predominaron entre las adolescentes en unión libre; la ocupación en el hogar (RM 0,28 [0,127-0,61]) y cenar sin compañía (RM 4,12 [1,62-10,8]) fueron significativamente más frecuentes en adolescentes sin pareja. El consumo de verduras fue menor en las adolescentes casadas y en quienes cohabitaban con pareja; el consumo de frijoles y pan dulce fue menor en adolescentes embarazadas casadas. Conclusión: debido a que ciertas variables y hábitos de alimentación mostraron diferencias entre los grupos es pertinente analizar las adolescentes embarazadas de acuerdo a su estado civil (AU)

INTRODUCTION OF PASTEURIZED/RAW COW'S MILK DURING THE SECOND SEMESTER OF LIFE AS A RISK FACTOR OF TYPE 1 DIABETES MELLITUS IN SCHOOL CHILDREN AND ADOLESCENTS.

OBJECTIVE: to demonstrate that type 1 diabetes mellitus (T1DM) in school children and adolescents is associated with the early introduction of pasteurized/raw cow's milk in the second semester of life. MATERIAL AND METHODS: this non-probabilistic study included 150 subjects (75 patients and 75 controls), divided according to sex and age (range, 6 to 16 years). T1DM was considered to be a dependent variable, and pasteurized/ raw cow's milk (P/RCM) was considered to be an independent variable in the study. The statistical analyses included chi-squared test, odds ratio and 95% confidence intervals. RESULTS: the subjects were 51% male, age 11 ± 3.2 years, and 80% were breastfed, 18% were exclusively breastfed, and 13% received pasteurized/raw cow's milk. The children receiving P/RCM had a higher risk of T1DM [OR, 3.9 (1.2-12.8)]. The presence of T1DM was three times higher in those consuming P/RCM vs. those receiving follow-up formula [RM, 3.2 (1.03-10.07)]. CONCLUSIONS: introducing pasteurized/raw cow's milk in the second semester of life increased by four times the likelihood of developing T1DM in children and adolescents.

Objetivo: demostrar que la diabetes mellitus tipo 1 (DMT1) en escolares y adolescentes se asocia a una temprana introducción de leche entera pasteurizada/no pasteurizada en el segundo semestre de vida. Material y métodos: en este estudio no probabilístico de casos y controles se incluyeron 150 participantes (75 pacientes y 75 controles), divididos de acuerdo a la edad y el sexo de 6 a 16 años de edad. Se consideró DMT1 como una variable independiente. El análisis estadístico incluyó la prueba de Ji cuadrada y razón de momios con su intervalo de confianza del 95% Resultados: los participantes fueron 51% varones, con edades de 11 ± 3.2 años y el 80% alimentados al pecho materno, 18% en forma exclusiva, y el 13% recibieron leche entera pasteurizada/no pasteurizada. Los niños que recibieron leche entera pasteurizada/no pasteurizada tuvieron un riesgo mayor de DMT1 [OR, 3,9 (1,2-12,8)]. La presencia de DMT1 fue tres veces más elevada en quienes consumieron leche entera pasteurizada/no pasteurizada que en aquellos que recibieron fórmula de seguimiento [RM, 3,2 (1,03-10,07)]. Conclusión: la introducción de leche entera pasteurizada/ no pasteurizada en el segundo semestre de vida incrementó cuatro veces la probabilidad de desarrollo de DMT1 en escolares y adolescentes.

Effects of Ezetimibe/Simvastatin and Rosuvastatin on Oxidative Stress in Diabetic Neuropathy: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

OBJECTIVE: To evaluate the effects of ezetimibe/simvastatin (EZE/SIMV) and rosuvastatin (ROSUV) on oxidative stress (OS) markers in patients with diabetic polyneuropathy (DPN). METHODS: We performed a randomized, double-blind, placebo-controlled phase III clinical trial in adult patients with Type 2 Diabetes Mellitus (T2DM) and DPN, as evaluated by composite scores and nerve conduction studies (NCS). Seventy-four subjects with T2DM were allocated 1 : 1 : 1 to placebo, EZE/SIMV 10/20 mg, or ROSUV 20 mg for 16 weeks. All patients were assessed before and after treatment: primary outcomes were lipid peroxidation (LPO), and nitric oxide (NO) surrogate levels in plasma; secondary outcomes included NCS, neuropathic symptom scores, and metabolic parameters. Data were expressed as mean ± SD or SEM, frequencies, and percentages; we used nonparametric analysis. RESULTS: LPO levels were reduced in both statin arms after 16 weeks of treatment (p < 0.05 versus baseline), without changes in the placebo group. NO levels were not significantly affected by statin treatment, although a trend towards significance concerning increased NO levels was noted in both statin arms. No significant changes were observed for the NCS or composite scores. DISCUSSION: EZE/SIMV and ROSUV are superior to placebo in reducing LPO in subjects with T2DM suffering from polyneuropathy. This trial is registered with NCT02129231.

The distribution of the indicator height for age of Mexican children and adolescents with Down syndrome according to different reference standards.

OBJECTIVE: To compare the indicator height for age in Mexican children with Down Syndrome (DS) with two different reference patterns of growth (American and Spanish) that might be suitable for the Mexican population. METHODS: A cross-sectional study was performed including 235 Mexican children and adolescents of both sexes with DS aged 45 days to 16 years enrolled in two specialized schools in the metropolitan area of Guadalajara. The dependent variables were weight/age; height/age; weight/ height and BMI. The data expressed was percentiles and the chi-square test was used to compare the distribution of the height/age index with American and Spanish reference patterns. In addition, a chi-square test was performed for the goodness of fit of the height/age index, with breakpoints lower and greater than the 50th percentile. RESULTS: The percentage of participants who were below the 50th percentile in the height/age index was significantly higher with the Spanish vs. the American reference pattern. The chi-square test for goodness of fit showed that the frequency of cases located below the 50th percentile in the height/age index was significantly higher with the American pattern in the age groups of 0 to 36 months (p = 0.022) and 37 to 72 months (p <0.001), but it was not significant (p = 0.225) in the older than 72 months age group. CONCLUSION: The American reference pattern is a better fit for the growth of Mexican children with DS compared with the Spanish reference pattern, and the distribution profile obtained with the standard growth and WHO reference was not suitable for the assessment of children with Down syndrome.

Objetivo: comparar el índice talla/edad en niños con síndrome de Down (SD) con dos patrones de referencia (americano y español) que podrían ser adecuados en niños mexicanos. Métodos: en un estudio transversal se incluyeron 295 niños y adolescentes de ambos sexos con SD desde 45 días hasta 16 años de edad, inscritos en dos escuelas del área metropolitana de Guadalajara. Variables dependientes: peso/edad; talla/edad; peso/talla e IMC. Los datos fueron expresados en percentiles y se utilizó la prueba de chi-cuadrado para comparar la distribución del índice de talla/edad entre los patrones de referencia de EUA y de España. Se realizó una prueba de bondad de ajuste del índice talla/edad con puntos de corte menor y mayor al percentil 50. Resultados: el porcentaje de participantes por debajo del percentil 50 en el índice de talla/edad fue significativamente mayor con la referencia española vs. americana. La prueba de bondad de ajuste mostró que la frecuencia de casos debajo del percentil 50 en el índice talla/edad fue significativamente mayor con la referencia estadounidense en el grupo de edad de 0-36 meses (p = 0,022) y 37-72 meses (p.

The distribution of the indicator height for age of Mexican children and adolescents with Down syndrome according to different reference standards / La distribución del indicador talla para la edad de niños y adolescentes mexicanos con síndrome de Down de acuerdo a diferentes patrones de referencia

Objective: to compare the indicator height for age in Mexican children with Down Syndrome (DS) with two different reference patterns of growth (American and Spanish) that might be suitable for the Mexican population. Methods: a cross-sectional study was performed including 235 Mexican children and adolescents of both sexes with DS aged 45 days to 16 years enrolled in two specialized schools in the metropolitan area of Guadalajara. The dependent variables were weight/age; height/age; weight/ height and BMI. The data expressed was percentiles and the chi-square test was used to compare the distribution of the height/age index with American and Spanish reference patterns. In addition, a chi-square test was performed for the goodness of fit of the height/age index, with breakpoints lower and greater than the 50th percentile. Results: the percentage of participants who were below the 50th percentile in the height/age index was significantly higher with the Spanish vs. the American reference pattern. The chi-square test for goodness of fit showed that the frequency of cases located below the 50th percentile in the height/age index was significantly higher with the American pattern in the age groups of 0 to 36 months (p = 0.022) and 37 to 72 months (p< 0.001), but it was not significant (p = 0.225) in the older than 72 months age group. Conclusion: the American reference pattern is a better fit for the growth of Mexican children with DS compared with the Spanish reference pattern, and the distribution profile obtained with the standard growth and WHO reference was not suitable for the assessment of children with Down syndrome (AU)

Objetivo: comparar el índice talla/edad en niños con síndrome de Down (SD) con dos patrones de referencia (americano y español) que podrían ser adecuados en niños mexicanos. Métodos: en un estudio transversal se incluyeron 295 niños y adolescentes de ambos sexos con SD desde 45 días hasta 16 años de edad, inscritos en dos escuelas del área metropolitana de Guadalajara. Variables dependientes: peso/edad; talla/edad; peso/talla e IMC. Los datos fueron expresados en percentiles y se utilizó la prueba de chicuadrado para comparar la distribución del índice de talla/edad entre los patrones de referencia de EUA y de España. Se realizó una prueba de bondad de ajuste del índice talla/edad con puntos de corte menor y mayor al percentil 50. Resultados: el porcentaje de participantes por debajo del percentil 50 en el índice de talla/edad fue significativamente mayor con la referencia española vs. americana. La prueba de bondad de ajuste mostró que la frecuencia de casos debajo del percentil 50 en el índice talla/edad fue significativamente mayor con la referencia estadounidense en el grupo de edad de 0-36 meses (p = 0,022) y 37-72 meses (p< 0,001), pero no fue significativa en el grupo de edad mayor de 72 meses. Conclusión: la referencia estadounidense se ajustó más al crecimiento de los niños mexicanos con síndrome de Down que la referencia española. El perfil de distribución obtenido con el estándar de crecimiento y referencia de la OMS no fue adecuado para la evaluación de niños con síndrome de Down (AU)

Energy expenditure in children with cerebral palsy and moderate / severe malnutrition during nutritional recovery.

OBJECTIVE: To analyze the total energy expenditure (TEE) and resting energy expenditure (REE) in children with cerebral palsy (CP) and moderate or severe malnutrition during nutritional recovery. METHODS: In an intervention study, thirteen subjects with CP (10 females and 3 males with a mean age of 9y11m ± 2y3m), level V of the Gross Motor Function Classification System and moderate or severe malnutrition were included. Eight were fed by nasogastric tube and five by gastrostomy. They were compared with 57 healthy participants (31 females and 26 males with mean age of 8y7m ± 10m). Anthropometric measurements, body composition and energy expenditure by bioelectrical impedance analysis (BIA) and indirect calorimetry (IC) were performed in both groups. RESULTS: TEE and REE were higher in healthy children than in children with CP in kcal/d and kcal/cm/d but were lower in kcal/kg/d (p <0.001). Intensive nutritional support for four weeks in children with CP produced a significant increase in energy expenditure. CONCLUSION: TEE and REE, in children with CP, are lower than in healthy children. Estimating the REE in children with CP and malnutrition is better performed in kcal/kg/d than in kcal/cm/d. Fat-free mass (FFM) is a good predictor of the REE in healthy children and children with CP.

Objetivo: Analizar el gasto energético total (GET) y gasto energético basal (GEB) en niños con parálisis cerebral infantil (PCI) y desnutrición moderada o grave durante la recuperación nutricia. Métodos: En un estudio de intervención, se incluyeron trece sujetos con PCI (10 mujeres y 3 hombres, con una edad promedio de 9a11m±2a3m), pertenecían al nivel V del Sistema de Clasificación de la Función Motora Gruesa y desnutrición moderada o grave. Ocho fueron alimentados por sonda nasogástrica y cinco por gastrostomía. Se compararon con 57 participantes sanos (31 mujeres y 26 varones con una edad promedio de 8a7m±10m). Se realizaron mediciones antropométricas, de composición corporal y de gasto energético mediante el análisis de impedancia bio-eléctrica (IBE) y calorimetría indirecta (CI) en ambos grupos. Resultados: El GET y GEB fueron mayores en los niños sanos que en los niños con parálisis cerebral en kcal/d y kcal/cm/d, pero fueron menores en kcal/kg/día (p.

Energy expenditure in children with cerebral palsy and moderate / severe malnutrition during nutritional recovery / Gasto energético en niños con parálisis cerebral infantil y desnutrición moderada y grave durante la recuperación nutricia

Objective: To analyze the total energy expenditure (TEE) and resting energy expenditure (REE) in children with cerebral palsy (CP) and moderate or severe malnutrition during nutritional recovery. Methods: In an intervention study, thirteen subjects with CP (10 females and 3 males with a mean age of 9y11m ± 2y3m), level V of the Gross Motor Function Classification System and moderate or severe malnutrition were included. Eight were fed by nasogastric tube and five by gastrostomy. They were compared with 57 healthy participants (31 females and 26 males with mean age of 8y7m ± 10 m). Anthropometric measurements, body composition and energy expenditure by bioelectrical impedance analysis (BIA) and indirect calorimetry (IC) were performed in both groups. Results: TEE and REE were higher in healthy children than in children with CP in kcal/d and kcal/cm/d but were lower in kcal/kg/d (p<0.001). Intensive nutritional support for four weeks in children with CP produced a significant increase in energy expenditure. Conclusion: TEE and REE, in children with CP, are lower than in healthy children. Estimating the REE in children with CP and malnutrition is better performed in kcal/kg/d than in kcal/cm/d. Fat-free mass (FFM) is a good predictor of the REE in healthy children and children with CP (AU)

Objetivo: Analizar el gasto energético total (GET) y gasto energético basal (GEB) en niños con parálisis cerebral infantil (PCI) y desnutrición moderada o grave durante la recuperación nutricia. Métodos: En un estudio de intervención, se incluyeron trece sujetos con PCI (10 mujeres y 3 hombres, con una edad promedio de 9a11m±2a3m), pertenecían al nivel V del Sistema de Clasificación de la Función Motora Gruesa y desnutrición moderada o grave. Ocho fueron alimentados por sonda nasogástrica y cinco por gastrostomía. Se compararon con 57 participantes sanos (31 mujeres y 26 varones con una edad promedio de 8a7m±10m). Se realizaron mediciones antropométricas, de composición corporal y de gasto energético mediante el análisis de impedancia bio-eléctrica (IBE) y calorimetría indirecta (CI) en ambos grupos. Resultados: El GET y GEB fueron mayores en los niños sanos que en los niños con parálisis cerebral en kcal/d y kcal/cm/d, pero fueron menores en kcal/kg/día (p<0,001). El apoyo nutricio intensivo durante cuatro semanas en los niños con parálisis cerebral produjo un incremento significativo en el gasto energético. Conclusión: El GET y GEB en niños con parálisis cerebral, son más bajos que en los niños sanos. La estimación del GEB en niños con parálisis cerebral y desnutrición moderada y/o grave se realiza mejor en kcal/kg/d que en kcal/cm/d. La masa libre de grasa (MLG) es un buen predictor del GEB en niños sanos y en niños con parálisis cerebral (AU)