Association between Maternal and Toddler Appetitive Traits in a Mexican Population.

The Child Eating Behaviour Questionnaire for toddlers (CEBQ-T-Mex) and the Adult Eating Behaviour Questionnaire (AEBQ-Esp) measure appetitive traits (ATs) in children and adults, respectively, both validated for use in Spanish. ATs are inherited variations in appetite, present from birth, that are reasonably stable throughout childhood and can explain why some infants over- or undereat in response to environmental exposures. "Food approach" traits predispose to overweight while "food avoidance" traits provide protection, but little is known about the relationships between parents' and their toddler's ATs. The aim was to examine the associations between maternal and toddler appetitive traits, using the AEBQ-Esp and CEBQ-T-Mex, and to examine the associations between ATs and Body Mass Index z-scores (BMIz). Sociodemographic data and the weights and heights of mothers and toddlers (aged 12-36 months) were collected from a teaching hospital in Guadalajara, Mexico. Mothers completed both the AEBQ-Esp and the CEBQ-T-Mex. Direct correlations were found between the ATs of toddlers and their mother (p < 0.005), except for "Slowness in Eating" (SE), and only an inverse correlation was found between the "Satiety Responsiveness" (SR) of toddlers and their BMIz (r = -0.147; p = 0.007). These results suggest that ATs could potentially run in families. These may be useful targets for family-wide interventions to support the development and maintenance of healthy eating behaviours in childhood.

Relationship between lipid profile, anthropometric indicators, and appetite-regulating hormones in infants according to type of feeding.

Introduction: Background: infants receiving full breastfeeding (FBF) regulate their appetites differently from those receiving human milk substitutes (HMS). In addition, early exposure to the dietary cholesterol in human milk could lead to better cholesterol regulation in later stages of life. Therefore, the purpose was to compare lipid profiles in 4-month-old infants and to correlate lipid profile with anthropometric indicators and appetite-regulating hormones according to the type of feeding. Methods: this was a cross-sectional and correlational study, which included 145 mother-infant dyads according to the type of feeding; 64 received FBF, 47 partial breastfeeding (PBF), and 34 HMS. The complete lipid profile, total ghrelin, leptin, peptide YY, and glucagon-like peptide type 1 were measured. Z-scores for weight/age, length/age, weight/length, triceps (TSF) and subscapular folds (SSF) and body mass index for age were also obtained. Results: there were significant differences in triglycerides and LDL cholesterol according to the type of feeding. In the HMS group, an inverse relationship was observed between ghrelin and triglycerides (p = 0.038), ghrelin and total cholesterol (TC) (p = 0.026), and peptide YY and HDL cholesterol (p = 0.017). In the PBF group, a direct relationship was observed between length/age (z) and triglycerides (p = 0.001) and between subscapular folds and TC (p = 0.049). In infants receiving HMS, a direct correlation was observed between weight/age (z) and TC (p = 0.045) and between length/age (z) and LDL cholesterol (p = 0.010). Conclusion: these findings show a relationship between growth, energy reserve, lipid profile, and modulation of appetite-regulating hormones according to the type of feeding they received.

Introducción: Introducción: los lactantes que reciben lactancia materna completa (LMC) regulan su apetito de manera diferente a los que reciben sucedáneos de la leche humana (SLH). Además, la exposición temprana al colesterol en la leche humana conduciría a mejor regulación del colesterol en etapas posteriores de la vida. El propósito fue de comparar el perfil lípidos en lactantes de cuatro meses y correlacionarlo con indicadores antropométricos y hormonas reguladoras del apetito según el tipo de alimentación. Métodos: en un estudio transversal y correlacional se incluyeron 145 díadas madre-lactante según el tipo de alimentación; 64 recibieron LMC, 47 lactancia materna parcial (LMP) y 34 SLH. Se midió el perfil lipídico, grelina total , leptina , péptido YY y péptido tipo 1 similar al glucagón. Se obtuvieron puntajes Z para peso/edad, longitud/edad, peso/longitud, pliegue cutáneo tricipital y subescapular e índice de masa corporal para la edad. Resultados: hubo diferencias significativas en triglicéridos y colesterol LDL según el tipo de alimentación. En el grupo HMS se observó una relación inversa entre grelina y triglicéridos (p = 0,038), grelina y colesterol total (TC) (p = 0,026), y péptido YY y colesterol HDL (p = 0,017). En el grupo PBF hubo relación directa entre longitud/edad (z) y triglicéridos (p = 0,001) y entre pliegues subescapulares y CT (p = 0,049). En los lactantes que recibieron HMS, se observó una correlación directa entre peso/edad (z) y CT (p = 0,045) y entre longitud/edad (z) y colesterol LDL (p = 0,010). Conclusión: los hallazgos muestran una relación entre perfil lipídico, crecimiento, reserva energética y modulación de las hormonas reguladoras del apetito según el tipo de alimentación.

Firmicutes, Bacteroidetes and Actinobacteria in Human Milk and Maternal Adiposity.

The main objective was to explore the relationship between the microbiota of human milk and adiposity in Mexican mothers during the first lactation stage. METHODS: Seventy lactating women were included. Adiposity by anthropometric measurements and by bioelectric impedance was obtained. The donation of human milk was requested, from which bacterial DNA was extracted and qPCR of the 16S region was performed. The Mann-Whitney U test, Spearman and Pearson correlations, and multiple linear regressions models were also calculated. RESULTS: The median percentage of Bacteroidetes had a direct and significant correlation with normal adiposity, current BMI, waist circumference, and body fat percentage. The correlation with current BMI became significantly inverse in women with BMI ≥ 25. In women with normal BMI, the percentage of Actinobacteria showed a direct and significant correlation with current BMI, waist circumference, and percentage of body fat. Multiple linear regressions showed that pre-pregnancy BMI was the variable with the highest predictive value with the Bacteroidetes phyla in normal BMI and in BMI ≥ 25. CONCLUSIONS: the adiposity of the woman before pregnancy and during lactation would have an important effect on the abundance of Bacteroidetes and Actinobacteria in human milk.

Intergenerational transmission of appetite: Associations between mother-child dyads in a Mexican population.

The Child Eating Behaviour Questionnaire (CEBQ) and the Adult Eating Behaviour Questionnaire (AEBQ) measure 'food approach' [Food responsiveness (FR); Emotional overeating (EOE); Enjoyment of food (EF); Desire to Drink] and 'food avoidant' [Satiety responsiveness (SR); Emotional undereating (EUE); Food fussiness (FF); Slowness in eating (SE)] appetitive traits (ATs) in children and adults, respectively. 'Food approach' traits predispose to overweight while 'food avoidance' traits provide protection, but little is known about the relationships between parents' and their offspring's ATs. The aim was to examine the associations between maternal and child appetitive traits, using the AEBQ-Esp and CEBQ-Mex adapted for use in Mexican populations. Sociodemographic data, weights and heights of mothers and their children (aged 3-13 years), who were recruited from a teaching hospital in Guadalajara, Mexico, were measured. Mothers completed both the AEBQ-Esp and the CEBQ-Mex. The CEBQ-Mex was developed, and its reliability was tested using Cronbach's alpha and Omega, and Confirmatory Factor Analysis (CFA) was used to assess its validity. Pearson's correlation coefficients were used to assess associations between mothers' and children's Ats. The sample included 842 mother-child dyads (mother's mean age = 34.8±SD6.9 years, BMI 29.7±6.1 kg/m2; children's mean age = 8.5 ±SD2.5 years, BMIz 1.5±1.6). Internal reliability was moderate to high [Cronbach alpha = .68-.86; Omega = .71-.87] for the CEBQ-Mex and validity was confirmed for an 8-factor model through CFA [RMSEA = 0.065; CFI = 0.840, NFI = 0.805; IFI = 0.842; and χ2(df = 532) = 2939.51, p < 0.001]. All but one of the children's appetitive traits showed small to moderate, significant correlations with their mother's counterpart [FR (r = .22; p<001); EOE (r = .30; p < .001); EF (r = .15; < .001); SR (r = .16; p < .001); EUE (r = .34; p < .001) and FF (r = .14; p < .001). Only SE was not significantly associated with maternal SE (r = .01; p>.05). ATs tend to run in families, signalling the intergenerational transmission of eating behaviours. These may be useful targets for family-wide interventions to support the development and maintenance of healthy eating behaviours in childhood.

Validity and Reliability of the Baby and Child Eating Behavior Questionnaire, Toddler Version (BEBQ-Mex and CEBQ-T-Mex) in a Low Sociodemographic Sample Recruited in a Mexican Hospital.

The objective of this study was to validate and measure the internal reliability of the Baby and Child Eating Behavior Questionnaires for Toddlers (BEBQ-Mex and CEBQ-T-Mex), that evaluate appetitive trait (ATs). Mothers recruited from a public hospital in Guadalajara, Mexico, completed the BEBQ-Mex or CEBQ-T-Mex along with information on sociodemographic characteristics. Internal reliability of the BEBQ-Mex was sufficient for Food Responsiveness (FR) (Cronbach α = 0.82), while Enjoyment of Food (EF) and Satiety Responsiveness (SR) showed poor reliability (α = 0.56) and Slowness in Eating (SE) had unacceptable reliability (a = 0.36). All reliability values for the CEBQ-T-Mex were acceptable (>0.70), except for SE (α = 0.64). Confirmatory factor analysis (CFA) revealed an adequate model fit for the BEBQ-Mex, except the SE subscale. CFA for the CEBQ-T-Mex confirmed the six-factor structure. Mothers of a low sociodemographic background were unable to recognize their infants' ATs; the BEBQ-Mex partly met the criteria for validity and reliability. Mothers from similar sociodemographic characteristics were more able to recognize the ATs of their toddlers than their infants; the CEBQ-T-Mex was found to be a valid and reliable tool. Findings support the need to help mothers' ability to recognize their infants' ATs, which have been previously associated with weight and growth.

Percentile Reference Values for the Neck Circumference of Mexican Children.

Neck circumference was studied for the first time in a pediatric population in 2010. Since then, various countries have proposed cutoff values to identify overweight, obesity, and metabolic syndrome. However, no reference values have been established for the Mexican child population. The aim of this study is to provide percentile reference values for the neck circumference of Mexican schoolchildren. Only normal-weight schoolchildren aged 6-11 years were included. Percentiles and growth charts were constructed based on the "Generalized Additive Model for Location, Scale and Shape" (GAMLSS). A total of 1059 schoolchildren (52.9% female) was evaluated. Weight, height, and BMI values were higher for males; however, this difference was not statistically significant. The 50th percentile for females was 24.6 cm at six years old and 28.25 cm at 11 years old, and for males, it was 25.75 cm and 28.76 cm, respectively. Both males and females displayed a pronounced increase in neck circumference between 10 and 11 years of age. The greatest variability was found in the 11-year-old group, with an increase of 5.5 cm for males and 5.4 cm for females. This study presents the first reference values for neck circumference for a Mexican child population.

Using a lactation room at the workplace is associated with longer breastfeeding duration in working mothers.

INTRODUCTION: IIntroduction: maternal employment after childbirth is associated with abandonment of breastfeeding; however, lactation rooms in the workplace increase the practice of breastfeeding. Objective: to compare the frequency and duration of breastfeeding among working mothers based on the presence of lactation rooms in their workplaces. Methods: we included mothers from different institutions whose infants were between 6 and 35 months (n = 158), and an ad hoc questionnaire was applied to assess breastfeeding, exclusive breastfeeding (EBF), partial breastfeeding (PBF), and use of human milk substitutes (HMS). Two groups were compared: working mothers with a lactation room at their workplace (n = 76) versus working mothers without this resource (n = 82). Results: breastfeeding duration (7.5 vs. 5.0 months, p < 0.001) and EBF (3.0 vs. 1.2 months, p = 0.005) were higher in mothers who had a lactation room. HMS use was shorter in mothers who had a lactation room (2.5 vs. 10.0 months, p = 0.001). There were more working mothers who breastfed for more than six months (75.0 % vs. 48.8 %) [OR = 3.15 (95 % CI, 1.60-6.19), p = 0.001] and 12 months (31.6 % vs. 14.6 %) [OR = 2.69 (95 % CI, 1.23-5.87), p = 0.014] when lactation rooms were available in their workplaces. Conclusion: the presence of a lactation room in the workplace was associated with a higher frequency and duration of breastfeeding.

INTRODUCCIÓN: RESUMEN Introducción: el empleo materno después del parto se asocia con el abandono de la lactancia materna, mientras que las salas de lactancia en el lugar de trabajo aumentan la práctica de la lactancia. Objetivo: comparar la frecuencia y duración de la lactancia materna entre madres trabajadoras en función de la presencia o no de salas de lactancia en sus lugares de trabajo. Métodos: incluimos madres de diferentes instituciones cuyos bebés tenían entre 6 y 35 meses (n = 158) y se aplicó un cuestionario ad hoc para evaluar la lactancia materna, la lactancia materna exclusiva (LME), la lactancia materna parcial (LMP) y el uso de sucedáneos de la leche humana (SLH). Se compararon dos grupos: madres trabajadoras con una sala de lactancia en su lugar de trabajo (n = 76) y madres trabajadoras sin este recurso (n = 82). Resultados: la duración de la lactancia (7,5 vs. 5,0 meses, p < 0,001) y LME (3,0 vs. 1,2 meses, p = 0,005) fueron mayores en las madres que tenían sala de lactancia. El uso de SLH fue más corto en las madres que tenían sala de lactancia (2,5 vs. 10,0 meses, p = 0,001). Hubo más madres trabajadoras que amamantaron más de seis meses (75,0 % vs. 48,8 %) [OR = 3,15 (IC 95 %: 1,60-6,19), p = 0,001] y 12 meses (31,6 % vs. 14,6 %) [OR = 2,69 (IC 95 %: 1,23-5,87), p = 0,014] cuando había salas de lactancia disponibles en sus lugares de trabajo. Conclusión: la presencia de una sala de lactancia en el lugar de trabajo se asoció a una mayor frecuencia y duración de la lactancia materna.

Factores asociados a las características de las evacuaciones en niños con parálisis cerebral infantil y estreñimiento crónico / No disponible

INTRODUCCIÓN: el estreñimiento crónico es un problema gastrointestinal común en los niños con parálisis cerebral infantil. Varios factores pueden influir en la frecuencia, la consistencia y el pH de las evacuaciones. OBJETIVO: identificar la asociación entre factores dietéticos, uso de anticonvulsivantes y antecedentes familiares con las características de las evacuaciones en niños con parálisis cerebral infantil y estreñimiento crónico. MATERIAL Y MÉTODOS: estudio transversal analítico en 45 niños con parálisis cerebral y estreñimiento crónico (19 niñas y 26 niños) con edad de 37 ± 13 meses. Se analizaron factores dietéticos, uso de anticonvulsivantes y antecedentes familiares. Se determinaron la frecuencia de las evacuaciones, la consistencia (escala Bristol) y el pH de las heces (con un potenciómetro). RESULTADOS: hubo correlación positiva entre la frecuencia de las evacuaciones y el consumo de oleaginosas (r = 0,339, p = 0,023). Existió correlación negativa entre las heces duras y la ingestión de líquidos (r = -0,336, p = 0,042); y entre el pH de las heces y el consumo de cereales ricos en fibra insoluble, las verduras ricas en fibra soluble, la zanahoria y la papa (r = -0,339, p = 0,030; r = -0,308, p = 0,044; r = -0,336, p = 0,027; y r = -0,307, p = 0,045, respectivamente). Se identificó asociación entre el uso de la politerapia anticonvulsivante y la consistencia dura de las evacuaciones (OR = 14,2 [IC 95% 1,16-174], p = 0,038). No se observó asociación entre los antecedentes familiares y el estreñimiento. CONCLUSIONES: el consumo de alimentos ricos en fibra, la ingestión de líquidos y la politerapia anticonvulsivante se asocian con las características de las evacuaciones en niños con parálisis cerebral infantil y estreñimiento crónico

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Factors associated with the stool characteristics of children with cerebral palsy and chronic constipation.

BACKGROUND: chronic constipation is a common gastrointestinal problem in children with cerebral palsy and several factors can influence the stool frequency, consistency and pH in these cases. AIM: to identify the association of dietary factors, use of anticonvulsants and family history of constipation with the stool characteristics of children with cerebral palsy and chronic constipation. METHODS: an analytical cross-sectional study was performed of 45 children with cerebral palsy and chronic constipation that included 19 females and 26 males, aged 37 ± 13 months. Dietary factors, the use of anticonvulsants and family history were analyzed. Stool frequency, consistency (Bristol Stool Form Scale) and pH (using a pH-meter) were also determined. RESULTS: there was a positive correlation between stool frequency and the consumption of oilseeds (r = 0.339, p = 0.023). There was a negative correlation between hard stools and fluid intake (r = -0.336, p = 0.042) and between stool pH and the consumption of cereals rich in insoluble fiber, high soluble fiber vegetables, carrots and potatoes (r = -0.339, p = 0.030; r = -0.308, p = 0.044; r = -0.336, p = 0.027; r = -0.307, p = 0.045, respectively). An association was also identified between the use of anticonvulsant polytherapy and hard stools (OR = 14.2 [95% CI 1.16-174], p = 0.038). There was no association between family history and constipation. CONCLUSIONS: rich-fiber food consumption, fluids intake and anticonvulsant polytherapy were associated with the stool characteristics of children with cerebral palsy and chronic constipation.

Concentration of ghrelin and leptin in serum and human milk in nursing mothers according to the type of feeding.

INTRODUCTION: Objective: we assessed the relationship between serum and human foremilk and hindmilk concentrations of ghrelin and leptin in nursing mothers according to the type of feeding. Methods: this cohort design was carried out on 131 mother-newborn dyads admitted to a physiological puerperium ward. The independent variables were the type of feeding, full breastfeeding (FBF, 56.5%) and partial breastfeeding (PBF, 43.5%). The dependent variables were the concentration of total ghrelin (pg/ml) and leptin (ng/ml) in serum, foremilk and hindmilk at eight and 16 weeks. Fasting blood samples were obtained from the nursing mothers at four months for serum assays. Unpaired Student's t-test, Mann-Whitney U test, Pearson's correlation tests, coefficient of determination and linear regression were used. Results: the concentration of ghrelin and leptin in hindmilk was higher than that of foremilk in both groups at eight and 16 weeks. The concentration of ghrelin and leptin was higher in serum than in foremilk in both groups. These values showed a direct and significant linear correlation with the exception of ghrelin in the FBF group. The serum concentration of leptin in mothers explained 32% of the variance of its concentration in foremilk in the FBF and 13% in the PBF groups. Conclusion: the hindmilk/foremilk gradient suggests an intake regulating mechanism during the fed. The concentration of ghrelin and leptin was higher in the serum than in foremilk and its correlation and determination coefficients could suggest plasma-milk transfer in addition to synthesis regulation by the mammary gland, adipose tissue or other organs.

INTRODUCCIÓN: Objetivo: evaluar la relación entre la concentración de suero y la leche materna y la concentración de grelina y leptina en leche materna en madres lactantes según el tipo de alimentación. Métodos: diseño de cohorte realizado en 131 diadas madre-lactante que ingresaron en una sala de puerperio fisiológico. Variables independientes: tipo de alimentación, lactancia materna completa (LMC, 56,5%) y lactancia materna parcial (LMP, 43,5%). Variables dependientes: concentración sérica de grelina total (pg/ml) y leptina (ng/ml), leche humana pre-tetada y pos-tetada a las ocho y 16 semanas. Se utilizaron pruebas no pareadas t de Student, U de Mann-Whitney, correlación de Pearson, coeficiente de determinación y regresión linear. Resultados: la concentración de grelina y leptina en leche humana pre-tetada fue mayor que en leche humana pos-tetada en ambos grupos a las ocho y 16 semanas. La concentración de grelina y leptina fue mayor en suero que en leche humana en ambos grupos; estos valores mostraron una correlación lineal directa y significativa con la excepción de la grelina en el grupo de LMC. La concentración sérica de leptina en las madres explicó el 32% de la varianza de su concentración en leche humana en LMC y el 13% en madres en LMP. Conclusión: el gradiente de leche humana pre-tetada/pos-tetada sugiere un mecanismo de regulación e ingestión de leche. La concentración de grelina y leptina fue mayor en suero que en leche humana y los coeficientes de determinación sugieren una transferencia de suero-leche, además de una regulación de la síntesis por la glándula mamaria, el tejido adiposo u otros órganos.

Bone mineral density and biochemical and hormonal indicators in children with quadriplegic cerebral palsy / Densidad mineral ósea e indicadores bioquímicos y hormonales en niños con parálisis cerebral cuadripléjica

Introduction: children with cerebral palsy (CP) have multiple risk factors for low bone mineral density or osteoporosis. Objective: to explore the association between bone mineral density (BMD) and biochemical and hormonal indicators of bone metabolism in children with quadriplegic cerebral palsy (CP). Methods: a cross-sectional analytical study included 59 participants from six to 18 years of age with quadriplegic CP. Serum concentrations of calcium, phosphorus, 25OHD metabolite, parathyroid hormone (PTH), alkaline phosphatase, and thyroid hormones were determined using standardized methods. The BMD measurement was obtained from the lumbar spine expressed in g/cm2 and Z-score. Unpaired Student's t-test, Chi-square test, odds ratio and Pearson's correlation were performed. Results: participants with CP and malnutrition had lower serum concentrations of calcium, phosphorus and alkaline phosphatase. Those who had low BMD showed lower serum concentrations of calcium, phosphorus and alkaline phosphatase. Most participants with low and normal BMD had vitamin D deficiency (27.1% and 10%) and insufficiency (35.4% and 30%), respectively. There was a significant correlation between BMD and serum concentrations of calcium, phosphorus, alkaline phosphatase, vitamin D and thyroid-stimulating hormone (TSH). There were no differences in the biochemical and hormonal indicators by level of gross motor function, use of anticonvulsants and oral versus enteral feeding method. Conclusion: malnutrition and alteration of vitamin D nutritional status were associated with low BMD and alterations of biochemical indicators of bone metabolism in pediatric patients with quadriplegic CP. The relationship between BMD and biochemical indicators of bone metabolism in children with quadriplegic CP was also demonstrated

Introducción: los niños con parálisis cerebral (PC) presentan múltiples factores de riesgo de densidad mineral ósea baja u osteoporosis. Objetivo: explorar la asociación entre la baja densidad mineral ósea (DMO) e indicadores bioquímicos y hormonales del metabolismo óseo en niños con PC cuadripléjica. Métodos: un estudio transversal analítico incluyó a 59 participantes de entre seis y 18 años de edad con PC cuadripléjica. Las concentraciones séricas de calcio, fósforo, metabolito 25OHD, hormona paratiroidea (PTH), fosfatasa alcalina y hormonas tiroideas se determinaron utilizando métodos estandarizados. La medición de DMO se obtuvo de la columna lumbar expresada en g/cm2 y puntaje Z. Se realizaron pruebas t de Student no pareada, Chi-cuadrado, razón de momios y correlación de Pearson. Resultados: los participantes con PC y desnutrición tenían concentraciones séricas más bajas de calcio, fósforo y fosfatasa alcalina. Los participantes con DMO baja tuvieron menor concentración sérica de calcio, fósforo y fosfatasa alcalina. Los participantes con DMO baja y normal tenían deficiencia de vitamina D (27.1% y 10%) e insuficiencia (35.4% y 30%), respectivamente. Hubo una correlación significativa entre DMO y las concentraciones séricas de calcio, fósforo, fosfatasa alcalina, vitamina D y hormona estimulante de la tiroides. Conclusión: la desnutrición y la alteración del estado nutricio de la vitamina D se asociaron con DMO baja y alteraciones de los indicadores bioquímicos del metabolismo óseo. Se demostró una asociación entre DMO e indicadores bioquímicos y hormonales del metabolismo óseo en niños con PC cuadripléjica

Neck circumference as an indicator of elevated central adiposity in children.

OBJECTIVE: We aimed to study the correlation between neck circumference (NC) and anthropometric adiposity indicators, and to determine cut-off points of NC for both sexes to identify elevated central adiposity in schoolchildren in western Mexico. DESIGN: Cross-sectional study. SETTING: Rural settings in western México.ParticipantsChildren from a convenience sample of six schools in Acatlán, Jalisco, Mexico (n 1802). RESULTS: NC showed a strong positive correlation with all anthropometric adiposity indicators in both sexes, which were notably higher in boys regardless of age. Noteworthy, waist circumference displayed the highest significant correlation when analysed by both age and sex. As age increased, NC cut-off points to identify elevated central adiposity ranged from 25·7 to 30·1 cm for girls and from 27·5 to 31·7 cm for boys. CONCLUSIONS: NC could be used as a simple, inexpensive and non-invasive indicator for central obesity assessment in Mexican schoolchildren.

Densidad mineral ósea e indicadores bioquímicos y hormonales en niños con parálisis cerebral cuadripléjica.

INTRODUCTION: Introduction: children with cerebral palsy (CP) have multiple risk factors for low bone mineral density or osteoporosis. Objective: to explore the association between bone mineral density (BMD) and biochemical and hormonal indicators of bone metabolism in children with quadriplegic cerebral palsy (CP). Methods: a cross-sectional analytical study included 59 participants from six to 18 years of age with quadriplegic CP. Serum concentrations of calcium, phosphorus, 25OHD metabolite, parathyroid hormone (PTH), alkaline phosphatase, and thyroid hormones were determined using standardized methods. The BMD measurement was obtained from the lumbar spine expressed in g/cm2 and Z-score. Unpaired Student's t-test, Chi-square test, odds ratio and Pearson's correlation were performed. Results: participants with CP and malnutrition had lower serum concentrations of calcium, phosphorus and alkaline phosphatase. Those who had low BMD showed lower serum concentrations of calcium, phosphorus and alkaline phosphatase. Most participants with low and normal BMD had vitamin D deficiency (27.1% and 10%) and insufficiency (35.4% and 30%), respectively. There was a significant correlation between BMD and serum concentrations of calcium, phosphorus, alkaline phosphatase, vitamin D and thyroid-stimulating hormone (TSH). There were no differences in the biochemical and hormonal indicators by level of gross motor function, use of anticonvulsants and oral versus enteral feeding method. Conclusion: malnutrition and alteration of vitamin D nutritional status were associated with low BMD and alterations of biochemical indicators of bone metabolism in pediatric patients with quadriplegic CP. The relationship between BMD and biochemical indicators of bone metabolism in children with quadriplegic CP was also demonstrated.

INTRODUCCIÓN: Introducción: los niños con parálisis cerebral (PC) presentan múltiples factores de riesgo de densidad mineral ósea baja u osteoporosis. Objetivo: explorar la asociación entre la baja densidad mineral ósea (DMO) e indicadores bioquímicos y hormonales del metabolismo óseo en niños con PC cuadripléjica. Métodos: un estudio transversal analítico incluyó a 59 participantes de entre seis y 18 años de edad con PC cuadripléjica. Las concentraciones séricas de calcio, fósforo, metabolito 25OHD, hormona paratiroidea (PTH), fosfatasa alcalina y hormonas tiroideas se determinaron utilizando métodos estandarizados. La medición de DMO se obtuvo de la columna lumbar expresada en g/cm2 y puntaje Z. Se realizaron pruebas t de Student no pareada, Chi-cuadrado, razón de momios y correlación de Pearson. Resultados: los participantes con PC y desnutrición tenían concentraciones séricas más bajas de calcio, fósforo y fosfatasa alcalina. Los participantes con DMO baja tuvieron menor concentración sérica de calcio, fósforo y fosfatasa alcalina. Los participantes con DMO baja y normal tenían deficiencia de vitamina D (27.1% y 10%) e insuficiencia (35.4% y 30%), respectivamente. Hubo una correlación significativa entre DMO y las concentraciones séricas de calcio, fósforo, fosfatasa alcalina, vitamina D y hormona estimulante de la tiroides. Conclusión: la desnutrición y la alteración del estado nutricio de la vitamina D se asociaron con DMO baja y alteraciones de los indicadores bioquímicos del metabolismo óseo. Se demostró una asociación entre DMO e indicadores bioquímicos y hormonales del metabolismo óseo en niños con PC cuadripléjica.

Relationship of anthropometric indexes and indicators of body composition by arm anthropometry on hospitalized pediatric patients.

INTRODUCTION: Introduction: the purpose of this study was to evaluate the relationship of arm anthropometric indicators with direct indicators of nutritional status in hospitalized pediatric patients. Methods: an analytical cross-sectional study with 760 patients hospitalized in the Pediatric Division of the Nuevo Hospital Civil de Guadalajara during 2014 was used. The anthropometric indices were weight/length, weight/height, weight/age, length/age, height/age, head circumference/age and body mass index (BMI)/age. The arm indicators were mid-upper arm circumference (MUAC), total arm area (TAA), arm muscle area (AMA), arm fat area (AFA) and fat percentage (FP). The ANOVA, Kruskall-Wallis, Mann-Whitney U and Pearson's correlation tests and also odds ratios were used to identify the probability of nutritional status impairment. Results: the prevalence of acute and chronic malnutrition was higher in infants (31% and 30%, respectively). With arm areas (TAA, AMA, AFA), the risk of deficit (≤ -2DE) was higher in infants and early preschoolers (p < 0.001). The correlation between the anthropometric indexes and the arm areas was direct and significant (p < 0.001). The BMI variability was explained in 68% by the AMA, AFA, and FP (p < 0.001); the variability of the height/age index was also explained in 34% by the AMA and AFA (p < 0.001). Conclusion: it is possible to diagnose both a chronic and acute deficit using the indirect indicators of the arm, while the body mass index only reflects an acute deficit. Therefore, arm areas would be more useful indicators in the assessment of nutritional status and the diagnosis of chronic-acute malnutrition in hospitalized pediatric patients.

INTRODUCCIÓN: Introducción: el objetivo de este estudio fue evaluar la relación de los indicadores antropométricos de brazo con los indicadores directos del estado de nutrición en pacientes pediátricos hospitalizados. Métodos: se utilizó un estudio transversal analítico con 760 pacientes ingresados en la División de Pediatría del Nuevo Hospital Civil de Guadalajara durante 2014. Los índices antropométricos fueron peso/longitud, peso/altura, peso/edad, longitud/edad, altura/edad, circunferencia cefálica e IMC. Los indicadores del brazo fueron circunferencia media del brazo (CMB), área total del brazo (ATB), área muscular del brazo (AMB), área grasa del brazo (AGB) y porcentaje de grasa. Se utilizaron las pruebas de ANOVA, Kruskall-Wallis, U de Mann-Whitney, correlación de Pearson y razón de momios para identificar la probabilidad de deterioro del estado nutricional. Resultados: la prevalencia de desnutrición aguda y crónica fue mayor en lactantes (31% y 30%, respectivamente). Con las áreas del brazo (ATB, AMB, AFA), el riesgo de déficit (≤ -2 DE) fue mayor en lactantes y preescolares tempranos (p < 0,001). La correlación entre los índices antropométricos y las áreas del brazo fue directa y significativa (p < 0,001). La variabilidad del IMC fue explicada en un 68% por AMB, AGB y porcentaje de grasa (p < 0,001); la variabilidad del índice de talla/edad también fue explicada en un 34% por AMB y AGB (p < 0,001). Conclusión: es posible diagnosticar el déficit crónico y agudo utilizando los indicadores indirectos del brazo, mientras que el IMC solo refleja un déficit agudo. Las áreas de brazo serían indicadores más útiles en el diagnóstico de desnutrición crónica-aguda en pacientes pediátricos hospitalizados.

Is there gender discrimination in full breastfeeding in Mexico?

INTRODUCTION: Objective: differences have been shown between males and females in terms of the prevalence of malnutrition in different parts of the world, which point to discrimination against females, including with respect to full breastfeeding. Therefore, the objective was to show that exclusive breastfeeding is less common for females in a population of medium-low and low socioeconomic strata. Methods: this was a cross-sectional analysis of a sample of 170 mother-infant dyads according to type of feeding (74 full breastfeeding, 57 partial breastfeeding and 39 human milk substitutes) at the Nuevo Hospital Civil de Guadalajara. Dependent variables according to type of feeding: full breastfeeding (exclusive and/or predominant), partial breastfeeding, and human milk substitutes. Independent variables: demographic data, schooling, occupation of mothers and/or parents, and family income. Kruskal-Wallis, Mann-Whitney U and Chi-square tests and odds ratio were used. Results: the probability of full breastfeeding was 3.8 times lower in females than in males. In a non-significant way, the likelihood of full breastfeeding was lower than that of partial breastfeeding, and full breastfeeding was lower than the combination of partial breastfeeding and human milk substitutes in females. Full breastfeeding and partial breastfeeding were lower than human milk substitutes, and partial breastfeeding was lower than human milk substitutes in females. Conclusion: there is a differentiated character in the privilege of full breastfeeding; it is four times lower in females than in males.

INTRODUCCIÓN: Objetivo: se han observado diferencias entre niñas y varones en la prevalencia de desnutrición en diferentes partes del mundo, lo que apunta a la discriminación contra las niñas, incluso con respecto a la lactancia materna completa. El objetivo fue mostrar que la lactancia completa es menos común en las niñas en una población de estratos socioeconómicos medio-bajo y bajo. Métodos: se realizó un análisis transversal de una muestra de 170 díadas madre-lactante según el tipo de alimentación (74 de lactancia completa, 57 de lactancia parcial y 39 sucedáneos de la leche humana) en el Nuevo Hospital Civil de Guadalajara. Variables dependientes según el tipo de alimentación: lactancia completa (exclusiva y/o predominante), lactancia parcial y sucedáneos de leche humana. Variables independientes: datos demográficos, escolaridad, ocupación de madres y/o padres e ingresos familiares. Se utilizaron pruebas de Kruskal-Wallis, Mann-Whitney U y Chi-cuadrado y razón de momios. Resultados: la probabilidad de lactancia materna completa fue 3,8 veces menor en niñas que en varones. De manera no significativa, la probabilidad de lactancia completa fue menor que la de lactancia parcial y la frecuencia de lactancia completa fue menor que la combinación de lactancia parcial y sucedáneos de leche humana en niñas. La frecuencia de lactancia completa y lactancia parcial fue menor que los sucedáneos de leche humana y la lactancia parcial fue menos frecuente que los sucedáneos de leche humana en niñas. Conclusión: hay un carácter diferenciado en el privilegio de ofrecer lactancia materna completa. Es cuatro veces menor en las niñas que en varones.

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

Socio-demographic variables and underlying pathologies associated to nutritional status of hospitalized children in a secondary-tertiary level hospital.

OBJECTIVE: the purpose was to evaluate the nutritional status in hospitalized children according to their socio-demographic variables, underlying pathology and based on hospital length of stay. METHODS: seven-hundred and sixty-three hospitalized patients of the Civil Hospital of Guadalajara Dr. Juan I. Menchaca were included in a cross-sectional study. The following anthropometric indices were taken: weight/length, weight/height, weight/age, length/age, height/age, head circumference/age and BMI/age. Data of socio-demographic variables and underlying pathology were also obtained. Student's t-test, Chi-squared test, ANOVA with post-hoc tests and logistic regression were used to identify the likelihood of risk of malnutrition. RESULTS: subjects were divided according to their hospital length of stay in lower than seven days and seven days or more. At the time of admission, children with stay of seven days or more showed a greater deficit in the height/age index (OR = 1.77 [95% CI 1.16-2.7], p = 0.007), head circumference (OR = 2.68 [95% CI 1.5-4.7], p ≤ 0.001) and BMI (OR = 2.9 [95% CI 1.9-4.4], p ≤ 0.001). Males had higher risk of moderate/severe malnutrition (OR = 1.87 [95% CI 1.22-2.85], p = 0.003) and higher deficit in head circumference (OR = 1.89 [95% CI 1.06-3.37], p = 0.029). Infants with gastrointestinal and respiratory problems had higher frequency of malnutrition at the time of admission than did those with other pathologies (p < 0.001). CONCLUSION: the pathological disease at time of admission and longer hospital length of stay increased the likelihood of malnutrition in male infants and preschool-aged children. There were demographic and educational risk factors in the home environment that could influence acute and chronic malnutrition.

Factors Associated With Anthropometric Indicators of Nutritional Status in Children With Chronic Kidney Disease Undergoing Peritoneal Dialysis, Hemodialysis, and After Kidney Transplant.

OBJECTIVE: The objective of the study was to demonstrate that there are differences in the factors associated with anthropometric indicators of nutritional status, with particular emphasis on arm indicators, in children with end-stage kidney disease undergoing peritoneal dialysis (PD), hemodialysis (HD), and after kidney transplant (KT). METHODS: An analytical cross-sectional study of consecutive cases included 130 children and adolescents with end-stage kidney disease undergoing substitutive treatment: 49 patients who underwent KT, 33 undergoing PD, and 47 undergoing HD. Socioeconomic data were obtained from all the 3 groups; anthropometric indicators of nutritional status were calculated. Student's t-test and analysis of variance were used for parametric variables. Chi-square test, Mann-Whitney U test, Kruskal-Wallis test, and odds ratio (OR) were used for nonparametric variables. RESULTS: The number of parents living as couples was higher for patients who underwent KT (OR = 3.5 [95% confidence interval {CI} 1.34-9.0]) and undergoing PD (OR = 3.0 [95% CI 1.06-8.8]) than those undergoing HD. The number of mothers who worked outside the home was higher for patients who underwent KT and undergoing PD than the mothers of patients undergoing HD (OR = 13.7 [95% CI: 4.56-41.05]; OR = 15.4 [CI 95% 4.8-49], respectively). Family income was higher for patients who underwent KT and undergoing PD (P = .019, P = .093, respectively). More than 40% of patients in all the 3 groups had growth impairment. Body mass index, mid-upper arm circumference, tricipital and subscapular skinfolds, total arm area, and arm fat area were affected in HD and PD groups (9 to 40%), while of the patients who underwent KT, 36.7% were overweight or obese. More than 50% of patients who underwent KT and undergoing HD and PD had involvement in the arm muscular area. CONCLUSIONS: Socioeconomic conditions are more influential for children in the HD program. The nutritional status of children after KT improves; however, not all anthropometric indicators are fully recovered. Children after KT are up to 9 times more likely to be overweight or obese.

Socio-demographic variables and underlying pathologies associated to nutritional status of hospitalized children in a secondary-tertiary level hospital / Variables sociodemográficas y patologías asociadas al estado nutricional de niños hospitalizados en una unidad de segundo-tercer nivel

Objective: the purpose was to evaluate the nutritional status in hospitalized children according to their socio-demographic variables, underlying pathology and based on hospital length of stay. Methods: seven-hundred and sixty-three hospitalized patients of the Civil Hospital of Guadalajara Dr. Juan I. Menchaca were included in a cross-sectional study. The following anthropometric indices were taken: weight/length, weight/height, weight/age, length/age, height/age, head circumference/age and BMI/age. Data of socio-demographic variables and underlying pathology were also obtained. Student's t-test, Chi-squared test, ANOVA with post-hoc tests and logistic regression were used to identify the likelihood of risk of malnutrition. Results: subjects were divided according to their hospital length of stay in lower than seven days and seven days or more. At the time of admission, children with stay of seven days or more showed a greater deficit in the height/age index (OR = 1.77 [95% CI 1.16-2.7], p = 0.007), head circumference (OR = 2.68 [95% CI 1.5-4.7], p ≤ 0.001) and BMI (OR = 2.9 [95% CI 1.9-4.4], p ≤ 0.001). Males had higher risk of moderate/ severe malnutrition (OR = 1.87 [95% CI 1.22-2.85], p = 0.003) and higher deficit in head circumference (OR = 1.89 [95% CI 1.06-3.37], p = 0.029). Infants with gastrointestinal and respiratory problems had higher frequency of malnutrition at the time of admission than did those with other pathologies (p < 0.001). Conclusion: the pathological disease at time of admission and longer hospital length of stay increased the likelihood of malnutrition in male infants and preschool-aged children. There were demographic and educational risk factors in the home environment that could influence acute and chronic malnutrition

Objetivo: el propósito fue evaluar el estado nutricio en niños hospitalizados de acuerdo a variables sociodemográficas, patología de ingreso y días de estancia hospitalaria. Métodos: en estudio transversal analítico se incluyeron 763 pacientes hospitalizados en el Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Se estimaron los índices: peso/edad, longitud/edad, estatura/edad, peso/talla, IMC y circunferencia cefálica/edad. Se obtuvieron variables sociodemográficas y el diagnóstico de ingreso. Se utilizaron las pruebas t de Student, Chi-cuadrado, ANOVA y post-hoc y regresión logística para identificar la probabilidad de riesgo de mala nutrición. Resultados: los participantes se dividieron de acuerdo a la duración de la estancia hospitalaria en menor de siete días e igual o mayor a siete días. Al ingreso, los niños con estancia de siete días o mayor mostraron déficit de los índices talla/edad (RM = 1,77 [IC 95% 1,16-2,7], p = 0,007), circunferencia cefálica (RM = 2,68 [IC 95% 1,5-4,7], p ≤ 0,001) e IMC (RM = 2,9 [IC 95% 1,9-4,4], p ≤ 0,001). Los varones mostraron mayor riesgo de desnutrición moderada o grave (RM = 1,87 [IC 95% 1,22-2,85], p = 0,003) y déficit en circunferencia cefálica (RM = 1,89 [IC 95% 1,06-3,37], p = 0,029). Los lactantes con problemas gastrointestinales y respiratorios tuvieron mayor frecuencia de desnutrición al ingreso hospitalario que aquellos con otras patologías (p < 0,001). Conclusión: la patología al momento del ingreso hospitalario y la estancia más prolongada aumentaron la probabilidad de desnutrición en lactantes varones y en preescolares. Hay factores de riesgo demográfico y educacional en la familia que podrían influir en la frecuencia de desnutrición aguda y/o crónica