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1.
Br J Nutr ; : 1-24, 2020 May 08.
Artículo en Inglés | MEDLINE | ID: mdl-32381141

RESUMEN

Complementary feeding (CF) and overweight relation during early childhood is inconsistent in the literature. We described CF during the first year of life and risk of overweight at 24-months of age association in the population-based 2004- and 2015-Pelotas (Brazil) Birth Cohorts (2004c and 2015c). CF introduction was evaluated at the 3- and 12-month follow-ups by asking mothers using a list of foods. Risk of overweight at 24-months of age was body mass index-for-age z-score above +1 standard deviation from the median of the WHO 2006 growth standards. Our analyses included 3,823 (2004c) and 3,689 (2015c) children. Early introduction CF (before 6-months of age) prevalence in 2004c was 93.3% (95%CI 92.5-94.1) and 2015c was 87.2% (95%CI 86.1-88.2). Tea was the item introduced earlier in both 2004c (68.8%) and 2015c (55.7%). At 6-months of age, vegetable mash was the most introduced food in 2004c (33.5%) and 2015c (47.9%). Between 2004c and 2015c, the introduction of fresh milk decreased 82.1% to 60.5% and yogurt from 94.4% to 78.1% during the first year. Risk of overweight prevalence at 24-months was 33.0% (95%CI 31.6-34.5) in 2004c and 32.0% (95%CI 30.5-33.5) in 2015c. In the 2015c, the adjusted odds of risk of overweight at 24-months were increased 1.66 and 1.50 times with the early introduction of fresh/powdered milk: plus water, tea or juice, and plus semi-solid/solid food groups, respectively. It is essential to reinforce the adherence to global recommendations on timely feeding introduction and encourage exclusive breastfeeding until 6-months of age to prevent child overweight.

2.
Int J Equity Health ; 19(1): 53, 2020 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-32272935

RESUMEN

BACKGROUND: Although the prevalence of child stunting is falling in Latin America, socioeconomic inequalities persist. However, there is limited evidence on ethnic disparities. We aimed to describe ethnic inequalities of stunting and feeding practices in thirteen Latin American countries using recent nationally representative surveys. METHODS: We analyzed national surveys carried out since 2006. Based on self-reported ethnicity, skin color or language, children were classified into three categories: indigenous/ afrodescendant/reference group (European or mixed ancestry). Stunting was defined as height (length)-for-age < - 2 standard deviations relative to WHO standards. Family wealth was assessed through household asset indices. We compared mean length/height-for-age and prevalence of stunting among the three ethnic groups. RESULTS: Thirteen surveys had information on indigenous and seven on afrodescendants. In all countries, the average length/height-for-age was significantly lower for indigenous, and in eleven countries there were significant differences in the prevalence of stunting: the pooled crude stunting prevalence ratio between indigenous and the reference group was 1.97 (95% CI 1.89; 2.05); after adjustment for wealth and place of residence, prevalence remained higher among indigenous (PR = 1.34, 95% CI 1.28; 1.39) in eight countries. Indigenous aged 6-23 months were more likely to be breastfed, but with poor complementary feeding, particularly in terms of dietary diversity. Afrodescendants showed few differences in height, and in two countries tended to be taller compared to the reference group. CONCLUSIONS: In all Latin American countries studied, indigenous tended to be shorter and afrodescendants presented few differences with relation to the reference group. In order to reach the SDG's challenge of leaving no one behind, indigenous need to be prioritized.

3.
Sci Rep ; 10(1): 1851, 2020 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-32024929

RESUMEN

Inadequate pre-pregnancy BMI and gestational weight gain (GWG) have been associated with sub-optimal child development. We used data from the 2015 Pelotas (Brazil) Birth Cohort Study. Maternal anthropometry was extracted from antenatal/hospital records. BMI (kg/m2) and GWG (kg) adequacy were classified according to WHO and IOM, respectively. Development was evaluated using the INTER-NDA assessment tool for 3,776 children aged 24 months. Suspected developmental delay (SDD) was defined as <10th percentile. Associations between maternal exposures and child development were tested using linear and logistic regressions. Mediation for the association between BMI and child development through GWG was tested using G-formula. Sex differences were observed for all child development domains, except motor. Maternal pre-pregnancy underweight increased the odds of SDD in language (OR: 2.75; 95%CI: 1.30-5.80), motor (OR: 2.28; 95%CI: 1.20-4.33), and global (OR: 2.14; 95% CI: 1.05-4.33) domains for girls; among boys, excessive GWG was associated with SDD in language (OR: 1.59; 95%CI: 1.13-2.24) and cognition (OR: 1.59; 95%CI: 1.15-2.22). Total GWG suppressed the association of pre-pregnancy BMI with percentiles of global development in the entire sample. Maternal underweight and excessive GWG were negatively associated with development of girls and boys, respectively. The association of pre-pregnancy BMI with global child development was not mediated by GWG, irrespective of child's sex.

5.
J Nutr ; 150(4): 910-917, 2020 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-31875480

RESUMEN

BACKGROUND: In contrast with the ample literature on within- and between-country inequalities in breastfeeding practices, there are no multi-country analyses of socioeconomic disparities in breastmilk substitute (BMS) consumption in low- and middle-income countries (LMICs). OBJECTIVE: This study aimed to investigate between- and within-country socioeconomic inequalities in breastfeeding and BMS consumption in LMICs. METHODS: We examined data from the Demographic Health Surveys and Multiple Indicator Cluster Surveys conducted in 90 LMICs since 2010 to calculate Pearson correlation coefficients between infant feeding indicators and per capita gross domestic product (GDP). Within-country inequalities in exclusive breastfeeding, intake of formula or other types of nonhuman milk (cow/goat) were studied for infants aged 0-5 mo, and for continued breastfeeding at ages 12-15 mo through graphical presentation of coverage wealth quintiles. RESULTS: Between-country analyses showed that log GDP was inversely correlated with exclusive (r = -0.37, P < 0.001) and continued breastfeeding (r = -0.74, P < 0.0001), and was positively correlated with formula intake (r = 0.70, P < 0.0001). Continued breastfeeding was inversely correlated with formula (r = -0.79, P < 0.0001), and was less strongly correlated with the intake of other types of nonhuman milk (r = -0.40, P < 0.001). Within-country analyses showed that 69 out of 89 did not have significant disparities in exclusive breastfeeding. Continued breastfeeding was significantly higher in children belonging to the poorest 20% of households compared with the wealthiest 20% in 40 countries (by ∼30 percentage points on average), whereas formula feeding was more common in the wealthiest group in 59 countries. CONCLUSIONS: BMS intake is positively associated with GDP and negatively associated with continued breastfeeding in LMICs. In most countries, BMS intake is positively associated with family wealth, and will likely become more widespread as countries develop. Urgent action is needed to protect, promote, and support breastfeeding in all income groups and to reduce the intake of BMS, in light of the hazards associated with their use.

6.
Int J Equity Health ; 18(1): 110, 2019 07 18.
Artículo en Inglés | MEDLINE | ID: mdl-31319862

RESUMEN

BACKGROUND: Guatemala has the highest prevalence of stunting among under-five children in Latin America. We aimed to compare indigenous and non-indigenous under-five child populations in relation to stunting, as well as to explore the intersectionality of ethnicity by wealth and by place of residence. We also studied how the ethnic inequalities changed over time, using five ENSMI surveys from 1995 to 2014. METHODS: Five national health surveys carried out between 1995 and 2014 were analysed. World Health Organization (WHO) 2006 growth standards were used to calculate stunting prevalence. Self-reported ethnicity was classified as indigenous or nonindigenous. Wealth was measured through an asset-based index, and households were classified into quintiles (for analyses of the whole populations) or tertiles (for analyses of intersectionality with ethnicity). Area of residence was recorded as urban or rural, according to country definition. RESULTS: Overall stunting prevalence declined by 9.8 percentage points (95% CI -16.4 to - 3.3) from 1995 to 2014. The slope index for absolute inequalities in stunting - which corresponds to the difference in prevalence between the wealthiest and poorest households - ranged from - 52.9 to - 60.4 percentage points, with no significant change over time. Children in rural areas were consistently more stunted than those in urban areas, but rural indigenous children were significantly worse than any other group. Indigenous children in the poorest tertile of family wealth consistently presented the highest stunting prevalence, compared to all other groups. Time trends in stunting were assessed through the average annual absolute change (AAAC). The fastest decline was observed among indigenous children from the middle wealth tertile (AAAC = - 1.21 percentage points per year (pp/y); 95% CI - 1.45 to - 0.96) followed by nonindigenous children also from the middle tertile (AAAC = - 0.80 pp./y; 95% CI - 0.99 to - 0.60). Stunting prevalence in the two poorest tertiles of indigenous children in 2015 was similar to what nonindigenous children presented in 1995, 20 years earlier. In the wealthiest tertile, indigenous children were far worse off than nonindigenous children 20 years earlier. CONCLUSIONS: In terms of stunting prevalence, poor and rural indigenous children are twenty years behind nonindigenous children with similar characteristics.


Asunto(s)
Trastornos del Crecimiento/epidemiología , Desnutrición/epidemiología , Población Rural/estadística & datos numéricos , Factores Socioeconómicos , Estatura , Niño , Preescolar , Grupos Étnicos/estadística & datos numéricos , Composición Familiar , Femenino , Guatemala/epidemiología , Encuestas Epidemiológicas , Humanos , América Latina , Masculino , Prevalencia , Autoinforme
7.
Salud Publica Mex ; 61(1): 78-85, 2019.
Artículo en Español | MEDLINE | ID: mdl-30753776

RESUMEN

OBJECTIVE: To compare the physical fitness of children from eight elementary schools in Morelos, México after the imple- mentation of an intervention to prevent childhood obesity. MATERIALS AND METHODS: 214 children were randomly selected (111 - intervention community and 103 - control community). Physical fitness was evaluated by the 6 minutes walking test and the 50 meters speed test, as well as the number of steps/day. RESULTS: The median of time in the speed test at the intervention site was 11.3 seconds and 13.8seconds at the control site (p<0.001). The median distance traveled in the walking test was 550 m in the intervention site and 420 m in the control site (p<0.001). The children of the intervention community took a median of 15 161 steps/ day and those of the control community took 13 749 steps/ day (p<0.05). CONCLUSIONS: Children from the intervention community have significantly better physical fitness.


Asunto(s)
Promoción de la Salud , Obesidad Pediátrica/prevención & control , Aptitud Física , Adolescente , Estatura , Peso Corporal , Niño , Trastornos de la Nutrición del Niño/epidemiología , Prueba de Esfuerzo , Femenino , Humanos , Masculino , México/epidemiología , Sobrepeso/epidemiología , Obesidad Pediátrica/epidemiología , Caminata
8.
Salud pública Méx ; 61(1): 78-85, ene.-feb. 2019. tab, graf
Artículo en Español | LILACS-Express | ID: biblio-1043361

RESUMEN

Resumen: Objetivo: Comparar la condición física de niños/as de ocho escuelas primarias del estado de Morelos, posimplementación de una intervención para prevenir obesidad infantil. Material y métodos: Se seleccionaron aleatoriamente 214 niños/ as (111 localidad intervención y 103 localidad control). La condición física se evaluó mediante pruebas de marcha con duración de seis minutos y de velocidad en 50 metros, así como número de pasos/día. Resultados: La mediana de tiempo en la prueba de velocidad en la localidad intervención fue de 11.3 segundos y en la localidad control 13.8 segundos (p<0.001). La mediana de la distancia recorrida en la prueba de marcha fue de 550 m en la localidad intervención y 420 m en la localidad control (p<0.001). Los niños/as de la comuni dad intervención tuvieron una mediana de 15 161 pasos/día y los de la localidad control, de 13 749 pasos/día (p<0.05). Conclusiones: Los niños/as de la localidad intervención tienen mejor condición física.


Abstract : Objective: To compare the physical fitness of children from eight elementary schools in Morelos, México after the imple mentation of an intervention to prevent childhood obesity. Materials and methods: 214 children were randomly selected (111 - intervention community and 103 - control community). Physical fitness was evaluated by the 6 minutes walking test and the 50 meters speed test, as well as the number of steps/day. Results: The median of time in the speed test at the intervention site was 11.3 seconds and 13.8 seconds at the control site (p<0.001). The median distance traveled in the walking test was 550 m in the intervention site and 420 m in the control site (p<0.001). The children of the intervention community took a median of 15 161 steps/ day and those of the control community took 13 749 steps/ day (p<0.05). Conclusions: Children from the intervention community have significantly better physical fitness.

9.
Salud Publica Mex ; 60(4): 388-394, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30137940

RESUMEN

OBJECTIVE: To evaluate whether child dietary intake of folate and vitamin B12, is associated with mental and psychomotor development in Mexican children, respectively, at 24 and 30 months of age. MATERIALS AND METHODS: Information about neurodevelopment and dietary intake of folate and vitamin B12 at 24 and 30 months of age among 229 children belonging to a perinatal cohort was analyzed longitudinally. Dietary information was assessed using a semi-quantitative food frequency questionnaire, and neurodevelopment by Bayley Scale of Infant Development II. RESULTS: At 30 months of age, dietary folate intake was marginally associated with increased Mental Development Index (MDI) (b=8.33; 95%CI -0.48, 17.14; p=0.06). Nonsignificant positive associations of vitamin B12 with MDI were found. Psychomotor Development Index (PDI) was not associated with these nutrients. CONCLUSIONS: Dietary folate intake in early childhood may benefit the mental development of children.


Asunto(s)
Desarrollo Infantil , Ácido Fólico , Vitamina B 12 , Adulto , Lactancia Materna , Cesárea , Preescolar , Conducta Alimentaria , Femenino , Estudios de Seguimiento , Humanos , Masculino , Edad Materna , México/epidemiología , Madres/estadística & datos numéricos , Estado Nutricional , Embarazo , Estudios Prospectivos , Trastornos Psicomotores/epidemiología , Trastornos Psicomotores/etiología , Trastornos Psicomotores/prevención & control , Ingesta Diaria Recomendada , Encuestas y Cuestionarios , Contaminación por Humo de Tabaco , Adulto Joven
10.
Salud pública Méx ; 60(4): 388-394, Jul.-Aug. 2018. tab
Artículo en Inglés | LILACS-Express | ID: biblio-979176

RESUMEN

Abstract Objective To evaluate whether child dietary intake of folate and vitamin B12, is associated with mental and psychomotor development in Mexican children, respectively, at 24 and 30 months of age. Materials and methods Information about neurodevelopment and dietary intake of folate and vitamin B12 at 24 and 30 months of age among 229 children belonging to a perinatal cohort was analyzed longitudinally. Dietary information was assessed using a semi-quantitative food frequency questionnaire, and neurodevelopment by Bayley Scale of Infant Development II. Results At 30 months of age, dietary folate intake was marginally associated with increased Mental Development Index (MDI) (β=8.33; 95%CI -0.48, 17.14; p=0.06). Non-significant positive associations of vitamin B12 with MDI were found. Psychomotor Development Index (PDI) was not associated with these nutrients. Conclusion Dietary folate intake in early childhood may benefit the mental development of children.


Resumen Objetivo Evaluar si la ingesta dietética infantil de folato y vitamina B12 se asocia con el desarrollo mental y psicomotor en niños mexicanos de 24 y 30 meses de edad. Material y métodos La información del neurodesarrollo y la ingesta dietética de folato y B12 a los 24 y 30 meses de edad de 229 niños pertenecientes a una cohorte perinantal, se analizó longitudinalmente. La información dietética se obtuvo por un cuestionario de frecuencia de alimentos semicuantitativo y el neurodesarrollo mediante la Escala de Desarrollo Infantil de Bayley II. Resultados A los 30 meses de edad, la ingesta dietética de folato se asoció marginalmente con un incremento del Índice de Desarrollo Infantil (IDM) (β=8.33; IC95% -0.48, 17.14; p=0.06). Se observaron asociaciones positivas no significativas entre la B12 y el IDM. El Índice de Desarrollo Psicomotor (IDP) no se asoció con dichos nutrientes. Conclusión La ingesta dietética infantil de folato puede beneficiar el desarrollo mental.

11.
Lancet Glob Health ; 6(8): e902-e913, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-30012271

RESUMEN

BACKGROUND: Latin American and Caribbean populations include three main ethnic groups: indigenous people, people of African descent, and people of European descent. We investigated ethnic inequalities among these groups in population coverage with reproductive, maternal, newborn, and child health interventions. METHODS: We analysed 16 standardised, nationally representative surveys carried out from 2004 to 2015 in Latin America and the Caribbean that provided information on ethnicity or a proxy indicator (household language or skin colour) and on coverage of reproductive, maternal, newborn, and child health interventions. We selected four outcomes: coverage with modern contraception, antenatal care coverage (defined as four or more antenatal visits), and skilled attendants at birth for women aged 15-49 years; and coverage with three doses of diphtheria-pertussis-tetanus (DPT3) vaccine among children aged 12-23 months. We classified women and children as indigenous, of African descent, or other ancestry (reference group) on the basis of their self-reported ethnicity or language. Mediating variables included wealth quintiles (based on household asset indices), woman's education, and urban-rural residence. We calculated crude and adjusted coverage ratios using Poisson regression. FINDINGS: Ethnic gaps in coverage varied substantially from country to country. In most countries, coverage with modern contraception (median coverage ratio 0·82, IQR 0·66-0·92), antenatal care (0·86, 0·75-0·94), and skilled birth attendants (0·75, 0·68-0·92) was lower among indigenous women than in the reference group. Only three countries (Nicaragua, Panama, and Paraguay) showed significant gaps in DPT3 coverage between the indigenous and the reference groups. The differences were attenuated but persisted after adjustment for wealth, education, and residence. Women and children of African descent showed similar coverage to the reference group in most countries. INTERPRETATION: The lower coverage levels for indigenous women are pervasive, and cannot be explained solely by differences in wealth, education, or residence. Interventions delivered at community level-such as vaccines-show less inequality than those requiring access to services, such as birth attendance. Regular monitoring of ethnic inequalities is essential to evaluate existing initiatives aimed at the inclusion of minorities and to plan effective multisectoral policies and programmes. FUNDING: The Bill & Melinda Gates Foundation (through the Countdown to 2030 initiative) and the Wellcome Trust.


Asunto(s)
Grupos Étnicos/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , Servicios de Salud Materno-Infantil , Servicios de Salud Reproductiva , Adolescente , Adulto , Región del Caribe , Estudios Transversales , Femenino , Encuestas de Atención de la Salud , Humanos , Lactante , América Latina , Persona de Mediana Edad , Embarazo , Adulto Joven
12.
Rev. Univ. Ind. Santander, Salud ; 48(2): 196-205, abr.-jun. 2016. ilus, tab
Artículo en Español | LILACS-Express | ID: lil-784973

RESUMEN

Introducción: La actividad física (AF) es un factor de protección ante múltiples enfermedades. Las recomendaciones mundiales para la AF están bien establecidas y son difundidas en todos los escenarios posibles, pero el ambiente construido podría presentar múltiples barreras para seguir dichas recomendaciones. Objetivo: Analizar algunas barreras del ambiente construido para la actividad física por niveles de marginación en la ciudad de Cuernavaca, México. Materiales y métodos: Empleando el programa Atlas ti 5.0, se categorizaron los datos obtenidos de 170 guías de observación. Se realizó el análisis de un acervo fotográfico de 341 imágenes de 20 AGEBS de la ciudad de Cuernavaca, utilizando un análisis de imágenes fijas connotativo, denotativo y por 3 categorías (Calzadas, tránsito y espacios deportivos). Se utilizó el programa Stata 12.0 para obtener frecuencias y porcentajes. Resultados: Se identificaron deficiencias en el diseño y uso de espacios como las banquetas, falta de señalización e inseguridad de las vías públicas. Se encontró carencia de espacios para la práctica de la actividad física. Solo hay una presencia del 10% de espacios deportivos en los 20 AGEBS estudiados. Se encontró que el 82.86% de las calles está en deficiente estado. La deficiente iluminación vial, carencia de ciclovías y grafitis con porcentajes importantes también se identificaron como barreras para la AF. Discusión: En Cuernavaca las posibilidades de acceso a espacios seguros, presentan múltiples barreras y por ende esta tendencia afecta de forma negativa la salud de los habitantes de la ciudad, además que no es congruente con las recomendaciones mundiales para la actividad física. Conclusiones: La identificación y abolición de las barreras deben estar dentro las prioridades de las políticas de salud públicas y las intervenciones deben procurar dicha transformación, de esta forma se superará la tendencia de solamente informar sobre los beneficios de la actividad física que predominan en la gran mayoría de las recomendaciones e intervenciones.


Introduction: Physical activity (PA) is a factor of protection against multiple diseases. Global recommendations for PA are well established and are spread in all possible scenarios, but the built environment could present multiple barriers to follow these recommendations. Objective: To Analyze some built environment barriers for physical activity by levels of marginalization in the city of Cuernavaca, Mexico. Material and methods: Using the software Atlas ti 5.0, data from 170 observation guides and were categorized. The analysis of a photographic collection of 341 images of 20 AGEBS of Cuernavaca was performed using an analysis connotative and denotative by 3 categories (roadways, traffic and sports areas). Stata 12.0 software was used to obtain frequencies and percentages. Results: Deficiencies in the design and use of spaces such as sidewalks, lack of signage and insecurity of public roads were identified. Lack of spaces for the practice of physical activity was found. There is only one presence of 10% of sports facilities in the 20 AGEBS studied. It was found that 82.86% of the streets are in poor condition. Poor street lighting, lack of bicycle paths and graffiti with significant percentages were also identified as barriers to PA. Discussion: In Cuernavaca the possibilities of access to safe spaces for FA have multiple barriers, this negatively affects the health of the habitants of the city, and that is not consistent with global recommendations for physical activity. Conclusions: Identifying and abolishing barriers must be within the priorities of public health policies and interventions should seek this transformation, to improve the tendency to only report on benefits of physical activity prevailing in the vast majority of programs.

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