Less underestimaton of excess weight by the categorical than the visual method. Its determinants and feeding practices in Mexican mothers of children aged 2 to 12 years.

Introduction: Introduction: perceived body weight refers to the subjectively assessed weight, which may not correspond to the objectively measured weight. Statistics show that 14 % to 83 % of parents misperceive their children's weight status, with a propensity for underestimation. Objective: we compared the accuracy of the visual versus the categorical method. We also identified factors and feeding practices associated with excess weight underestimation. Material and methods: we carried out a cross-sectional study in five states of Mexico with 1,845 mother-child dyads of children aged 2-12 years. The mothers were interviewed about weight perception with two methods, visual and categorical. The Child Feeding Questionnaire identified maternal feeding practices. Actual weight and height were categorized according to WHO criteria. Analysis consisted of Cohen's kappa estimation, multivariate logistic regression, and Mann-Whitney tests. Results: more mothers correctly identified the weight of their children with the categorical than with the visual method (68 % vs 42 %, p < 0.0001). The excess weight underestimation was lower (49 % vs 82 %, p < 0.0001) and the degree of agreement was higher with the categorical method (kappa, 0.39 and 0.08). The better results remained regardless of age. Age 2-5 years increased the odds of overweight/obesity underestimation. Feeding practices differed by weight perception category, child's age, and method of assessment. Conclusions: the categorical method was more accurate. Recognition of correct weight perception is one of the first actions required for controlling childhood overweight/obesity.

Introducción: Introducción: la percepción del peso corporal se refiere al peso evaluado subjetivamente, que puede no corresponder al peso medido objetivamente. Las estadísticas muestran que entre el 14 % y el 83 % de los padres tienen una percepción inadecuada del estado del peso de sus hijos, predominando la subestimación. Objetivo: comparar la precisión del método categórico y la del visual e identificar los factores y prácticas de alimentación asociados a la subestimación del exceso de peso. Material y métodos: se realizó un estudio transversal en cinco estados de México con 1,845 díadas madre-hijo de niños de 2-11 años. Las madres fueron entrevistadas sobre su percepción del peso con un método visual y uno categórico. El Cuestionario de Alimentación Infantil identificó las prácticas de alimentación. El peso y la altura se clasificaron con los criterios de la OMS. Se estimó la kappa de Cohen y se utilizaron la regresión logística multivariada y las pruebas de Mann-Whitney. Resultados: más madres identificaron correctamente el peso de sus hijos con el método categórico que con el visual (68 % vs. 42 %, p < 0,0001). La subestimación del exceso de peso fue menor (49 % vs 82 %, p <0,0001) y el grado de concordancia mayor con el método categórico (kappa: 0,39 y 0,08). Los resultados se mantuvieron independientemente de la edad. La edad de 2-5 años aumentó la probabilidad de subestimar el sobrepeso/obesidad. Las prácticas de alimentación difirieron por categoría de percepción del peso, edad del niño y método de evaluación. Conclusiones: el método categórico fue más preciso. El reconocimiento de la correcta percepción del peso constituye una de las primeras acciones para el control del sobrepeso/obesidad infantil.

[Confirmatory factor analysis of the Comprehensive Feeding Practices Questionnaire in Mexican mothers of preschool children]. / Análisis factorial confirmatorio del Cuestionario Integral de Prácticas de Alimentación en madres mexicanas de niños preescolares.

INTRODUCTION: Introduction: identifying maternal attitudes and behaviors related to child feeding could be difficult since the underlying constructs are abstract and complex. Different questionnaires have been used to identify these constructs: one of the most widely used is the Comprehensive Feeding Practices Questionnaire (CFPQ), which had been validated in different populations. However, no previous study ever validated the CFPQ in Mexican mothers. Material and methods: a process of cultural adaptation was done to adapt the CFPQ to Mexican mothers, and subsequently a confirmatory factor analysis was done. A total of 300 mother-preschooler pairs participated. Weight and height were measured and the nutritional status was obtained. Results: the CFPQ is a useful questionnaire to identify child feeding practices, since the model's goodness of fit indices were acceptable (CFI = 0.943, TLI = 0.937, NFI = 0.874 and RMSEA = 0.042), as was the internal consistency of the CFPQ. Conclusion: the CFPQ version that was translated into Spanish and adapted to Mexican mothers demonstrated significant internal reliability, and therefore is useful to identify and describe maternal child-feeding practices.

INTRODUCCIÓN: Introducción: identificar las actitudes y comportamientos de las madres en relación con la alimentación infantil puede resultar difícil ya que los constructos subyacentes son abstractos y complejos. Para identificar estos constructos se han utilizado diferentes cuestionarios: uno de los más utilizados es el Cuestionario Integral de Prácticas de Alimentación (CIPA), que se ha validado en diferentes poblaciones. Sin embargo, ningún estudio previo ha validado el CIPA en madres mexicanas. Material y métodos: se realizó un proceso de adaptación transcultural para adecuar el CIPA a las madres mexicanas y, posteriormente, se ejecutó un análisis factorial confirmatorio. Participaron 300 diadas madre-hijo/a en edad preescolar. Se realizaron mediciones del peso y la talla del preescolar y se obtuvo el estado nutricio. Resultados: el CIPA es un cuestionario útil para identificar las prácticas de alimentación infantil dado que los índices de bondad de ajuste del modelo fueron aceptables (CFI = 0,943, TLI = 0,937, NFI = 0,874 y RMSEA = 0,042), así como la consistencia interna. Conclusión: la versión del CIPA traducida al español y adaptada a las madres mexicanas demostró una fiabilidad interna significativa, por lo cual resulta útil para identificar y describir las prácticas maternas de alimentación infantil.

Maternal Perception of the Child's Weight, Lifestyle Problems and Self-Efficacy to Deal with Them / Percepción materna del peso del hijo, problemas del estilo de vida y autoeficacia para manejarlos / Percepção materna do peso do filho, problemas do estilo de vida e autoeficácia para lidar com eles

Objetivos: associar a percepção materna do peso do filho (PMPF) e o estado nutricional dele. Descrever problemas comportamentais do estilo de vida do filho (PCEV) e autoeficácia materna (AE) para lidar com eles, verificar diferenças entre com e sem excesso de peso-obesidade (EP-OB) do filho e PMPF. Materiais e métodos: participaram 274 díades (mãe-filho em idade pré-escolar). A PMPF foi avaliada por meio de palavras e imagens. As mães responderam à Lista de Verificação de Comportamentos do Estilo de Vida. Peso e altura do filho foram medidos. Resultados: 18,8 % (n = 13) mães de filos com EP-OB e 78,8 % (n = 160) mães de filhos sem EP-OB tiveram PMPF adequada por palavras (X 2 = 77.759; gl = 1; p < ,001). Foi identificado que as mães de filhos com EP-OB referiram mais PCEV e menos AE. As mães de filhos com EP-OB tiveram que lidar com mais baixa AE e mais PCEV. Quando as mães percebem o EP-OB do filho por palavras, têm menos AE (U = 1118, p = ,015) e mais PCEV (F = 17,041, p = ,001). Conclusões: PMPF não adequada predominou em mães de filhos com EP-OB. Quando o EP-OB é percebido, mais PCEV e menos AE. Promover PMPF adequada particularmente em mães de filhos com EP-OB é recomendado. As imagens ajudam a reconhecer o EP-OB do filho mais do que a classificá-lo numa categoria.

Objetivos: asociar la percepción materna del peso del hijo (PMPH) y estado nutricional del hijo. Describir problemas conductuales del estilo de vida del hijo (PCEV) y autoeficacia materna (AE) para manejarlos, verificar diferencias conforme a con y sin sobrepeso-obesidad (SP-OB) del hijo y PMPH. Material y métodos: participaron 274 diadas (madre-hijo preescolar). La PMPH se evalúo por palabras e imágenes. Las madres contestaron la Lista de Verificación de Conductas del Estilo de Vida. Se midió peso y talla del hijo. Resultados: 18.8 % (n = 13) madres de hijos con SP-OB y 78.8 % (n = 160) madres de hijos sin SP-OB tuvieron PMPH adecuada por palabras (X2 = 77.759, gl = 1, p < .001). Las madres de hijos con SP-OB tuvieron que manejar más baja AE y más PCEV. Cuando las madres perciben el SP-OB del hijo por palabras, tienen menor AE (U = 1118, p = .015) y más PCEV (F = 17.041, p = .001). Conclusiones: Predominó PMPH no adecuada en madres de hijos con SP-OB. Cuando se percibe el SP-OB, más PCEV y menor AE. Se recomienda promover PMPH adecuada particularmente en madres de hijos con SP-OB. Las imágenes ayudan a reconocer el SP-OB del hijo más que a clasificarlo en una categoría.

Objectives: To associate the maternal perception of the child's weight (MPCW) and the child's nutritional status. To describe child's lifestyle behavior problems (CLBPs) and maternal self-efficacy (SE) to deal with them, as well as to verify differences according to children with and without overweight-obesity (OW-OB) and MPCW. Material and methods: There was participation of 274 dyads (mother-preschool child). MPCW was assessed through words and images. The mothers answered the Lifestyle Behaviour Checklist. The child's weight and height were measured. Results: 18.8 % (n = 13) of the mothers of children with OW-OB and 78.8 % (n = 160) of the mothers of children without OW-OB obtained adequate MPCW values through words (X2 = 77.759; DoF = 1; p < .001). It was identified that the mothers of children with OW-OB reported more CLBPs and less SE. When the child's OW-OB is perceived through words, there are more CLBPs (F = 17.041; p = .001) and less SE (U = 1,118; p = .015). Conclusions: Inadequate MPCW was predominant in mothers of children with OW-OB. When OW-OB is perceived, there are more CLBPs and fewer SE. It is recommended to promote adequate MPCW, particularly in mothers of children with OW-OB. Images assist in the identification of the child's OW-OB more than to classify it into a category.

Adicción a los Alimentos y Antojos en Preescolares referidos por sus Cuidadores / Food Addiction and Cravings in Preschoolers Residents Recognized by Their Caregivers

Resumen Objetivos: 1) Identificar y contrastar los síntomas de adicción a los alimentos en preescolares con y sin sobrepeso-obesidad (SP-OB), 2) Identificar y contrastar la frecuencia e intensidad de los antojos por alimentos en preescolares con y sin SP-OB, 3) Identificar factores que determinan el índice de masa corporal (IMC) del preescolar. Materiales y Métodos: Estudio descriptivo correlacional, participaron 201 cuidadores. Se aplicó la Escala Adicción a los Alimentos de Yale para Niños (YFAS-C) y Cuestionario Características de Antojos por los Alimentos. Se midió peso y talla del preescolar. Resultados: El coeficiente de fiabilidad Kuder-Richardson de YFAS-C, fue 0.635. El 91% de los cuidadores fueron madres. La media de síntomas de adicción a los alimentos en preescolares con SP-OB fue=0.3488 (n = 43) y sin SP-OB ẋ = 0.3987 (n = 158), U = 3351.00, p ˃ 0.05. Anticipación de refuerzo positivo fue la característica de antojo con la media más alta (ẋ= 9.05, DE = 4.21) y la más baja emociones (ẋ = 2.40, DE = 0.878), no se encontraron diferencias significativas. No se encontró relación entre los síntomas de adicción a los alimentos y el IMC del preescolar. Los antojos contribuyeron al IMC del preescolar, varianza explicada 12.2%. Conclusiones: La escala YFAS-C es la única diseñada para evaluar los síntomas de adicción a los alimentos en niños, sin embargo, en el presente estudio no se identificaron síntomas. Se recomienda continuar explorando este concepto, en este grupo de edad.

Abstract Objective: 1) To identify and to compare the food addiction symptoms of preschoolers with and without overweight-obesity (OW-OB), 2) To identify and to compare the frequency and intensity of food preschoolers cravings with and without overweight-obesity, 3) To identify factors that determine of preschooler BMI. Material and Methods: Descriptive correlational study, participated 201 caregivers. The Yale Food Addiction Scale for Children YFAS-C and Food Cravings Characteristics Questionnaire were applied. Preschooler weight and height were measured. Results: Kuder-Richardson reliability coefficient of YFAS-C was 0.635. A 91% of caregivers were mothers. Food addiction symptoms mean of preschoolers with OW-OB ẋ = 0.3488 (n = 43) and without OW-OB ẋ = 0.3987 (n = 158), U = 3351.00, p ˃ 0.05. The positive reinforcement anticipation was craving characteristic with the highest mean (ẋ = 9.05, SD = 4.21) and the lowest was emotions (ẋ = 2.40, SD = 0.878), no significant differences were found. No relation between food addiction symptoms and preschooler BMI was found. Cravings contributed to the preschool BMI, variance explained 12.2%. Conclusions: The YFAS-C scale is the only one designed to evaluate the food addiction symptoms of children, however none food addiction symptoms were identified. It is recommended to continue exploring this concept in this age group.

[Analysis of the psychometric properties of the Eating Behavior Self-efficacy Scale in Mexican adolescents]. / Análisis de las propiedades psicométricas de la Escala de Autoeficacia de la Conducta Alimentaria en adolescentes mexicanos.

INTRODUCTION: Introduction: self-efficacy plays an important role in eating behaviors; for example, excess weight is associated with low EC and poor nutrition. The Eating Behavior Self-Efficacy Scale (EACA) identifies the ability to control the intake of healthy, and of high-calorie foods. Objective: to evaluate the psychometric properties of EACA in adolescents residing in northeast Mexico, and to analyze the relationship of self-efficacy with sex, age, and nutritional status of participants. Methods: confirmatory factor analyses (CFA) were performed, and both reliability (internal consistency) and convergent validity of EACA were analyzed. A total of 467 adolescents who were studying the 7th to 9th grade of basic education, and who were residents in northeast Mexico were enrolled. Results: the goodness-of-fit indices of the proposed model were acceptable: CMIN/DF = 2.831; CFI = 0.952; GFI = 0.931; AGFI = 0.905; SRMS = 0.318, and RMSEA = 0.063), as was internal consistency (α = 0.90). Mean age was 13.54 years (SD = 0.93), and weight ranged from 30.9 to 130.4 kg (SD = 13.33). Conclusions: the CFA of the proposed model has a high internal consistency, and the four-factor structure has an adequate fit. It can be used to measure self-efficacy in relation to eating behavior in Mexican adolescents. It is recommended to test this model in similar populations.

INTRODUCCIÓN: Introducción: la autoeficacia (AE) desempeña un rol importante en las conductas relacionadas con la alimentación; por ejemplo, el exceso de peso se asocia con una baja AE y una alimentación inadecuada. La Escala de Autoeficacia de la Conducta de Alimentación (EACA) permite identificar la capacidad de control de la ingesta de alimentos saludables y de alimentos altamente calóricos. Objetivo: evaluar las propiedades psicométricas de la EACA en adolescentes residentes en el noreste de México y analizar la relación de la AE con el sexo, la edad y el estado nutricional de los participantes. Métodos: se realizó un análisis factorial confirmatorio (AFC) y se analizaron la fiabilidad (consistencia interna) y la validez convergente de la EACA. Participaron 467 adolescentes que cursaban entre el 7º y el 9º grado de educación básica, residentes en el noreste de México. Resultados: los índices de bondad del ajuste del modelo propuesto fueron aceptables: (CMIN/DF = 2,831; CFI = 0,952; GFI = 0,931; AGFI = 0,905; SRMS = 0,318 y RMSEA = 0,063), así como la consistencia interna (α = 0,90). La edad promedio era de 13,54 años (DE = 0,93) y el peso oscilaba entre 30,9 y 130,4 kg (DE = 13,33). Conclusiones: el AFC del modelo propuesto tiene una consistencia interna alta y la estructura factorial de cuatro factores tiene un ajuste adecuado. Puede utilizarse para medir la AE en relación con la conducta de alimentación de los adolescentes mexicanos. Se recomienda contrastar este modelo en poblaciones similares.

Study protocol: intervention in maternal perception of preschoolers' weight among Mexican and Mexican-American mothers.

BACKGROUND: Childhood obesity is a public health issue negatively affecting children's physical and psychosocial health. Mothers are children's primary caregivers, thus key players in childhood obesity prevention. Studies have indicated that mothers underestimate their children's weight. If mothers are unaware of their children's weight problem, they are less likely to participate in activities preventing and treating excess weight. The "Healthy Change" intervention is designed to change maternal perception of child's weight (MPCW) through peer-led group health education in childcare settings. METHODS/DESIGN: The "Healthy Change" is a multicenter two-arm randomized trial in four centers. Three centers are in Mexican States (Nuevo Leon, Tamaulipas, and Zacatecas). The fourth center is in San Antonio, Texas, USA. A total of 360 mother-child pairs (90 pairs per center) are to be randomly and evenly allocated to either the intervention or the control group. Intervention group will receive four-session group obesity prevention education. Control group will receive a four-session personal and food hygiene education. The education is delivered by trained peer-mother promotoras. Data will be collected using questionnaires and focus groups. The primary outcome is a change in proportion of mothers with accurate MPCW. Secondary outcomes include change in maternal feeding styles and practices, maternal self-efficacy and actions for managing child excessive weight gain. McNemar's Test will be used to test the primary outcome. The GLM Univariate procedure will be used to determine intervention effects on secondary outcomes. The models will include the secondary outcome measures as the dependent variables, treatment condition (intervention/control) as the fixed factor, and confounding factors (e.g., mother's education, children's gender and age) as covariates. Sub-analyses will be performed to compare intervention effects on primary and secondary outcomes between the samples from Mexico and Texas, USA. Qualitative data will be analyzed through analysis of inductive content. A combined coding model will be developed and used to code transcripts using the NVivo software. DISCUSSION: Healthy Change intervention could help change MPCW, an initial step for obesity prevention among preschoolers. This study presents a first of its kind intervention available in Spanish and English targeting Mexican and Mexican-American mothers in Mexico and USA. TRIAL REGISTRATION: ISRCTN12281648.

Percepción materna del peso del hijo preescolar con sobrepeso - obesidad / Mother's perception of the weight of the preschooler child's with overweight-obesity

Introducción: la obesidad infantil es un problema de salud pública a nivel mundial, es factor de riesgo para múltiples problemas físicos y socioemocionales. Para que las intervenciones dirigidas a tratar el exceso de peso tengan éxito, es necesario que la madre perciba el sobrepeso u obesidad de su hijo. Objetivo: identificar cómo las madres perciben el peso de su hijo en edad pre-escolar con sobrepeso-obesidad y los métodos que se han utilizado para evaluar la percepción. Métodos: búsqueda en las bases de datos Scielo, PubMed, Redalyc y LILACS, para identificar artículos publicados del 2010 al 2014 cuyos participantes incluyeran madres e hijos pre-escolares de 4-7 años de edad. Los descriptores fueron: percepción materna, peso corporal, obesidad infantil, hijo y sus equivalentes en inglés y portugués. La muestra final fue de seis artículos. Conclusiones: un alto porcentaje de madres no percibe adecuadamente el exceso de peso en sus hijos, sobre todo cuando se utilizan palabras y no imágenes para evaluar la percepción. Por tanto, existe la necesidad de continuar con el estudio de la percepción materna del peso del hijo y el impacto que esto tiene, para que los padres se involucren en el manejo del tratamiento de la obesidad infantil(AU)

Introduction: childhood obesity is a public health problem worldwide, is a risk factor for multiple physical and socio-emotional problems. For success in interventions to treat overweight, it is necessary for the mother to perceive overweight or obesity in her child. Objective: to identify how mothers perceives the weight of their preschooler child with overweight-obesity and the methods used to assess such perception. Methods: search in the databases Scielo, PubMed, Redalyc and LILACS, in order to identify articles published from 2010 to 2014 whose participants included mothers and preschooler children at age 4-7 years. The descriptors were mother's perception, body weight, childhood obesity, child and their equivalents in English and Portuguese. The final sample consisted of six articles. Conclusions: a high percentage of mothers do not adequately recognize overweight in their children, especially when words and not images are used to assess the perception. Therefore, there is the need for continuing the study of maternal perception of child weight and the impact this has, in order for parents to become involved in managing the treatment of childhood obesity(AU)

An educational strategy for improving knowledge about breast and cervical cancer prevention among Mexican middle school students.

INTRODUCTION: Prevention programs have not achieved the expected results in preventing mortality from breast and cervical cancer in Mexico. Therefore, we propose a complementary strategy. METHODOLOGY: An educational strategy for high school students in Mexico (2011-2013) was designed (longitudinal design, two measurements and a single intervention). The postintervention assessment included: 1) knowledge acquired by students about cancer prevention and 2) The performance of the student as a health promoter in their household. The strategy was based on analysis of cases and developed in three sessions. An assessment tool was designed and validated (Test-Retest). The levels of knowledge according to the qualifications expected by chance were determined. Wilcoxon test compared results before and after intervention. RESULTS: An assessment instrument with 0.80 reliability was obtained. 831 high school students were analyzed. Wilcoxon rank-sum test showed a significant learning after the intervention (Z = - 2.64, p = 0.008) with improvement of levels of knowledge in a 154.5%. 49% of students had a good performance as health promoters. CONCLUSIONS: The learning in preventive measures is important to sensitize individuals to prevention campaigns against cancer. This strategy proved to improve the level of knowledge of students in an easy and affordable way.

[Maternal Predictors of Body Mass Index of Pre-school and School Age Children]. / Predictores maternos del índice de masa corporal del hijo pre-escolar y escolar.

The objective was to identify maternal variables that could be used as predictors of the child's body mass index (BMI). We considered the following variables: (a) socio-demographic (age, education, occupation, marital status and family income); (b) anthropometric (BMI); and (c) upbringing strategies (monitoring and limits for eating habits, monitoring and sedentary behavior limits, discipline and control in feeding. A predictive correlational study was carried out with 537 dyads (mother-child). Children enrolled in 4 public schools (2 for pre-school children and 2 for primary school children) were selected for probabilistic, random sampling. The mothers answered the Feeding and Activity Upbringing Strategies Scale, giving socio-demographic information and the dyads' weight and height was measured. The data were analyzed for correlations and path analysis. It was found that the average age of mothers was 34.25 years (SD=6.91), with 12.40 years of education (SD=3.36), 53.3% mentioned that they were housewives and 46.7% had a paid job outside of the home; 38.5% showed pre-OB and 27.3% some degree of OB. The child's average age was 7.26 years (SD=2.46), and 3.2% showed low weight, 59.6% normal weight and 37.2% OW-0B. It was found that working outside the home, having a higher maternal BMI, less control and more discipline in feeding are variables that predict higher BMI in the child. We recommend the design of interventions to reduce and treat the child's OW-OB taking into account the predictors that were found.

Predictores de la percepción materna del peso del hijo con sobrepeso-obesidad / Predictors of Maternal Perception about Weight of her Child with Overweight-Obesity

Se identificaron predictores de la percepción materna del peso del hijo (PMPH) con sobrepeso - obesidad (SP- OB). Participaron 2.874 madres e hijos, residentes en el Noreste de México; 951 tenían un hijo con SP-OB. La PMPH se evaluó por palabras (PP) y por imágenes (PI). Por PP 63.71% y 74.9% de madres de hijos con SP-OB no percibieron adecuadamente el peso del hijo y por PI, 27% y 10.99%. Mediante regresión logística, el modelo para PP fue χ² = 152.05, gl = 9, p = 0.001, varianza explicada 21.5% y para PI fue χ² = 192.35, gl = 9, p = 0.001, varianza explicada 31.9%. Edad del hijo y si el médico informa de SP en el niño/a, fueron variables que contribuyeron a los modelos. Se concluye que las madres de niños con SP-OB no perciben de forma adecuada esta situación. Se resalta la importancia de informar respecto al SP-OB del hijo.

Several predictors of a maternal perception of her child's weight (MPCW) when the child is overweigh-obese (OW-OB) were identified. Participants: 2,842 mothers and children who reside in Mexico's northeastern region, 951 mothers had an OW-OB child. The MPCW was evaluated for words (PW) and images (PI). PW, 63.71% and 74.9% of the mothers with an OW-OB child, did not perceive the child's weight adequately and PI, 27% and 10.99%. Through Logistic Regression Analysis, a model for PW was χ² = 152.05, gl = 9, p = 0.001, 21.5% explained variance; and for PI χ² = 192.35, gl = 9, p = 0.001, 31.9% explained variance. The child's age, a doctor's report that the child had OW, were some variables that contributed to the models. We concluded that mothers with OW-OB children do not adequately perceive this situation. We emphasize the importance of reporting of a child's OW-OB condition.

Factores de riesgo en adolescentes para el desarrollo de diabetes mellitus tipo 2 / Risk factors for developing type 2 diabetes in adolescents

Resumen:

Introducción: la diabetes mellitus tipo 2 es una nueva morbilidad en adolescentes y motivo de gran preocupación, dado que en la mayoría de los casos permanece sin diagnosticar por mucho tiempo; cuando se identifica es difícil el manejo terapéutico e impacta la calidad de vida de quien la padece. Objetivo: describir los factores del riesgo para desarrollar diabetes mellitus tipo 2 en adolescentes que acuden a instituciones de educación pública.

Metodología: estudio transversal analítico en el que participaron 264 adolescentes de 12 a 18 años de edad, de uno u otro sexo. Se estudiaron seis factores de riesgo no invasivos: índice de masa corporal por edad y sexo, antecedente familiar de diabetes mellitus tipo 2, acantosis nigricans, hipertensión arterial, antecedente materno de diabetes gestacional y bajo peso al nacimiento. Resultados: del total de participantes, 76 % presentó antecedente familiar de diabetes mellitus tipo 2, 26 % sobrepeso u obesidad, 27 % acantosis nigricans, 11 % hipertensión arterial, 2 % antecedente materno de diabetes gestacional y 10 % bajo peso al nacimiento; 14 % no presentó factores de riesgo y 17 % tenía tres o más factores de riesgo; 58 % de los adolescentes con sobrepeso-obesidad presentó dos o más factores de riesgo para desarrollar diabetes mellitus tipo 2. Conclusiones: se identificaron factores de riesgo para diabetes mellitus tipo 2 en los adolescentes de 12 a 18 años. El personal de enfermería es el primer contacto del paciente con el sistema de salud, por lo tanto, desempeña un papel importante en la educación en salud y en la identificación de los factores de riesgo en los niños y los adolescentes.

Abstract:

Introduction: Type 2 diabetes mellitus is an increasing disease among adolescents and of great concern, since in most cases it remains undiagnosed for a long time. When identified its therapeutic management is difficult and impacts the quality of life of patients.

Objective: To describe the risk factors for developing type 2 diabetes mellitus in adolescents attending public educational institutions.

Methods: Cross-sectional analitical study in which 264 adolescents aged 12-18 years of both sexes were engaged. Six noninvasive risk factors were studied: body mass index by age and sex, family history of type 2 diabetes mellitus, acanthosis nigricans, hypertension, maternal history of gestational diabetes, low birth weight.

Results: 76 % of the participants have a family history of type 2 diabetes mellitus, 26 % are overweight and obese, 27 % acanthosis nigricans, 11 % hypertension, 2 % maternal history of gestational diabetes, 10 % low birth weight; 14 % do not show any risk factors, 17 % had three or more factors. Of those with overweight and obese 58 % had two or more risk factors for developing type 2 diabetes.

Conclusions: Risk factors for type 2 diabetes mellitus were identified in adolescents from 12 to 18 years. Nurses are the patient's first contact with the health system therefore they play an important role for health education activities and identification of risk factors for developing type 2 diabetes in childhood and adolescence.

Maternal Eating and Physical Activity Strategies and their Relation with Children's Nutritional Status / Estratégias maternas referentes à alimentação e à atividade física e sua relação com o estado nutricional dos filhos / Estrategias Maternas de Alimentación y Actividad Física y su Relación con el Estado Nutricional de los Hijos

OBJECTIVES: to describe the maternal eating and physical activity strategies (monitoring, discipline, control, limits and reinforcement) [MEES]; to determine the relation between MEES and the child's nutritional status [body mass index (BMI) and body fat percentage (BFP)]; to verify whether the MEES differ according to the child's nutritional status. METHOD: participants were 558 mothers and children (3 to 11 years of age) who studied at public schools. The Parental Strategies for Eating and Activity Scale (PEAS) was applied and the child's weight, height and BFP were measured. For analysis purposes, descriptive statistics were obtained, using multiple linear regression and the Kruskal-Wallis test. RESULTS: the highest mean score was found for reinforcement (62.72) and the lowest for control (50.07). Discipline, control and limits explained 12% of the BMI, while discipline and control explained 6% of the BFP. Greater control is found for obese children (χ2=38.36, p=0.001) and greater reinforcement for underweight children (χ2=7.19, p<0.05). CONCLUSIONS: the mothers exert greater control (pressure to eat) over obese children and greater recognition (congratulating due to healthy eating) in underweight children. Modifications in parental strategies are recommended with a view to strengthening healthy eating and physical activity habits. .

OBJETIVOS: descrever as estratégias maternas referentes à alimentação e à atividade física (monitoramento, disciplina, controle, limites e reforço), determinar a relação entre as estratégias maternas referentes à alimentação e à atividade física e o estado nutricional da criança (índice de massa corporal e porcentagem de gordura corporal) e verificar se as estratégias maternas diferem de acordo com o estado nutricional da criança. MÉTODO: participaram 558 mães e filhos (3 a 11 anos), estudantes em escolas públicas. A Escala Estratégias Parentais referentes à Alimentação e à Atividade foi aplicada, e o peso, a altura e a porcentagem de gordura corporal da criança foram medidos. Para a análise, foram obtidas estatísticas descritivas e foram aplicados a regressão linear múltipla e o teste de Kruskal-Wallis. RESULTADOS: o reforço apresentou a média mais alta (62,72) e o controle, a mais baixa (50,07). Disciplina, controle e limites representaram 12% do índice de massa corporal, e disciplina e controle, os 6% da porcentagem de gordura corporal. O maior controle é exercido em crianças que apresentam obesidade (χ2=38,36, p=0,001), e o maior reforço, em crianças com baixo peso (χ2=7,19, p<0,05). CONCLUSÕES: mães exercem maior controle (pressão para comer) sobre crianças obesas e concedem maior reconhecimento (elogio por uma alimentação saudável) às crianças com baixo peso. Recomenda-se que as estratégias parentais sejam modificadas, a fim de fortalecer hábitos saudáveis de alimentação e atividade física. .

OBJETIVOS: describir las estrategias maternas de alimentación y actividad física (monitoreo, disciplina, control, límites y reforzamiento) [EMAA]; Determinar la relación de EMAA con el estado nutricional del hijo [índice de masa corporal (IMC) y porcentaje de grasa corporal (PGC)]; Verificar si las EMAA son diferentes de acuerdo al estado nutricional del hijo. MÉTODO: participaron 558 madres e hijos (3 a 11 años) estudiantes de escuelas públicas. Se aplicó la Escala Estrategias Parentales de Alimentación y Actividad (PEAS), se midió peso, talla y PGC del hijo. Para el análisis se obtuvieron estadísticas descriptivas, se aplicó regresión lineal múltiple y prueba de Kruskal Wallis. RESULTADOS: reforzamiento presentó la media más alta (62.72) y control la más baja (50.07). Disciplina, control y límites explicaron 12% del IMC, disciplina y control el 6% del PGC. Se ejerce mayor control en hijos con obesidad (χ2=38.36, p=0.001) y mayor reforzamiento en hijos con bajo peso (χ2=7.19, p<0.05). CONCLUSIONES: las madres ejercen mayor control (presión para comer) en hijos con obesidad y otorgan mayor reconocimiento (felicitar por comer saludable) en hijos con bajo peso. Se recomienda modificar las estrategias parentales para fortalecer hábitos saludables de alimentación y actividad física. .

Maternal Eating and Physical Activity Strategies and their Relation with Children's Nutritional Status.

OBJECTIVES: to describe the maternal eating and physical activity strategies (monitoring, discipline, control, limits and reinforcement) [MEES]; to determine the relation between MEES and the child's nutritional status [body mass index (BMI) and body fat percentage (BFP)]; to verify whether the MEES differ according to the child's nutritional status. METHOD: participants were 558 mothers and children (3 to 11 years of age) who studied at public schools. The Parental Strategies for Eating and Activity Scale (PEAS) was applied and the child's weight, height and BFP were measured. For analysis purposes, descriptive statistics were obtained, using multiple linear regression and the Kruskal-Wallis test. RESULTS: the highest mean score was found for reinforcement (62.72) and the lowest for control (50.07). Discipline, control and limits explained 12% of the BMI, while discipline and control explained 6% of the BFP. Greater control is found for obese children (χ²=38.36, p=0.001) and greater reinforcement for underweight children (χ²=7.19, p<0.05). CONCLUSIONS: the mothers exert greater control (pressure to eat) over obese children and greater recognition (congratulating due to healthy eating) in underweight children. Modifications in parental strategies are recommended with a view to strengthening healthy eating and physical activity habits.

Genetic structure of Mexican Mestizos with type 2 diabetes mellitus based on three STR loci.

BACKGROUND: The aims of this population genetics study were: 1) to ascertain whether Mexicans with type 2 diabetes mellitus (DM) were genetically homogeneous and 2) to compare the genetic structure of this selected population with the previously reported data of four random populations (Nuevo León, Hispanics, Chihuahua, and Central Region of Mexico). METHODS: A sample of 103 unrelated individuals with DM and whose 4 grandparents were born in five zones of Mexico was interviewed in 32 Medical Units in the Mexican Institute of Social Security (IMSS). The non-coding STRs D16S539, D7S820, and D13S317 were analyzed. RESULTS: Genotype distribution was in agreement with Hardy-Weinberg expectations for all three markers. Allele frequencies were found to be similar between the selected population and the four random populations. Gene diversity analysis suggested that more than 99.57% of the total gene diversity could be attributed to variation between individuals within the population and 0.43% between the populations. CONCLUSIONS: According to the present and previous studies using molecular and non-molecular nuclear DNA markers not associated with any disease, the Mexican Mestizo population is found to be genetically homogeneous and therefore the genetic causes of DM are less heterogeneous, thereby simplifying genetic epidemiological studies as has been found in a previous study with the same design in Mexican women with breast cancer.

Maternal perceptions on Well Child Care.

The aim was to analyze well child nursing care (WCC) and to distinguish if the care is procedure or user centered. The concepts of the nursing work process and the micro-politics of health work supported this qualitative study. Systematic direct observation of 87 WCC consultations was accomplished at one Family Medicine Unit and semistructured interviews were held with 25 mothers who attended WCC consultations with their child. Data saturation and understanding of the meaning were the criteria used to determine the number of observations and interviews. Thematic analysis was applied. The activity was focused on procedures, which cannot be considered WHCC. The mothers value comprehensive care and request information on the growth and development of their children. Educative topic should be addressed and trust relations should be established with a view to user-centered care delivery.

Maternal perceptions on Well Child Care / Percepções maternas do Cuidado à Criança Sadia / Percepciones maternas del Cuidado del Niño Sano

The aim was to analyze well child nursing care (WCC) and to distinguish if the care is procedure or user centered. The concepts of the nursing work process and the micro-politics of health work supported this qualitative study. Systematic direct observation of 87 WCC consultations was accomplished at one Family Medicine Unit and semistructured interviews were held with 25 mothers who attended WCC consultations with their child. Data saturation and understanding of the meaning were the criteria used to determine the number of observations and interviews. Thematic analysis was applied. The activity was focused on procedures, which cannot be considered WHCC. The mothers value comprehensive care and request information on the growth and development of their children. Educative topic should be addressed and trust relations should be established with a view to user-centered care delivery.

O objetivo do estudo foi analisar o Cuidado à Criança Sadia (CCS) e distinguir se é cuidado baseado nos procedimentos ou cuidado baseado no usuário. Os conceitos do processo de trabalho de enfermagem e micropolítica do trabalho em saúde fundamentaram o presente estudo qualitativo. Realizou-se observação sistemática direta de 87 atenções de CCS em uma Unidade de Medicina Familiar e entrevista semiestruturada a 25 mães que compareceram, junto a seu filho, à atenção de CCS. A saturação dos dados e a compreensão do significado foram os critérios para o número de observações e entrevistas. Aplicou-se a análise temática. Encontrou-se que a atividade está baseada nos procedimentos, o que não pode se considerar CCS. As mães valorizam a atenção integral e solicitam informação relacionada ao crescimento e desenvolvimento de seu filho. Recomenda-se abordar tópicos educativos e estabelecer relação de confiança que permita fornecer cuidado baseado no usuário.

El objetivo del estudio fue analizar el cuidado de enfermería del niño sano (CNS) y distinguir si se trata de cuidado centrado en procedimientos o centrado en el usuario. Los conceptos del proceso de trabajo de enfermería y micro política del trabajo en salud fundamentaron el presente estudio cualitativo. Se realizó observación sistemática directa a 87 consultas de CNS en una Unidad de Medicina Familiar y entrevista semi-estructurada a 25 madres que acudieron con su hijo a la consulta de CNS. La saturación de datos y comprensión del significado fueron los criterios para el número de observaciones y entrevistas. Se aplicó análisis temático. Se encontró que la actividad se centra en procedimientos, lo que no puede ser considerado CNS. Las madres valoran la atención integral y solicitan información del crecimiento y desarrollo de su hijo. Se recomienda abordar tópicos educativos y establecer relación de confianza que permita brindar cuidado centrado en el usuario.

Evaluación de la percepción materna del peso del hijo y de la heredabilidad del IMC en diadas mestizas del Sureste de México

Estudio descriptivo correlacional. Los objetivos fueron: 1) evaluar la percepción materna del peso del hijo mediante dos pruebas percepción por palabras (PP) e índice de masa corporal del hijo percibido por la madre (IMCP), 2) Evaluar sensibilidad y especificidad de las pruebas y 3) Cuantificar la heredabilidad (h2) del índice de masa corporal (IMC) en 173 diadas (madre-hijo). La PP fue valorada por la pregunta ¿cómo cree que su hijo esta? Para valorar el IMCP, la madre refirió peso y talla del hijo y se calculó el IMC del hijo percibido por la madre. Se midió peso y talla a madres e hijos. Se encontró que 10.3% de madres de hijos con sobrepeso (SP) y 1.8% de madres de hijos con obesidad (OB) los percibieron de forma adecuada por la prueba (PP) y por la prueba IMCP el 38.5% y 67.3% de madres de hijos con SP y OB respectivamente. La sensibilidad de PP fue 5.3% y especificidad 29.1%. La sensibilidad de IMCP fue 55.3% y especificidad 54.4%. La h2 del IMC fue de 15%. Se concluye que las madres no perciben el SP-OB de sus hijos y que el cuestionar a la madre peso y talla del hijo (IMCP) podría ayudar a percibir el SP-OB del hijo. La h2 del IMC indica que los factores del estilo de vida en esta población contribuyen al SP-OB. Dada la amplia diversidad socio-económica y cultural, estos resultados de Campeche deberán de ser validados con diseños similares de estudio.

Descriptive correlational study. The objectives were the following: 1) evaluate maternal perception of her child’s weight through two test, Word-perception (WP) test and the Body mass index (BMI) of the child as perceived by the mother (Body weight index perception [BWIP]); 2) evaluate the sensitivity and specificity of the tests, and 3) quantify BMI heritability (h2) in 173 mother-child dyads. WP was assessed by asking the question, How do you think your child is? For assessing BWIP, the mother referred the child’s weight and height, and we calculated the child’s BMI as perceived by the mother. The weight and height of the mothers and their children were measured. We found that 10.3% of mothers of children with Overweight (OW) and 1.8% of mothers of children with Obesity (OB) perceived their children adequately by means of WP; by means of the BWIP test, 38.5 and 67.3% of mothers of children with OW and OB, respectively, exhibited adequate perception. BWIP sensitivity was 55.3% and specificity was 54.4%. BWI h2 was 15%. We was concluded that mothers did not perceive the OW-OB of their children, and that asking the mother for the weight and height of the child (BMIP) will aids her to perceive the OW-OB of her child. The BWI h2 indicate that the lifestyle factors of this population contribute to OW-OB. Given the broad socioeconomic and cultural diversity, these results of the southeastern Mexican state of Campeche should be evaluated with similar study designs.

[Evaluation of the maternal perception of childhood overweight-obesity and maternal recognition of health risk in a Mexican border city]. / Percepción materna de sobrepeso-obesidad infantil y riesgos de salud en Nuevo Laredo, Tamaulipas, México.

OBJECTIVES: To evaluate 1) maternal perception (MP) of their child's weight, 2) MP of overweight-obesity (OW-OB) of unrelated children (URC),3) MP of image with health risk, and 4) recognition of OW-OB health risks. MATERIAL AND METHODS: A total of 325 mother-child dyads participated. A panel with 7 images was used.The child's body mass index was the gold standard. RESULTS: A total of 84 of 100 mothers of OW-OB children did not accurately perceive their children's weight. Of the total sample, 97.5% perceived the OW-OB of URC and 83.1% the OW-OB image with health risk. Most of the mothers recognized the health risks. CONCLUSION: It is necessary to design multidisciplinary intervention programs to help mothers of OW-OB children accurately recognize their children's weight and, thus, reduce the high prevalence of OW-OB in our population.

Percepción materna de sobrepeso-obesidad infantil y riesgos de salud en Nuevo Laredo, Tamaulipas, México / Evaluation of the maternal perception of childhood overweight-obesity and maternal recognition of health risk in a Mexican border city

OBJETIVOS: Evaluar 1) la percepción materna (PM) del peso del hijo, 2) la PM de sobrepeso-obesidad (SP-OB) de niños no emparentados(NNE),3)laPMde la imagenconriesgode salud y 4) el reconocimiento de riesgos de salud del SP-OB. MATERIAL Y MÉTODOS: Participaron 325 diadas madre-hijo.Se utilizó un panel de siete imágenes.El índice de masa corporal medido del hijo fue el estándar de oro. RESULTADOS: 84 de 100 madres de niños con SP-OB no percibieron adecuadamente el peso del hijo.El 97.5 por ciento percibió el SP-OB de NNE y 83.1 por ciento la imagen con SP-OB con riesgo de salud. La mayoría reconoció riesgos de salud. CONCLUSIÓN: Es necesario diseñar programas de intervención multidisciplinarios para ayudar a las madres de niños con SP-OB a reconocer de forma adecuada el peso de su hijo y así disminuir la prevalencia de SP-OB en dicha población.

OBJECTIVES: To evaluate 1) maternal perception (MP) of their child's weight, 2) MP of overweight-obesity (OW-OB) of unrelated children (URC),3) MP of image with health risk, and 4) recognition of OW-OB health risks. MATERIAL AND METHODS: A total of 325 mother-child dyads participated.A panel with 7 images was used.The child's body mass index was the gold standard. RESULTS: A total of 84 of 100 mothers of OW-OB children did not accurately perceive their children's weight. Of the total sample, 97.5 percent perceived the OW-OB of URC and 83.1 percent the OW-OB image with health risk.Most of the mothers recognized the health risks. CONCLUSION: It is necessary to design multidisciplinary intervention programs to help mothers of OW-OB children accurately recognize their children's weight and, thus, reduce the high prevalence of OW-OB in our population.

[Evaluation of the maternal perception of her child's weight and body mass index heritability in mestizas dyads in Southeastern Mexico]. / Evaluación de la percepción materna del peso del hijo y de la heredabilidad del IMC en diadas mestizas del Sureste de México.

Descriptive correlational study. The objectives were the following: 1) evaluate maternal perception of her child's weight through two test, Word-perception (WVP) test and the Body mass index (BMI) of the child as perceived by the mother (Body weight index perception [BWIP]); 2)evaluate the sensitivity and specificity of the tests, and 3) quantify BMI heritability (h2) in 173 mother-child dyads. WP was assessed by asking the question, How do you think your child is? For assessing BWIP, the mother referred the child's eight and height, and we calculated the child's BMI as perceived by the mother. The weight and height of the mothers and their children were measured. We found that 10.3% of mothers of children with Overweight (OW) and 1.8% of mothers of children with Obesity (OB) perceived their children adequately by means of WP; by means of the BWIP test, 38.5 and 67.3% of mothers of children with OW and OB, respectively, exhibited adequate perception. BWIP sensitivity was 55.3% and specificity was 54.4%. BWI h2 was 15%. We was concluded that mothers did not perceive the OW-OB of their children, and that asking the mother for the weight and height of the child (BMIP) will aids her to perceive the OW-OB of her child. The BWI h2 indicate that the lifestyle factors of this population contribute to OW-OB. Given the broad socioeconomic and cultural diversity, these results of the southeastern Mexican state of Campeche should be evaluated with similar study designs.