Lactancia materna y alimentación complementaria en un grupo de niños y niñas atendidos por un programa de atención integral en Bogotá, Colombia / Breastfeeding and complementary feeding in a group of children participating in a comprehensive service program in Bogotá, Colombia

RESUMEN La situación nutricional de los niños menores de 2 años de edad está relacionada principalmente con su alimentación, la cual incluye lactancia materna exclusiva hasta los 6 meses de edad y una alimentación complementaria adecuada y segura desde los 6 meses de edad, manteniendo la lactancia materna hasta los 2 años o más, por tal razón se caracterizó la alimentación en un grupo de niños y niñas de O a 24 meses de la ciudad de Bogotá. Estudio descriptivo longitudinal, donde se aplicó encuesta alimentaria en 5 momentos a 388 madres de niños participantes, estableciéndose frecuencias simples, con intervalos de confianza al 95% y pruebas de diferencia Chi2. La Lactancia Materna (LM) en la primera hora de vida fue 68,8%, a los 2 meses 96.1% y esta prevalencia disminuyó gradualmente a 43,3% a los 24 meses. La prevalencia de lactancia materna exclusiva hasta los 6 meses fue 22,9% y la duración media 2,9 meses. El suministro de leche artificial inició a los 0 meses, alcanzó el 60% a los 6 meses. El 50% de los niños y niñas había iniciado alimentación complementaria alrededor de los 2 meses de edad. En la mayoría de los niños, a los 24 meses no cumplían con el consumo establecido de frutas, verduras y carnes, así mismo, con la recomendación mundial de lactancia materna exclusiva debido al suministro temprano de leche artificial y otros alimentos.

ABSTRACT The nutritional status of children under 2 years of age is mainly related to their diet, which includes exclusive breastfeeding until 6 months of age and adequate and safe supplementary feeding from 6 months of age, maintaining breastfeeding for 2 or more years. For this reason, feeding was characterized in a group of children from 0 to 24 months of the city of Bogotá. We conducted a longitudinal descriptive study, where a food survey was completed on 5 occasions by 388 mothers of participating children, establishing simple frequencies, with 95% confidence intervals and Chi2 difference tests. Breastfeeding (BF) in the first hour of life was 68.8% and 96.1% at 2 months. This prevalence gradually decreased to 43.3% at 24 months. The prevalence of exclusive breastfeeding up to 6 months was 22.9% and the average duration was 2.9 months. The supply of artificial milk began at 0 months and was 60% at 6 months. 50% of children had started complementary feeding around 2 months of age. At 24 months, children's diets did not meet the established norms for consumption of fruits, vegetables and meats. Due to the early supply of artificial milk and other foods, the worldwide recommendation to exclusively breastfeed was also not met.

La lactancia materna desde la perspectiva de madres adolescentes de Bogotá / Breastfeeding from the perspective of teenage mothers in Bogotá

Introducción. En Colombia, la práctica de lactancia exclusiva y total es inadecuada y de corta duración, especialmente en mujeres adolescentes. Teniendo en cuenta que las adolescentes constituyen un grupo social con sus propios estilos de vida, es necesario conocer cuáles son los significados que construyen alrededor de la lactancia y cuáles son las características de su experiencia de lactar para identificar aspectos que limitan o facilitan esta práctica, generando conocimientos para mejorar las estrategias de promoción de la lactancia. Objetivo. Caracterizar la experiencia de lactancia materna en adolescentes en período de lactancia, e identificar aspectos positivos, limitaciones y necesidades sentidas desde su propia perspectiva. Materiales y métodos. Se trata de un estudio cualitativo con enfoque fenomenológico. Se hicieron 24 entrevistas y se conformaron tres grupos de mujeres adolescentes en diferentes períodos posparto. La información se recolectó en Bogotá con mujeres que participaban en un programa de la Secretaría Distrital de Integración Social. El proceso de sistematización se desarrolló paralelamente con el proceso de análisis. Este proceso comprendió las relaciones entre categorías y las redes que se forman entre ellas. Resultados. Las adolescentes no alimentan sus hijos con lactancia materna exclusivamente y refieren varias dificultades en el acto de lactar. La alimentación complementaria incluye alimentos no naturales. La maternidad y la lactancia no son acordes con la percepción de ser adolescente. Conclusiones. Las adolescentes reconocen los beneficios que ofrece la lactancia materna para sus hijos y para ellas; sin embargo, su experiencia de lactancia materna difiere de las recomendaciones para lograr una lactancia materna exclusiva y una alimentación complementaria saludable. Entre las causas identificadas, sobresale la ausencia de acompañamiento acertado y oportuno.

Introduction: In Colombia, breastfeeding is inadequate and -especially in teenage girls- short. Given that adolescents are a social group with their own lifestyles, we need to know what meanings they have regarding breastfeeding, and also what the characteristics of their breastfeeding experience are, in order to identify issues that limit or facilitate this practice, which will produce the knowledge to improve breastfeeding promotion strategies. Objective: To characterize the experience of breastfeeding in nursing adolescents and identify strengths, limitations and perceived needs from their own perspective. Materials and methods: This was a phenomenological qualitative study. We conducted 24 interviews and had three focal groups with female adolescents in different postpartum periods. Data collection was carried out in Bogotá, with women participating in a program of the Secretaría Distrital de Integración Social. The systematic process was developed in parallel with the analysis process. It involved the relationships between categories and the networks that form among them. Results: Teenagers do not breastfeed exclusively, identifying several difficulties in the act of breastfeeding. Complementary feeding includes unnatural foods. Maternity and breastfeeding are not consistent with the perception of being a teenager. Conclusions: Adolescents recognize the benefits of breastfeeding for their children and for them; however, their breastfeeding experience differs from the recommendations to achieve exclusive breastfeeding and a healthy complementary feeding. Among the identified causes, we highlight the lack of accurate backing and timely support.

Comparación de dos metodologías utilizadas para la determinación del síndrome metabólico en población adulta / Comparison of two methodologies used for determining metabolic syndrome in adult population

Introducción. El síndrome metabólico se caracteriza por la aparición simultánea o secuencial de diversas alteraciones metabólicas e inflamatorias a nivel molecular, celular o hemodinámico, asociadas a resistencia a la insulina y adiposidad de predominio visceral. Diferentes grupos de expertos, como la International Diabetes Federation (IDF) y el National Cholesterol Education Program (NCEP), han tratado de elaborar criterios para su diagnóstico. Objetivo. Establecer los niveles de concordancia de los criterios de diagnóstico para el síndrome metabólico. Material y métodos. El estudio incluyó 357 individuos. Se hizo el análisis descriptivo de variables cualitativas y de resultados de laboratorio y medición antropométrica para la determinación de la prevalencia de síndrome metabólico, según las definiciones de los dos grupos mencionados. Se utilizaron concordancia kappa y regresión logística, para la comparación de las metodologías. Resultados. Las prevalencia del síndrome metabólico, según la International Diabetes Federation, es de 19,9 % y por el Adult Treatment Panel (ATP) III fue de 10,4 %. La estimación de concordancia entre los criterios diagnósticos de la Federación y los del Panel fue escasa (fair agreement) κ=0,3997; IC95%: 0,28-0,52). Conclusiones. En la población trabajadora que participó en este estudio, la prevalencia del síndrome metabólico se presentó en mayor porcentaje utilizando la definición de la International DiabetesFederation y fue más alta en los hombres que en las mujeres. Los criterios diagnósticos para el síndrome metabólico deben usarse teniendo en cuenta la población en estudio, así como el sexo y la edad.

Introduction: Metabolic syndrome is characterized by the simultaneous or sequential appearance of various metabolic and inflammatory changes at molecular, cellular or hemodynamic level associated with the presence of insulin resistance and dominant visceral adiposity. Different expert groups, including the International Diabetes Federation and the National Cholesterol Education Program, have tried to develop criteria for its diagnosis. Objective: To establish diagnostic criteria concordance levels for metabolic syndrome.. Materials and methods: A total of 357 people were part of the study. We performed a descriptive analysis of qualitative variables, and laboratory and anthropometric measurement results to determine the prevalence of metabolic syndrome according to the International Diabetes Federation and National Cholesterol Education Program - ATP III definitions. We used kappa concordance and logistic regression for the comparison of methodologies.. Results: The prevalence of metabolic syndrome was 19.9% according to the International Diabetes Federation, and 10.4% using the National Cholesterol Education Program - ATP III. The estimate of agreement between the two diagnostic criteria of the International Diabetes Federation and the National Cholesterol Education Program - ATP III was fair (low) (κ=0.3997, CI 95% 0.28-0.52).. Conclusions: In the working population who participated in this study, the obtained prevalence of metabolic syndrome occurred at a higher rate using the International Diabetes Federation definition, being higher in men than in women. The use of diagnostic criteria for metabolic syndrome must take into account the study population as well as sex and age.

[Comparison of two methodologies used for determining metabolic syndrome in adult population]. / Comparación de dos metodologías utilizadas para la determinación del síndrome metabólico en población adulta.

INTRODUCTION: Metabolic syndrome is characterized by the simultaneous or sequential appearance of various metabolic and inflammatory changes at molecular, cellular or hemodynamic level associated with the presence of insulin resistance and dominant visceral adiposity. Different expert groups, including the International Diabetes Federation and the National Cholesterol Education Program, have tried to develop criteria for its diagnosis. OBJECTIVE: To establish diagnostic criteria concordance levels for metabolic syndrome. MATERIALS AND METHODS: A total of 357 people were part of the study. We performed a descriptive analysis of qualitative variables, and laboratory and anthropometric measurement results to determine the prevalence of metabolic syndrome according to the International Diabetes Federation and National Cholesterol Education Program - ATP III definitions. We used kappa concordance and logistic regression for the comparison of methodologies. RESULTS: The prevalence of metabolic syndrome was 19.9% according to the International Diabetes Federation, and 10.4% using the National Cholesterol Education Program - ATP III. The estimate of agreement between the two diagnostic criteria of the International Diabetes Federation and the National Cholesterol Education Program - ATP III was fair (low) (κ=0.3997, CI 95% 0.28-0.52). CONCLUSIONS: In the working population who participated in this study, the obtained prevalence of metabolic syndrome occurred at a higher rate using the International Diabetes Federation definition, being higher in men than in women. The use of diagnostic criteria for metabolic syndrome must take into account the study population as well as sex and age.

[Breastfeeding from the perspective of teenage mothers in Bogotá]. / La lactancia materna desde la perspectiva de madres adolescentes de Bogotá.

INTRODUCTION: In Colombia, breastfeeding is inadequate and -especially in teenage girls- short. Given that adolescents are a social group with their own lifestyles, we need to know what meanings they have regarding breastfeeding, and also what the characteristics of their breastfeeding experience are, in order to identify issues that limit or facilitate this practice, which will produce the knowledge to improve breastfeeding promotion strategies. OBJECTIVE: To characterize the experience of breastfeeding in nursing adolescents and identify strengths, limitations and perceived needs from their own perspective. MATERIALS AND METHODS: This was a phenomenological qualitative study. We conducted 24 interviews and had three focal groups with female adolescents in different postpartum periods. Data collection was carried out in Bogotá, with women participating in a program of the Secretaría Distrital de Integración Social. The systematic process was developed in parallel with the analysis process. It involved the relationships between categories and the networks that form among them. RESULTS: Teenagers do not breastfeed exclusively, identifying several difficulties in the act of breastfeeding. Complementary feeding includes unnatural foods. Maternity and breastfeeding are not consistent with the perception of being a teenager. CONCLUSIONS: Adolescents recognize the benefits of breastfeeding for their children and for them; however, their breastfeeding experience differs from the recommendations to achieve exclusive breastfeeding and a healthy complementary feeding. Among the identified causes, we highlight the lack of accurate backing and timely support.

Micronutrient status and global DNA methylation in school-age children.

Aberrations in global LINE-1 DNA methylation have been related to risk of cancer and cardiovascular disease. Micronutrients including methyl-donors and retinoids are involved in DNA methylation pathways. We investigated associations of micronutrient status and LINE-1 methylation in a cross-sectional study of school-age children from Bogotá, Colombia. Methylation of LINE-1 repetitive elements was quantified in 568 children 5-12 years of age using pyrosequencing technology. We examined the association of LINE-1 methylation with erythrocyte folate, plasma vitamin B12, vitamin A ferritin (an indicator of iron status) and serum zinc concentrations using multivariable linear regression. We also considered associations of LINE-1 methylation with socio-demographic and anthropometric characteristics. Mean (± SD) LINE-1 methylation was 80.25 (± 0.65) percentage of 5-mC (%5-mC). LINE-1 methylation was inversely related to plasma vitamin A. After adjustment for potential confounders, children with retinol levels higher than or equal to 1.05 µmol/L showed 0.19% 5-mC lower LINE-1 methylation than children with retinol levels lower than 0.70 µmol/L. LINE-1 methylation was also inversely associated with C-reactive protein, a marker of chronic inflammation, and female sex. We identified positive associations of maternal body mass index and socioeconomic status with LINE-1 methylation. These associations were not significantly different by sex. Whether modification of these exposures during school-age years leads to changes in global DNA methylation warrants further investigation.

Nutrition in Colombian pregnant women.

OBJECTIVE: The present study aimed to evaluate the nutritional status of pregnant women in Colombia and the associations between gestational BMI and sociodemographic and gestational characteristics. DESIGN: Cross-sectional study. A secondary analysis was made of data from the 2005 Demographic and Health Survey of Colombia. SETTING: Bogotá, Colombia. SUBJECTS: Pregnant adolescents aged 13-19 years (n 430) and pregnant women aged 20-49 years (n 1272). RESULTS: The gestational BMI and sociodemographic characteristics of the adolescents differed from those of the pregnant adult women. Thirty-one per cent of the adolescents were underweight for gestational age, compared with 14·5 % of the adult women. Eighteen per cent of adolescents were overweight for gestational age, in contrast to 37·3 % of adult women. The overall prevalence of anaemia was 44·7 % and the prevalence of low serum ferritin was 38·8 %. Women within the high quintiles of the wealth index (prevalence odds ratio (POR) = 0·56; 95 % CI 0·34, 0·91, P < 0·02) had lower odds of being underweight. Women who received prenatal care (POR = 2·17; 95 % CI 1·48, 3·09, P < 0·001) and were multiparous (POR = 2·10; 95 % CI 1·43, 3·15, P < 0·0 0 1) had higher odds of being overweight. Women in extended families (POR = 0·63; 95 % CI 0·50, 0·95, P < 0·025) had lower odds of being overweight. CONCLUSIONS: Underweight in pregnant adolescents and overweight in adult women coexist as a double burden in Colombia. Factors associated with malnutrition among pregnant women and adolescents should be considered for future interventions in countries experiencing nutritional transition.

Micronutrient and anthropometric status indicators are associated with physical fitness in Colombian schoolchildren.

Poor physical fitness is associated with increased health-related risks in children. The association of nutritional status indicators and physical fitness in children residing in developing countries is not well characterised. We conducted a cross-sectional study among 1945 children of age 5-12 years in Bogotá, Colombia, to assess whether anthropometric and micronutrient status indicators were associated with performance in the shuttle run and standing long jump tests. Stunted children scored significantly lower in the run (0·4 s; P = 0·0002) and jump (6 cm; boys only; P = 0·003) tests than non-stunted children, after adjustment for age and other factors. Children who were thin, overweight or obese ran slower than normal-weight children (P < 0·01). Lower jump scores were associated with overweight or obesity and greater arm fat area in boys only (P < 0·0001). Girls with low ferritin concentrations ran 0·6 s slower than girls with normal ferritin concentrations (P = 0·02). Erythrocyte folate concentrations were linearly related to higher run (P < 0·0001) and long jump scores (P = 0·0001). Boys with marginal or low vitamin B12 status had 4 cm lower long jump scores than children with normal status (P = 0·01). Suboptimal anthropometric and micronutrient status are related to poorer performance in fitness tests. The effects of improving nutritional status on physical fitness of children warrant investigation.

Intestinal protozoan infections in relation to nutritional status and gastrointestinal morbidity in Colombian school children.

While Giardia duodenalis infection has been consistently associated with nutrient malabsorption and stunting in children, the effects of other protozoans on nutritional status or gastrointestinal morbidity are less clear. We sought to determine whether infection with common intestinal protozoans including Giardia duodenalis, Entamoeba coli and Blastocystis hominis was associated with anthropometric and micronutrient status, gastrointestinal symptoms, visits to the doctor or school absenteeism in children 5-12 years of age from Bogotá, Colombia. We obtained stool samples from 442 children enrolled in primary schools in 2006 and examined the presence of intestinal protozoans in relation to height, body mass index, plasma concentrations of vitamins A and B12, ferritin and zinc and erythrocyte folate. In addition, we examined the associations between protozoan infections and the incidence of common gastrointestinal symptoms, which were registered prospectively in morbidity diaries. The prevalence rates of G. duodenalis, E. coli and B. hominis infection were 6.3, 23.1 and 22.4%, respectively. Giardia infection was associated with lower height-for-age z-score (p = 0.04), whereas E. coli infection was associated with low erythrocyte folate (p = 0.04), and B. hominis infection was related to higher vitamin A levels (p = 0.05). Infection with E. coli was also associated with a significantly higher incidence of fever but fewer visits to the doctor, while B. hominis infection was associated with significantly less diarrhea, diarrhea with vomiting, doctor visits and school absenteeism. In conclusion, G. duodenalis and E. coli infections were associated with indicators of poor nutritional status in this population, while B. hominis was related to apparently decreased morbidity.

Relation between vitamin B12 and folate status, and hemoglobin concentration and parasitemia during acute malaria infections in Colombia.

Anemia is a common complication of human malaria. Since micronutrient deficiencies are highly prevalent in malaria-endemic areas and appear to contribute to anemia etiology, we conducted a cross-sectional study in Tumaco, Colombia, to examine the associations between plasma vitamin B12 or erythrocyte folate concentrations and hemoglobin (Hb) among 96 adults with predominantly Plasmodium falciparum malaria. Prevalence of folate and vitamin B12 deficiencies was 26.0 and 26.6%, respectively. There was an inverse, linear relation between folate and Hb concentrations. Adjusted difference in Hb between lowest and highest folate quartiles was 1g/dL (p=0.04; p, test for trend=0.01). Vitamin B12 was not associated with Hb concentrations and did not modify the associations between folate and Hb. Incidentally, body mass index (BMI) was inversely associated with parasitemia and risk of clinical malaria. Future longitudinal studies are warranted to determine the potential pathophysiological role of folate in malaria-related anemia.

Are vitamin A and iron deficiencies re-emerging in urban Latin America? A survey of schoolchildren in Bogota, Colombia.

BACKGROUND: In Latin America, the burden of vitamin A and iron deficiencies has been documented primarily in preschool-age children. There are few recent reports on the vitamin A and iron status of school-age children. OBJECTIVE: We aimed to determine the prevalence and predictors of vitamin A and iron deficiencies in Colombian schoolchildren. METHODS: We examined plasma retinol and ferritin concentrations in relation to socioeconomic and anthropometric factors in a representative sample of 2811 low- and middle-income children 5 to 12 years of age in Bogotá, Colombia. RESULTS: The prevalence rates of deficiencies of vitamin A (plasma retinol < 0.70 micromol/L) and iron (plasma ferritin <15 microg/L) were 14% and 3%, respectively. In multivariate analysis, plasma retinol concentrations were positively associated with child's age and household's socioeconomic stratum, whereas ferritin concentrations were positively related to child's age, number of home assets, and having a nonsingle mother. Ferritin concentrations were much lower among girls than boys in the 11- and 12-year-old age group, whereas there were only small positive differences between girls and boys in younger children (p for interaction < .0001). Both vitamin A and iron deficiencies were independently associated with lower z-scores for body-mass-index-for-age, after adjustment for sociodemographic factors and C-reactive protein concentrations. Neither vitamin A nor iron status was related to height-for-age. CONCLUSIONS: The prevalence rates of vitamin A and iron deficiencies among schoolchildren from Bogotd, Colombia, are not negligible. Both vitamin A and iron status are positively associated with socioeconomic status and anthropometric indices. The effect of improving vitamin A and iron status on physical growth and other functional outcomes needs to be further examined in this age group.

Provision of a school snack is associated with vitamin B-12 status, linear growth, and morbidity in children from Bogota, Colombia.

In 2004, Bogotá's Secretary of Education (SED) initiated a snack program in public primary schools. A midmorning food ration was provided free of charge to children to supplement 30 and 50% of their daily requirements of energy and iron, respectively. The purpose of this study, an observational investigation of 3202 children ages 5-12 y, was to examine whether the snack program improved children's nutritional and health status. We measured micronutrient levels (plasma ferritin and vitamin B-12, and erythrocyte folate), anthropometry, and reported morbidity during the first semester of the 2006 school year. After adjusting for socioeconomic status and other school interventions, children at schools receiving the snack (n = 1803) had greater increases in plasma vitamin B-12 (42 pmol/L; P < 0.0001) from baseline to 3 mo of follow-up than children at schools not receiving the snack (n = 1399). They also experienced a smaller decrease in height-for-age Z-scores than children who did not receive the snack (P = 0.001). Provision of the SED snack was associated with significantly fewer reported days with morbidity symptoms (e.g. cough with fever, diarrhea with vomiting), 44% fewer doctor visits (P = 0.02), and 23% fewer days of school absenteeism (P = 0.03). The snack was not related to ferritin or folate levels. In conclusion, provision of a school-administered snack was related to improved vitamin B-12 status and linear growth and decreased reported morbidity. Although provision of the snack was not related to BMI changes over a 4-mo period, snack components such as candy and sugar-sweetened beverages should be replaced with healthier options, as the rates of child overweight in Colombia are not negligible.

[Cardiovascular risk markers in schoolchildren from five provinces of eastern Colombia]. / Marcadores de riesgo cardiovascular en escolares de cinco departamentos de la región oriental en Colombia.

INTRODUCTION: Cardiovascular disease is a public health problem globally; it represents the second cause of mortality in Colombia. This highlights the importance of identifying risk markers from the time of childhood, in order to diminish mortality rates proactively. OBJECTIVES: The lipid profile, homocysteine and C reactive protein plasma concentrations were determined in order to identify relationships between these markers and age, sex and school type. MATERIALS AND METHODS: A descriptive study was undertaken in 600 schoolchildren, aged 5 to 14, where the lipid profile, and the plasmatic concentrations of homocysteine and C-reactive protein were evaluated. RESULTS: Higher average levels of total cholesterol, low density cholesterol and triglycerides were observed in females (p<0.05) as compared with males. The prevalences of high lipid were higher in females than in males--7.9% vs. 3.0% for total cholesterol; 11.6% vs. 4.7% for low density cholesterol and 6.9% vs. 5.7% for triglycerides. Children in private schools had higher levels of lipid than those in public ones (p<0.05). The prevalence of homocysteine levels above 6.3 micromol/L was higher (64.3%) in males than in females (56.1%). No statistically significant differences with respect to sex, age or type of school were observed when comparing the prevalence of high levels C-reactive proteins. CONCLUSIONS: The prevalence of high lipid profile levels in female schoolchildren suggested a policy of adopting intervention measures at an early age. Other factors require further investigation, such as the homocysteine levels observed in males and the C protein levels in order to detect their contribution to cardiovascular disease.

Vitamin B-12 status is associated with socioeconomic level and adherence to an animal food dietary pattern in Colombian school children.

Vitamin B-12 is related to neurocognitive function in school-age children, yet sociodemographic and dietary correlates of vitamin B-12 status in this age group are not well characterized. The prevalences of vitamin B-12 or folate deficiencies in Colombia are unknown. We conducted a cross-sectional study in a representative sample of 2800 low- and middle-income children aged 5-12 y from Bogotá's public schools. Plasma vitamin B-12 and erythrocyte folate concentrations (mean +/- SD) were 327 +/- 106 pmol/L and 858 +/- 256 nmol/L, respectively. The prevalence of vitamin B-12 deficiency (<148 pmol/L) was 1.6% and the prevalence of marginal status (148-221 pmol/L) was 15.0%. Only 2 children had folate deficiency (<305 nmol/L). In multivariate analysis, mean vitamin B-12 concentrations significantly decreased with age and were 15 pmol/L higher in girls than boys (95%CI = 8, 23). Vitamin B-12 was inversely related to the mother's parity and positively associated with the amount of money spent on food per person per day at home and the household's neighborhood socioeconomic status (SES) classification. Folate concentrations were lower in girls than in boys and significantly increased with the household's SES. We identified 4 dietary patterns with principal components analysis of a FFQ in a random subsample (n = 972). Plasma vitamin B-12 was strongly, positively associated with a pattern that included frequent intake of beef, chicken, and dairy products in a dose-response manner (P-trend, adjusted, = 0.008). Low vitamin B-12 status is not negligible in Colombian school children and is associated with poverty and marginal intake of animal food sources.

Marcadores de riesgo cardiovascular en escolares de cinco departamentos de la región oriental en Colombia / Cardiovascular risk markers in schoolchildren from five provinces of eastern Colombia

Introducción. La enfermedad cardiovascular es un problema de salud pública en el mundo y representa la segunda causa de mortalidad en Colombia; de ahí, la importancia de identificar marcadores de riesgo desde la infancia, para disminuir las tasas de mortalidad. Objetivos. Determinar el perfil lipídico, la homocisteína y la proteína C reactiva e identificar la relación entre estos marcadores con edad, sexo y tipo de colegio, en escolares entre 5 y 14 años. Materiales y métodos. Estudio descriptivo de 600 escolares, en el que se evaluaron lípidos, homocísteina y proteína C reactiva en plasma. Resultados. Los promedios de colesterol total, colesterol de baja densidad y triglicéridos fueron más elevados en las niñas que en los niños (p<0,05); la prevalencia de lípidos elevados fue mayor en las niñas que en los niños: 7,9 por ciento Vs. 3,0 por ciento; 11,6 por ciento Vs. 4,7 por ciento y 6,9por ciento Vs. 5,7 por ciento para colesterol total, colesterol de baja densidad y triglicéridos, respectivamente. Con relación a los colegios, los privados mostraron niveles de lípidos más altos que los públicos (p<0,05). La prevalencia de niveles de homocisteína mayores de 6,3 µmol /L fue más alta en los varones (64,3 por ciento) que en las niñas (56,1 por ciento); las concentraciones de proteína C reactiva no presentaron diferencias estadísticamente significativas por sexo, edad o tipo de colegio. Conclusiones. La prevalencia de niveles altos de perfil lipídico observados en las niñas, sugieren la posibilidad de implementar medidas de intervención en la población infantil. Es necesario investigar la intervención de otros factores, en los niveles de homocisteína de los varones y en la proteína C reactiva, para determinar su contribución en las enfermedades cardiovasculares.

[Iron and vitamin A micronutrient status, risk factors for their deficiencies and anthropometric assessment in preschool child from Funza municipality, Colombia]. / Estado de los micronutrientes hierro y vitamina A, factores de riesgo para las deficiencias y valoración antropométrica en niños preescolares del municipio de Funza, Colombia.

INTRODUCTION: The malnutrition and deficiencias of iron and vitamin A are frequent in the Colombian population and are associated with biological and environmental risk factors. OBJECTIVE: Prevalence of anemia, iron and vitamin A deficiencies and nutritional status was determined by anthropometric assessment in a population of preschool children in the municipality of Funza. Associations were made between micronutrient deficiency and other risk factors reported in the literature. MATERIALS AND METHODS: The nutrition status of 287 child preschool was assessed by means of anthropometric evaluation, levels of hemoglobin, ferritin, and vitamin A in blood sera, in addition to fecal examination. A survey was administered to identify risk factors associated with these deficiencies. RESULTS: Of these children, 40.8% showed anemia, 5.2% iron deficiency and 4.6% vitamin A deficiency. In addition, the children were generally malnourished. Significant associations were noted between low levels of hemoglobin, rented housing, lack of a nutritional program, low levels of vitamin A, and illness in the previous month. Nonsignificant, but statistical association was observed with other risk factors. CONCLUSION: Incentive programs are necessary to improve the nutritional situation of the preschool children from Funza municipality, Colombia. Nutritional status can be determined by examination of levels of folic acid, vitamin B12, iron and vitamin A in association with social risk factors.

Estado de los micronutrientes hierro y vitamina A, factores de riesgo para las deficiencias y valoración antropométrica en niños preescolares del municipio de Funza, Colombia / Iron and vitamin A micronutrient status, risk factors for their deficiencies and anthropometric assessment in preschool child from Funza municipality, Colombia

Introducción. La malnutrición y las deficiencias de hierro y vitamina A son frecuentes en la población colombiana y están asociadas con factores de riesgo biológicos y ambientales. Objetivo. Determinar la prevalencia de anemia, la deficiencia de hierro y vitamina A y el estado nutricional por antropometría en niños preescolares del municipio de Funza; identificar la asociación entre la deficiencia de micronutrientes y los factores de riesgo para estas deficiencias reportados en la literatura. Materiales y métodos. Estudio descriptivo en 287 preescolares mediante valoración antropométrica, bioquímica de concentraciones sanguíneas de hemoglobina, ferritina y vitamina A y examen coprológico. Por encuesta se investigó sobre algunos de los factores de riesgo para estas deficiencias. Resultados. El 40,8 por ciento de los preescolares tenía anemia; el 5,2 por ciento, deficiencia de hierro, y el 4,6 por ciento, deficiencia de vitamina A; además, se encontraron preescolares con desnutrición. Se encontró asociación entre las concentraciones bajas de hemoglobina, vivir en inquilinato y no ser beneficiario de algún programa nutricional; también hubo asociación entre la deficiencia de vitamina A y el riesgo de adquirirla con morbilidad sentida en el último mes. Aunque sin asociación estadística, se identificó una alta frecuencia de otros factores de riesgo para las deficiencias de los micronutrientes. Conclusión. Existe la necesidad de fortalecer programas fundamentados en las condiciones existentes para mejorar la situación nutricional de los preescolares del municipio de Funza. Es importante indagar si se presenta anemia nutricional relacionada con ácido fólico y vitamina B12, así como sobre otros factores de riesgo asociados con la deficiencia nutricional por hierro y vitamina A.

Introduction. The malnutrition and deficiencias of iron and vitamin A are frequent in the Colombian population and are associated with biological and environmental risk factors. Objective. Prevalence of anemia, iron and vitamin A deficiencies and nutritional status was determined by anthropometric assessment in a population of preschool children in the municipality of Funza. Associations were made between micronutrient deficiency and other risk factors reported in the literature. Materials and methods. The nutrition status of 287 child preschool was assessed by means of anthropometric evaluation, levels of hemoglobin, ferritin, and vitamin A in blood sera, in addition to fecal examination. A survey was administered to identify risk factors associated with these deficiencies. Results. Of these children, 40.8% showed anemia, 5.2% iron deficiency and 4.6% vitamin A deficiency. In addition, the children were generally malnourished. Significant associations were noted between low levels of hemoglobin, rented housing, lack of a nutritional program, low levels of vitamin A, and illness in the previous month. Nonsignificant, but statistical association was observed with other risk factors. Conclusion. Incentive programs are necessary to improve the nutritional situation of the preschool children from Funza municipality, Colombia. Nutritional status can be determined by examination of levels of folic acid, vitamin B12, iron and vitamin A in association with social risk factors.

[Stability and effect of ingestion on the levels of folate in plasma]. / Estabilidad y efecto de la ingestión sobre los niveles de folatos en plasma.

The physiological demand of folates increases during adolescence, pregnancy and lactation due to the rapid growth and anabolic activity during these stages of life. The periconceptional deficiency of folates is a risk for the presence of neural tube defects. We studied the stability of folates concentration in plasma and the effect of ingestion of a breakfast rich in folates on the postprandial levels of this micronutrient, up to two hours after food intake. For the stability assay the samples were stored protected from light at -70 degrees C and analysed at time intervals of 1, 8, 30, 90 and 120 days. The mean folates concentration in plasma was higher in postprandial stage (8.9 ng/dl) that in fasting (7.9 ng/dl), which represents a statistically significant (p < 0.01) increase of 11%. This study confirms that fasting is important in folates determination for diagnosis and research purposes to establish deficiency prevalence of this micronutrient in a population. Concerning the stability of folates concentration, we did not find a significant difference between the several time analysis (p > 0.1); this suggests that folates concentrations in plasma remain stable under the experimental conditions described.

Frecuencia de anticuerpos antifosfolipidos en enfermedades autoinmunes y sifilis: correlación con caracteristicas clinicas y de laboratorio

Objetivos: establecer la prevalencia de anticuerpos anticardiolipina (aCL) y de anticoagulante lúpico (LAC) en pacientes con lupus eritematoso sistemico (LES), sindrome antifosfolipido (APS), artritis reumatoidea (AR) y sifilis temprana latente. Correlacionar los niveles de aCL con la presentacion clinica y los hallazgos de laboratorio. Material y metodo: se seleccionaron 100 controles normales y 140 pacientes agrupados asi: grupo 1: sindrome antifosfolipido primario (PAPS): 15; grupo 2, LES:60;grupo 3,AR:35 y grupo 4, sifilis temprana latente:30. Se determinó la presencia de aCL y LAC. Resultados: prevalencia de antifosfolipidos: aCL,100 porciento en el grupo 1; 57 porciento en el 2; 51 porciento en el 3 y 73 porciento en el 4. LAC, 42 porciento en el 1; 24 porciento en el 2; 9 porciento en el 3 y 3 porciento en el 4. Las caracteristicas clinicas mas frecuentemente encontradas en la poblacion son trombosis arterial y venosa, y perdida fetal. En los grupos 1 y 2 se encontro asociación entre aCL (IgG y/o IgA) y LAC, a diferencia de lo observado en los grupos 3 y 4, los cuales no presentan manifestaciones del APS asociadas con aCL o LAC. Conclusion: encontramos prevalencias mas altas de aCL y LAC en pacientes con LES, comparadas con otros estudios. La asociacion de varias clases de aCL fue comun en los pacientes con LES y PAPS. En nuestra población la trombosis arterial y/o venosa fueron caracteristicas clinicas del APS más frecuentemente encontradas y las que presentaron una fuerte asociacion con a PL. No encontramos una relacion entre aCL y perdida fetal o trombocitopenia, ni diferencias estadisticas en las carcteristicas clinicas y de laboratorio entre APS primario y secundario