Body frame size, body image, self-esteem, and health-related quality of life in schoolchildren.

OBJECTIVE: The aim of this study was to explore the relationship between body frame size (BFS) and body image, self-esteem, and health-related quality of life (HRQL) in Mexican schoolchildren. METHODS: This cross-sectional study included children aged 6 to 11 years. Body image, self-esteem, and HRQL were evaluated through interviews. Two frame-size measures, biacromial and bitrochanteric diameters, were collected and summed for categorizing BFS as small, medium, or large. Height and weight were also measured. Spearman's correlations were determined and adjusted by sex, age, and body mass index (BMI). Multiple logistic regression analyses were performed with the psychological measure as the binary dependent variable, the categories of BFS as the independent variable, and sex, age, and BMI as control variables. RESULTS: The correlation between BFS and body image was 0.15 (P < .01) and after BMI adjustment was 0.07 (P > .05). BFS did not correlate with self-esteem nor HRQL (P > .05). Of the children, 79% were dissatisfied with their body image, 20% had a low self-esteem, and 31.8% had a poorly perceived HRQL; there were no differences by BFS. The multivariate analysis showed that a large BFS was not associated with body image dissatisfaction (OR 1.2, 95% CI 0.6-2.3), low self-esteem (OR 1.3, 95% CI 0.7-2.6), or poor HRQL (OR 1.3, 95% CI 0.8-2.2). CONCLUSIONS: BFS was not correlated with body image, self-esteem, or HRQL. A high self-esteem and a good level of HRQL prevailed, but a high proportion of children were dissatisfied with their body image. School interventions should promote an appropriate body image and a healthy lifestyle.

Discriminatory Accuracy of Preeclampsia Risk Factors in Primary Care.

BACKGROUND: Although it is common to use risk factors in the screening for preeclampsia, they do not always accurately identify patients who truly have this condition. AIM OF THE STUDY: To determine the discriminatory accuracy of known preeclampsia risk factors, both individually and in combination. METHODS: We studied patients undergoing prenatal care who were diagnosed with preeclampsia or eclampsia (n = 160 cases) in primary care and those who were not (n = 430 controls). Data on history of preeclampsia, type 2 diabetes, chronic hypertension, multiple gestation, first pregnancy, pregnancy interval ≥10 years, overweight/obesity, mean arterial pressure (MAP) ≥80 mmHg, and age (<20 years and ≥40 years) were obtained using a dichotomous scale. Discriminatory accuracy indicators were true-positive (TP) and false-positive (FP) rates, positive and negative likelihood ratios (LR+ and LR-), diagnostic odds ratio (DOR), and the area under the receiver-operating characteristic (AUROC) curve; stratified by parity. The case-control status was the reference standard. RESULTS: Certain combinations performed better than individual factors, independent of parity status. Among multiparous women, MAP ≥80 mmHg together with previous preeclampsia and overweight/obesity accumulated the greatest number of discriminatory accuracy indicators, with acceptable values: TP, 72.2%; FP, 1.5%; LR+, 48.4; LR-, 0.3; DOR, 171.6; and AUROC, 0.85. CONCLUSIONS: Discriminatory accuracy was low for almost all individual preeclampsia risk factors. However, the accuracy improved after some factors were combined. To the best of our knowledge, this is the first study to examine the discriminatory accuracy of preeclampsia risk factors used for screening high-risk pregnancies in primary care in Mexico.

[Myocardial infarction in young mexicans associated to metabolic syndrome]. / Infarto agudo al miocardio en jóvenes mexicanos asociado a síndrome metabólico.

BACKGROUND: Acute coronary diseases are catastrophic, especially in young patients. OBJECTIVE: To determine the risk of metabolic syndrome (MS) for premature acute myocardial infarction (AMI), combined with familial, behavioral, and nutritional factors in the northeast of Mexico. MATERIAL AND METHODS: This is a case control study of patients less than 47 years of age with no personal history of angina, AMI, or cerebrovascular disease. Cases corresponded to patients with AMI (incident and primary cases; n = 55) and controls were blood donors located at the same hospital (n = 55). Behavioral, nutritional, and cardiometabolic risk factors were measured. Multivariate logistic regression was used for estimating odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: MS increased the risk for premature AMI (95% CI: 1.73-39.5) eightfold, followed by smoking (OR: 7.76; 95% CI: 1.27-47.3), family history of AMI or sudden death (OR: 11.0; 95% CI: 2.03-60.4), and sedentary lifestyle (OR: 2.26; 95% CI: 2.52-9.80), independent of potential confounders. CONCLUSIONS: The study highlights the magnitude of the risk of MS for AMI in Mexican young adults. The phenomenon of coronary diseases among young adults needs essential attention from the health sector.

Body frame size in school children is related to the amount of adipose tissue in different depots but not to adipose distribution.

OBJECTIVES: The main aim of this study was to test the hypothesis that body frame size is related to the amount of fat in different adipose tissue depots and to fat distribution in schoolchildren. METHODS: Children aged between 5 and 10 years were included in this cross-sectional study (n = 565). Body frame size, adiposity markers (anthropometric, skinfolds thickness, and ultrasound measures), and fat distribution indices were analyzed. Correlation coefficients adjusted by reliability were estimated and analyzed by sex; the significance of the difference between two correlation coefficients was assessed using the Fisher z-transformation. RESULTS: The sample included primarily urban children; 58.6% were normal weight, 16.1% overweight, 19.6% obese, and the rest were underweight. Markers of subcutaneous adiposity, fat mass and fat-free mass, and preperitoneal adiposity showed higher and significant correlations with the sum of the biacromial + bitrochanteric diameter than with the elbow diameter, regardless of sex. The fat distribution conicity index presented significant but weak correlations; and visceral adipose tissue, hepatic steatosis, and the waist-for-hip ratio were not significantly correlated with body frame size measures. CONCLUSIONS: Body frame size in school children was related to the amount of adipose tissue in different depots, but not adipose distribution. More studies are needed to confirm this relationship and its importance to predict changes in visceral fat deposition during growth.

Prevalence and Determinants of Repeat Mammography Among Women from a Developing Country.

Failures in repeat mammography decrease the potential benefits of screening; however, it is notable that the recent use of mammography is more frequently studied than repeat use. We estimated the prevalence and analyzed determinants for repeat mammography among women from Mexico, a developing country of Latin America. It was a two-stage study with an initial cross-sectional design (n = 1045) and a final case-control design that involved women of at least 45 years of age with no history of breast, ovarian, or uterine cancer. Case subjects were those with three or more mammograms in the last 5 years, with the last one carried out within the last two years (n = 444); control subjects included those who underwent ≥3 mammograms throughout their life with the most recent carried out >2 years ago (n = 444). Through interviews, we evaluated context-dependency, fulfillment of expected outcomes, self-efficacy, and risk perception, among other factors. We estimated the prevalence with 95 % confidence intervals (CI), and odds ratios (OR) using multivariate binary logistic regression. The prevalence of repeat mammography was 40.4 % (95 % CI 37.4-43.4). Self-efficacy demonstrated the highest effect on repeat use (OR 7.7, 95 % CI 4.7-12.6), followed by awareness context-dependency (OR 4.9, 95 % CI 3.3-7.2), the use of Papanicolaou testing (OR 3.5, 95 % CI 2.3-5.2), the fulfillment of expected waiting time outcome (OR 2.4, 95 % CI 1.2-4.7), and context-dependency related to self-referral/health provider referral (OR 2.4, 95 % CI 1.7-3.4), independent of risk perception, age, education, and positive emotional state of mind. The study showed a need for increasing the prevalence of promoting awareness of the determining factors of repeat mammography, which is a necessary component in the early detection of breast cancer.

[Not Available]. / Threshold values of sagittal abdominal diameter for the detection of cardio-metabolic risk factors in Northeastern Mexico: a cross-sectional study.

BACKGROUND: The use of sagittal abdominal diameter (SAD) has been proposed for screening cardio-metabolic risk factors; however, its accuracy can be influenced by the choice of thresholds values. AIM: To determine the SAD threshold values for cardio-metabolic risk factors in Mexican adults; to assess whether parallel and serial SAD testing can improve waist circumference (WC) sensitivity and specificity; and to analyze the effect of considering SAD along with WC and body mass index (BMI) in detecting cardio-metabolic risk. METHODS: This cross-sectional study was conducted during 2012-2014 in Northeast Mexico (n = 269). Data on anthropometric, clinical, and biochemical measurements were collected. Sex-adjusted receiver-operating characteristic curves (ROC) were obtained using hypertension, dysglycemia, dyslipidemia and insulin resistance as individual outcomes and metabolic syndrome as a composite outcome. Age-adjusted odds ratios and 95% confidence intervals (CI) were estimated using logistic regression. RESULTS: The threshold value for SAD with acceptable combination of sensitivity and specificity was 24.6 cm in men and 22.5 cm in women. Parallel SAD testing improved WC sensitivity and serial testing improved WC specificity. The co-occurrence of high WC/high SAD increased the risk for insulin resistance by 2.4-fold (95% CI: 1.1-5.3), high BMI/high SAD by 4.3-fold (95% CI: 1.7-11.9) and SAD alone by 2.2-fold (95% CI: 1.2.-4.2). CONCLUSIONS: The use of SAD together with traditional obesity indices such as WC and BMI has advantages over using either of these indices alone. SAD may be a powerful screening tool for interventions for high-risk individuals.

Threshold values of sagittal abdominal diameter for the detection of cardio-metabolic risk factors in Northeastern Mexico: a cross-sectional study / Valores de corte del diámetro sagital del abdomen para la detección de factores de riesgo cardiovascular en el noreste mexicano: estudio transversal

Background: The use of sagittal abdominal diameter (SAD) has been proposed for screening cardio-metabolic risk factors; however, its accuracy can be influenced by the choice of thresholds values. Aim: To determine the SAD threshold values for cardio-metabolic risk factors in Mexican adults; to assess whether parallel and serial SAD testing can improve waist circumference (WC) sensitivity and specificity; and to analyze the effect of considering SAD along with WC and body mass index (BMI) in detecting cardio-metabolic risk. Methods: This cross-sectional study was conducted during 2012-2014 in Northeast Mexico (n = 269). Data on anthropometric, clinical, and biochemical measurements were collected. Sex-adjusted receiver-operating characteristic curves (ROC) were obtained using hypertension, dysglycemia, dyslipidemia and insulin resistance as individual outcomes and metabolic syndrome as a composite outcome. Age-adjusted odds ratios and 95% confidence intervals (CI) were estimated using logistic regression. Results: The threshold value for SAD with acceptable combination of sensitivity and specificity was 24.6 cm in men and 22.5 cm in women. Parallel SAD testing improved WC sensitivity and serial testing improved WC specificity. The co-occurrence of high WC/high SAD increased the risk for insulin resistance by 2.4-fold (95% CI: 1.1-5.3), high BMI/high SAD by 4.3-fold (95% CI: 1.7-11.9) and SAD alone by 2.2-fold (95% CI: 1.2.-4.2). Conclusions: The use of SAD together with traditional obesity indices such as WC and BMI has advantages over using either of these indices alone. SAD may be a powerful screening tool for interventions for high-risk individuals (AU)

Introducción: el diámetro sagital del abdomen (SAD) se ha usado para detectar factores de riesgo cardiometabólicos; su precisión se ve afectada por los valores de corte. Objetivo: determinar valores de corte para factores de riesgo cardiometabólicos en mexicanos adultos; evaluar la sensibilidad y especificidad cuando se utiliza en serie o en paralelo con la circunferencia de la cintura (WC); y analizar el uso del SAD individualmente o junto a WC o el índice de masa corporal (IMC) para detectar factores de riesgo cardiometabólicos. Métodos: en forma transversal, de 2012 a 2014 se estudiaron 209 sujetos provenientes del noreste mexicano. Se recopilaron datos antropométricos, clínicos y bioquímicos. Se construyeron curvas ROC ajustadas por sexo utilizando como resultado individual hipertensión, disglicemia y resistencia a la insulina y como resultado compuesto, el síndrome metabólico. Se calcularon razón de momios e intervalos de confianza (IC 95%) mediante regresión logística. Resultados: los valores de corte fueron 24,6 cm en hombres y 22,5 cm en mujeres. El SAD en paralelo con la WC mejoró sensibilidad y en forma seriada, la especificidad de WC. La coocurrencia de WC y SAD por encima de los rangos incrementó el riesgo para resistencia a la insulina 2,4 veces (95% CI: 1,1-5,3); BMI y SAD elevados, 4,3 veces (95% CI: 1,7-11,9) y SAD individualmente, 2,2 veces (95% CI: 1,2-4,2). Conclusiones: utilizar el SAD junto a índices tradicionales de obesidad (WC y BMI) tiene ventajas sobre su uso individual. El SAD puede ser una poderosa herramienta de tamizaje para intervenciones en individuos de alto riesgo (AU)

Clinical coaching in primary care: Capable of improving control in patients with type 2 diabetes mellitus?

AIMS: Few clinical coaching studies are both endorsed by real cases and focused on reducing suboptimal diabetes control. We evaluated the effectiveness of coaching on improving type 2 diabetes goals after 3 years of implementation in primary care. METHODS: A cross-sectional study with follow up was conducted during 2008-2011. Coaching consisted of guiding family doctors to improve their clinical abilities, and it was conducted by a medical doctor trained in skill building, experiential learning, and goal setting. Effectiveness was assessed by means of fasting plasma glucose and glycosylated hemoglobin outcomes. The main analysis consisted of 1×3 and 2×3 repeated measures ANOVAs. RESULTS: A significant coaching×time interaction was observed, indicating that the difference in glucose between primary care units with and without coaching increased over time (Wilks' lambda multivariate test, P<0.0001). Coaching increased 1.4 times (95%CI 1.3, 1.5) the possibility of reaching the fasting glucose goal after controlling for baseline values. There was also a significant improvement in glycosylated hemoglobin (Bonferroni-corrected p-value for pairwise comparisons, P<0.0001). CONCLUSIONS: A correctible and even preventable contributing component in diabetes care corresponds to physicians' performance. After 3 years of implementation, coaching was found to be worth the effort to improve type 2 diabetes control in primary care.

[Metabolic syndrome in workers of a second level hospital]. / Síndrome metabólico en trabajadores de un hospital de segundo nivel.

BACKGROUND: People with metabolic syndrome (20-25 % of the world population) are three times more likely to suffer a heart attack or stroke and twice as likely to die from this cause. The objective of this study was to assess the prevalence of metabolic syndrome in workers of a second level hospital. METHODS: This was a cross-sectional study with 160 healthcare workers in Monterrey, México. Sociodemographic, anthropometric and biochemical data were obtained to assess the prevalence of metabolic syndrome. Bivariate and multiple logistic regression analysis were carried out in order to assess the relationship between metabolic syndrome and sociodemographic and occupational variables. RESULTS: The prevalence of metabolic syndrome among workers was 38.1 %. Nurses were more affected with 32.8 %. Overweight and obesity were prevalent in 78 %. In the logistic regression there was a significant association between metabolic syndrome and not having partner (OR 3.98, 95 % CI [1.54-10.25]) and obesity (OR 4.69, 95 % CI [1.73-12.73]). CONCLUSIONS: The prevalence of metabolic syndrome and obesity is alarming. Appropriate and prompt actions must be taken in order to reduce the risk of cardiovascular disease in this population.

Introducción: las personas con el síndrome metabólico (20-25 % de la población mundial) tienen una probabilidad tres veces mayor de sufrir un ataque cardiaco o un accidente cerebrovascular y una dos veces mayor de morir por esta causa. El objetivo es determinar la prevalencia del síndrome metabólico en trabajadores de un hospital de segundo nivel. Métodos: estudio transversal con 160 trabajadores de un hospital de Monterrey, México. Se obtuvieron datos sociodemográficos, antropométricos y bioquímicos para calcular la prevalencia del síndrome metabólico. Se realizó análisis bivariado y de regresión logística múltiple para evaluar la relación entre el síndrome metabólico y variables sociodemográficas y laborales. Resultados: la prevalencia de síndrome metabólico fue del 38.1 %; el personal de enfermería fue el más afectado con un 32.8 %. El sobrepeso y la obesidad fueron prevalentes en un 78 %. El 69 % de los hombres y el 85 % de las mujeres presentaron obesidad central. En la regresión logística hubo una relación significativa entre el síndrome metabólico y la variante no tener pareja (RM 3.98, IC 95 % [1.54-10.25]) y obesidad (RM 4.69, IC 95 % [1.73-12.73]). Conclusiones: la prevalencia del síndrome metabólico y la obesidad son preocupantes; deben tomarse acciones oportunas para disminuir el riesgo de enfermedad cardiovascular en esta población.

[Estimation of overweight and obesity in preschoolers according to national and international normativity]. / Estimación de sobrepeso y obesidad en preescolares. Normatividad nacional e internacional.

BACKGROUND: Prevalence of overweight and obesity in children under 5 years can be affected by type of anthropometric indicator and selected threshold values. We assessed variation on estimates according to national and international regulations (NOM-031-SSA2-1999, NOM-008-SSA3-2010, GPC-SSA-025-08 and GPC-IMSS-029-08; WHO-2006, CDC-2000 and IOTF, respectively). METHODS: Cross-sectional study in all the daycare centers (100 %) affiliated to Instituto Mexicano del Seguro Social-Nuevo León during June-December, 2010 (n = 11 141 children). Overweight and obesity were defined on the basis of each regulation, and total and stratified prevalences by age and sex were estimated. RESULTS: According to national regulation, overweight/obesity estimates varied from 12 to 22 %, and to international normativity, from 3 to 14 %. The highest prevalence was given by NOM-008-SSA3-2010 and GPC-SSA-025-08; and the lowest by WHO-2006. There were no differences by sex, but they existed by age; the highest discrepancy occurred in the 3.0-3.9 age group with 28 %. CONCLUSION: Health personnel and health policy makers should be aware of variation on estimates according to the definition employed. We recommend to standardize national regulation for pointing out overweight/obesity in preschoolers.

INTRODUCCIÓN: la prevalencia de sobrepeso/obesidad en menores de 5 años se puede ver afectada por tipo de indicador antropométrico y punto de corte aplicado. Se evaluó la variación en las estimaciones según la normatividad nacional (NOM-031-SSA2-1999, NOM-008-SSA3-2010, GPC-SSA-025-08 y GPC-IMSS-029-08) y la internacional (OMS-2006, CDC-2000 e IOTF). MÉTODOS: estudio transversal en 100 % de guarderías afiliadas al Instituto Mexicano del Seguro Social-Nuevo León durante junio-diciembre de 2010 (n = 11 141 infantes). Se definió sobrepeso y obesidad con base en cada normatividad y se estimaron las prevalencias totales y estratificadas por edad y sexo. RESULTADOS: de acuerdo con la normatividad nacional, el sobrepeso/obesidad varió entre 12 y 22 %; y con la normatividad internacional, entre 3 y 14 %. La mayor prevalencia fue con la NOM-008-SSA3-2010 y GPC-SSA-025-08; y la menor, con OMS-2006. No hubo diferencias por sexo, pero sÍ por edad; la mayor discrepancia ocurrió en niños entre 3.0 y 3.9 años, con 28 puntos porcentuales. CONCLUSIÓN: el personal y las personas relacionadas con la generación de políticas de salud tienen que estar conscientes de la variación de las estimaciones según la definición utilizada. Se recomienda estandarizar la normatividad nacional para señalar sobrepeso/obesidad en preescolares.

[Prevalence of overweight and obesity in children from Monterrey, Nuevo León]. / Prevalencia de sobrepeso y obesidad en niños de Monterrey, Nuevo León.

BACKGROUND: Pediatric obesity is a major health problem around the globe. It has increased in the last decades up to 30 % (in 2010). The aim of this study was to establish the prevalence of overweight and obesity in children from zero to 14 years from three family medicine units and one school. METHODS: A prospective study of prevalence, which included children of both sexes who assisted to three family medicine units and a junior high school. We assessed the somatometry and compared it in accordance to the World Health Organization 2006-2007 references and standards. RESULTS: The overall overweight and obesity prevalence in 1624 children was 45.5 % (15.5 % of overweight and 29.9 % of obesity, respectively). A total of 354 of 840 women (42.1 %) and 385 of 784 men (49 %) had overweight and obesity (p < 0.05). In both sexes, we did not observed a difference in overweight (15.7, women; 15.4, men). However, with regards to obesity, women showed 26.4 versus 33.6 of men (p < 0.05). We observed only one family unit with major obesity prevalence, which probably had an initial overestimation. CONCLUSIONS: We found one of the highest prevalences of overweight and obesity in children at a national level: up to 45 % in a state of Mexican northwestern. Obesity doubled overweight, and it was almost 10 % higher in men than in women.

INTRODUCCIÓN: la obesidad infantil es un problema de salud pública mundial y se ha incrementado en forma alarmante en las últimas décadas hasta en 30 % en el 2010. El objetivo de este estudio fue establecer la prevalencia de sobrepeso y obesidad en niños de cero a 14 años de tres unidades de medicina familiar (UMF). MÉTODOS: estudio prospectivo, de prevalencia, que incluyó a niños de ambos sexos que acudieron a tres UMF y una escuela primaria. Se evaluó la somatometría y se comparó de acuerdo con estándares y referencias de crecimiento de la Organización Mundial de la Salud (OMS) 2006-2007. RESULTADOS: la prevalencia de sobrepeso y obesidad en todo el grupo fue de 45.5 % en los 1624 niños de 0 a 14 años (15.5 %, sobrepeso; 29.9 %, obesidad). Un total de 354 de 840 mujeres (42.1 %) y 385 de 784 hombres (49 %) tuvieron sobrepeso u obesidad (p < 0.05). En las mujeres no se observó diferencia en cuanto a sobrepeso en relación con los hombres (15.7 frente a 15.4 %), pero sí en relación con la obesidad: 26.4 frente a 33.6 % (p < 0.05). Solo se observó una de las UMF con mayor prevalencia de obesidad, lo que probablemente se relacione con un sesgo de sobrerregistro. Conclusiones: se encontró una de las prevalencias de sobrepeso y obesidad infantiles más altas reportadas a nivel nacional, hasta en 45 %, en un estado del noreste mexicano. La obesidad fue dos a uno mayor al sobrepeso y casi 10 % mayor en hombres que en mujeres.

[Breast cancer in México: a 10-year trend analysis on incidence and age at diagnosis].

INTRODUCTION: Breast cancer is an important public health problem. Some countries have achieved a downward trend while in others, continues ascending. In México, information on incidence and age at diagnosis is isolated in time, and knowledge on trend analysis is lacking. OBJECTIVE: To examine the 2003-2012 trend of the incidence rate and age at diagnosis of breast cancer in the northeast of México. We also analyze the trend of positivity to nodes, hormone receptors and HER2; and its association with age at diagnosis. MATERIAL AND METHODS: This is an epidemiological study of breast cancer patients in a tertiary care hospital in Monterrey, México (n = 3,488). Only new cases with a histology report were included; if this was not available, the cytology result was considered. Trend analysis was performed using the JoinPoint regression program Version 3.5. RESULTS: The breast cancer incidence rate increased from 26.7 to 49.8 per 100,000 between 2003 and 2011 (p < 0.05). The adjusted rate showed an annual percentage rate of change of +6.2% (95%CI 4.2, 8.2). The mean age was 55.7 ± 13.7 years and remained stable over time. Nodes, hormone receptors and HER2 positivity rate also remained stable over time. Age < 50 years increased twice the risk for positivity to nodes (OR 2.0, 95%CI 1.4, 2.7), ER-PR- (OR 1.8, 95% CI 1.4, 2.4) and ER-PR-HER2- (OR 1.9, 95%CI 1.5, 2.5). CONCLUSIONS: The 10-year analysis showed a significant upward trend. This study represents a first effort in our country, for determining patterns on incidence and age at diagnosis of breast cancer, as well as that of biomarkers.

Obesidad central única y combinada con sobrepeso/obesidad en preescolares mexicanos

La circunferencia de cintura (CC) constituye una herramienta útil para identificar niños con mayor riesgo de complicaciones relacionadas con grasa abdominal. Se determinó la magnitud de obesidad central, única y combinada con sobrepeso/obesidad en infantes 1-5 años de edad. También se identificaron valores percentilares suavizados de CC específicos para edad y sexo, y se compararon con datos disponibles de otros países. Se realizó un estudio transversal en niños de 8 guarderías en Monterrey, México (n=903; 431 niños y 472 niñas). Debido a que el riesgo por obesidad abdominal inicia con CC en percentil 75, se consideraron dos puntos de corte, percentil 75 y 90. Se definió sobrepeso con base en índice de masa corporal para edad y sexo en percentil 85-94; y obesidad, en percentil ≥95. El análisis consistió de prevalencias puntuales e intervalos de confianza de 95%. El software LMS Chart Maker Light se utilizó para suavizar los valores percentilares de CC. La media de edad de la población fue 2,7±1,0 años. Los mexicanos registraron diferencias de 1 cm de CC más que los afro-americanos; y hasta 4 cm menos que los méxico-norteamericanos. La combinación de obesidad central con CC percentil ≥75 con sobrepeso/obesidad, fue 25,1% (IC95% 22,3-28,0) y única 15,4% (IC95% 13,0-17,8). La prevalencia de obesidad abdominal única con CC percentil ≥90, fue de 4.4% (IC95% 3.0, 5.8). Las estancias infantiles representan una oportunidad para desafiar la obesidad central. La CC puede ser utilizada desde edad temprana para tamizaje y atención a niños con mayor riesgo cardiovascular.

Central: single and combined with overweight/ obesity in preeschool Mexican children. Waist circumference (WC) is a useful measure for identifying children at higher risk of complications related with abdominal fat. We determined the magnitude of central adiposity, single and combined with overweight and obesity in infants 1-5 years old. We also identified smoothed age-and sex-specific WC percentile values, which were compared with other countries available data. This was a cross-sectional study in children of 8 day care centers located in Monterrey, Mexico (n=903, 431 boys and 472 girls). Because the risk due to abdominal obesity begins at WC percentile ≥75, we considered two thresholds, percentile 75 y 90. Overweight was defined based on body mass index at percentile 85-94 for age and sex; and obesity, at percentile ≥95. Analysis consisted of point prevalence and 95% confidence intervals. The LMS Chart Maker Light software was used for smoothing WC percentile values. The study population mean age was 2.7±1.0 years. Mexican children’s WC was 1 cm above that of Afro-American; and it was up to 4 cm below that Mexican-American. Prevalence of central obesity with WC at percentile 75 combined with overweight/obesity was 25.1% (95%CI 22.3-28.0) and single, 15.4% (95CI% 13.0- 17.8). Prevalence of single abdominal obesity with WC at percentile ≥90 was 4.4% (IC95% 3.0, 5.8). Day care centers represent a key opportunity for defying central obesity. WC can be used since early age for screening and caring children at higher cardiovascular risk.

[Single central obesity and combined with overweight/obesity in preeschool Mexican children]. / Obesidad central única y combinada con sobrepesolobesidad en preescolares mexicanos.

Waist circumference (WC) is a useful measure for identifying children at higher risk of complications related with abdominal fat. We determined the magnitude of central adiposity, single and combined with overweight and obesity in infants 1-5 years old. We also identified smoothed age-and sex-specific WC percentile values, which were compared with other countries available data. This was a cross-sectional study in children of 8 day care centers located in Monterrey, Mexico (n = 903, 431 boys and 472 girls). Because the risk due to abdominal obesity begins at WC percentile > or = 75, we considered two thresholds, percentile 75 y 90. Overweight was defined based on body mass index at percentile 85-94 for age and sex; and obesity, at percentile > or = 95. Analysis consisted of point prevalence and 95% confidence intervals. The LMS Chart Maker Light software was used for smoothing WC percentile values. The study population mean age was 2.7 +/- 1.0 years. Mexican children's WC was 1 cm above that of Afro-American; and it was up to 4 cm below that Mexican-American. Prevalence of central obesity with WC at percentile 75 combined with overweight/obesity was 25.1% (95% CI 22.3-28.0) and single, 15.4% (95 CI% 13.0-17.8). Prevalence of single abdominal obesity with WC at percentile > or = 90 was 4.4% (IC 95% 3.0, 5.8). Day care centers represent a key opportunity for defying central obesity. WC can be used since early age for screening and caring children at higher cardiovascular risk.

[Discrepancy in attitudes toward diabetes between physicians and diabetic patients attending the private, social security or state medical services]. / Comparación de actitudes hacia la diabetes entre médicos y pacientes diabéticos usuarios del sector privado, seguridad social o servicios de salud del Estado.

OBJECTIVE: One of the biggest challenges of the Mexican Health System is to get results of the treatment goals in diabetic patients, which can be frustrated by physician and patient's attitudes. The present study evaluates divergence of attitude of health providers and diabetic patients according to health sectors: private, social security or State medical services. MATERIAL AND METHODS: They contributed 255 physicians and 255 diabetic patients in ambulatory care from three health sectors: private, social security and welfare (employees and patients were exclusive providers and patients of corresponding institutions). The Diabetes Attitude Scale 3 (DAS-3) was applied, a self-administered instrument used to compare attitudes between health care professionals and patients. Discrepancies were analyzed with t-tests, chi2, one-way ANOVA and post hoc multiple comparisons for observed means based on the Tukey test. RESULTS: Physician and patient's attitudes differed in all scales except for psychosocial impact of diabetes, which was independent of the health sector. Attitudes were not alike with respect to severity of the disease, value of tight control of glucose levels and patient autonomy, with no distinction of health sector. Discrepancy of need for special training was the only attitude that varied by health sector (F = 4.1; p = 0.02); it was similar for the private and social security sector but different for the welfare sector. CONCLUSIONS: All health sectors should recognize attitude discrepancies between doctors and patients to favor collaborative strategies that benefit a better control of the disease.