Edgar M. Vásquez-Garibay

Factores de riesgo de dislipidemia en niños y adolescentes con obesidad

OBJETIVO: Evaluar el riesgo de dislipidemia asociado a obesidad en ninos y adolescentes. MATERIAL Y METODOS: En un estudio transversal analitico se incluyeron 62 ninos y adolescentes obesos (IMC > centila 95 y pliegue cutaneo tricipital > centila 90) y 70 no obesos (IMC centilas 5-85), con edades de 5 a 15 anos, sin enfermedades cronicas. Se investigaron caracteristicas personales y antecedentes familiares de enfermedades cronicas y se determino el perfil serico de lipidos. Se calculo el riesgo de presentar alteraciones en el perfil serico de lipidos en ninos con obesidad mediante la razon de momios (RM) y se realizo analisis multivariado. RESULTADOS: La edad promedio para todo el grupo fue de 9.8 ± 2.7 anos; 63 individuos eran del sexo femenino y 69 del masculino. La presencia de obesidad se asocio a riesgo de valores anormales de colesterol, trigliceridos, LDL, HDL y dislipidemia (>1 valor anormal) (RM 4.47-15.0). En obesos el analisis multivariado mostro que la pertenencia al sexo femenino se asocio significativamente a dislipidemia. CONCLUSIONES: La obesidad en ninos y adolescentes se asocia a riesgo elevado de presentar dislipidemia; este riesgo es mayor en las mujeres.

Liver function test results predict nutritional status evaluated by arm anthropometric indicators.

Objectives: To compare the anthropometric indicators based on weight and height with the anthropometric indicators based on arm measurements and to predict the anthropometric nutritional status with liver function tests (LFTs) in children with chronic liver disease (CLD). Patients and Methods: A cross-sectional study in a referral pediatric hospital enrolled 79 children with CLD (mean age 72.6 ± 61.8 months, 54% female). An independent variable of LFT was used to determine the outcome variable of nutritional status. Anthropometric indicators of height versus age, weight versus height, head circumference versus age, and arm indicators versus age were analyzed with Pearson correlation, the determination coefficient r2, and multiple regression. Results: A total of 44.3% of patients studied had growth impairment. The anthropomorphic indicator of weight for height identified malnutrition in 11.4%, compared with 43% identified by mid- to upper arm circumference (MUAC) and 40.5% identified with total arm area. MUAC (P < 0.001), total arm circumference (P < 0.001), arm muscle area (P = 0.009), and arm fat area (P = 0.023) identified more cases of z score less than −2 SD than weight/height. The presence of ascites misled weight-for-height measurements. Conjugated bilirubin and albumin had significant correlations with almost all of the anthropometric indicators. Alkaline phosphatase correlated significantly with all of the arm anthropometric indicators. A regression analysis led to 7 prediction models; the highest prediction of z score less than −2 SD was with triceps skinfold and conjugated bilirubin, albumin, and γ-glutamyltransferase; height-for-age z score less than −2 SD was predicted by measurements of conjugated bilirubin, prothrombin time, and alanine aminotransferase. Conclusions: The data presented underline the correlation between the liver damage severity evaluated by LFT and the nutritional status estimated by anthropometric indicators. In our view these observations reflect the close relationship between liver function and the degree of liver damage to growth and current nutritional status.

The impact of infant feeding patterns on infection and diarrheal disease due to enterotoxigenic Escherichia coli

OBJECTIVE Determine the impact of dietary risk factors on patterns of infection by heat labile toxin-producing Escherichia coli (LT-ETEC). MATERIALS AND METHODS Ninety-eight infants were followed from birth for one year in Guadalajara, Mexico, beginning in august of 1986. Stool and breast milk samples were collected weekly from infants and their mothers, respectively. Mothers were also interviewed on a weekly basis regarding the health of the infants. Parametric hazard models were fit to durations of different LT-ETEC disease states determined through the analysis of stools. The childs consumption of supplemental foods and liquids as well as specific levels of LT-ETEC-specific breast milk antibodies were included in each model as time-varying covariates. RESULTS The hazard of LT-ETEC asymptomatic infection increased 400 percent among children who received oats gruel (hazard rate = 4.01; 95% CI 2.77-5.24). The duration of infection was reduced if the child had had a previous LT-ETEC diarrheal episode (2.12; 95% CI 1.74-2.49) but was prolonged if the child consumed herbal teas (0.53; 95% CI 0.27-0.7). Herbal teas and high LT-ETEC-specific breast milk antibody levels each reduced the hazard of symptomatic infection by ninety percent. Symptomatic episodes became asymptomatic more rapidly if a child was given rice water. CONCLUSIONS Specific weaning foods increase the risk of infection. Breastmilk antibodies and liquid infusions reduce diarrheal disease and infection duration.

Socio-demographic factors associated with caustic substance ingestion in children and adolescents.

OBJECTIVE Caustic substance ingestion is a public health issue in some underdeveloped countries. Published information on socio-demographic factors related to this problem is scarce. The aim of this study was to evaluate the association of socio-demographic factors with caustic ingestion in children. METHODS DESIGN case-control study. Cases were children with caustic substance ingestion who were attended to during 2006 (n=94) at a pediatric referral hospital in Guadalajara, Mexico; the controls were a random sample of children who were hospitalized or seen as outpatients in the same pediatric referral hospital (n=641). The socio-demographic variables were studied using a validated questionnaire (Children Nutrition Organization Survey). STATISTICS OR, 95% CI and logistic regression. RESULTS Mean age of the cases was 3.2 years (SD 2.4) and 37.2% of cases were girls. Caustic ingestion occurred at home in 63.8% of cases and at a relatives home in 23.4% of cases. Alkaline products were ingested by 85.1%; containers had no warning labels in 72.3% of cases and no childproof safety caps in 92.6% of cases. The socio-demographic variables associated with caustic ingestion included higher family income, lower educational level of the mother, higher proportion of fathers working as independent professionals, extended family, mothers age <30 years, and mother working outside the home. CONCLUSIONS The observed family risk profile for caustic ingestion was higher family income, young working mother with low educational level, father working as independent professional, and extended family.

Secondary malnutrition and overweight in a pediatric referral hospital: associated factors.

Objectives: To establish the prevalence and identify the clinical and sociodemographic factors associated with malnutrition and overweight in a pediatric referral hospital. Patients and Methods: We studied a cross-sectional, random sample from a pediatric hospital. Malnutrition was defined as acute when the z score of weight/height was less than −2.0 and as chronic if in addition the height/age z score was less than −2.0. Overweight risk was defined as a body mass index percentile between 85 and 94, and overweight as a body mass index percentile of 95 or higher. Results: The study included 641 patients, with mean age 7.1 ± 4.9 years (56% male). The overall prevalence of acute malnutrition was 8% and chronic malnutrition 17.0%. Overweight risk was present in 15.4% and overweight in 12.2%. Acute malnutrition was predicted by conditions on admission (hospitalization: odds ratio [OR] 2.3, confidence interval [CI] 1.3–4.3; nonsurgical subspecialty: OR 2.1, CI 1.0–4.3) and number of siblings (1 child, single mother: OR 2.6, CI 1.3–5.0). Chronic malnutrition was predicted by age (infants vs preschoolers: OR 2.0, CI 1.1–3.6; infants vs school children: OR 3.1, CI 1.8–5.5) and illness duration (>30 days: OR 2, CI 1.1–3.7). Overweight risk was associated with age (>36 months: OR 2.0, CI 1.6–3.4) and the fathers educational level (college and university: OR 2.3, CI 1.3–4.3). Overweight was predicted by sex (boys: OR 2.0, CI 1.0–3.6) and age (>36 months: OR 1.7, CI 1.0–2.8). Conclusions: Overweight was as prevalent as malnutrition. Malnutrition was associated with clinical condition, age, family size, and illness duration, whereas overweight was related to age, sex, and fathers education. Overweight appears as a novel finding in the nutritional profile of pediatric referral hospitals in Mexico.

Intensive nutritional support improves the nutritional status and body composition in severely malnourished children with cerebral palsy

OBJECTIVE To demonstrate that a nutritional support intervention, via naso-enteral tube-feeding or gastrostomy, has a significant impact on the nutritional status and body composition in severely malnourished children with cerebral palsy spastic quadriplegia. METHODS Thirteen patients with moderate/severe malnutrition and cerebral palsy spastic quadriplegia who were fed via naso-enteral tube-feeding or gastrostomy were included in a cohort study. Anthropometric measurements and estimated body composition by bioelectric impedance analysis were obtained. ANOVA and Wilcoxon tests were used. RESULTS During the four weeks of nutritional recovery, an average weight increase of 2700 g was achieved. There were significant increases in anthropometric indicators, including BMI and weight/length (p < 0.01). The increase in arm fat area was significantly higher than the increase in arm muscle area (104.5 vs 17.5%). CONCLUSION Intensive nutritional support for four weeks had a significant effect on the nutritional status and body composition of severe and moderately malnourished children with cerebral palsy spastic quadriplegia.

Effect of chronic iron deficiency on neuropsychological domains in infants.

The aim of this study was to assess the effects of chronic iron deficiency on neuropsychological traits in infants. We established the nutritional iron status and assessed the neuropsychological characteristics of 58 Mexican 14- to 18-month-old infants. The Bayley Scales of Infant Development, preschool language scales and an environmental sound perception task designed expressly for the study, were used. The infants’ mothers were asked to fill out 2 questionnaires concerning their child’s sociodemographic background. Six different neuropsychological domains were analyzed. Results showed that the chronic iron deficiency group did show significantly lower scores on language, environmental sound perception, and motor measures, when compared with infants with normal nutritional iron status at 6 and 14 to 18 months. Our conclusion is that the development of language and motor skills and environmental sound perception appeared to be sensitive to the effects of chronic iron deficiency in infants.

Anthropometric indicators of nutritional status and growth in very low birth-weight premature infants hospitalized in a neonatal intensive care unit

BACKGROUND Anthropometric indicators are difficult to interpret in very low birth weight (VLBW) premature infants, including both appropriate for gestational age (AGA) and small for gestational age (SGA) infants. Therefore, the purpose was to describe the anthropometric indicators of growth and nutritional status in VLBW premature infants AGA and SGA, hospitalized in a neonatal intensive care unit (NICU). STUDY DESIGN The descriptive and prospective study design included 114 preterm infants, adequate for gestational age/small for gestational age hospitalized in the intensive care unit. Head, thigh, mid upper arm circumference, skin-fold measurements and weight/age, length/ age, and weight/length indices were obtained. Correlations were made among the anthropometric indices, and a multivariate regression analysis with weight/age as dependent variable was performed. RESULTS Weight/age in AGA premature infants had high number of significant anthropometric correlations. The SGA premature infants had few and weak correlations. The regression analysis showed that anthropometric indices better explain changes in the weight/age index in adequate for gestational age premature infants. CONCLUSION Weight/age in the VLBW/AGA premature infants could reflect growth, nutritional status and energy stored as fat, but in the VLBW/SGA premature infants, thigh circumference and mid arm circumference would be better indicators just of nutritional status.

Energy expenditure in children with cerebral palsy and moderate / severe malnutrition during nutritional recovery

OBJECTIVE To analyze the total energy expenditure (TEE) and resting energy expenditure (REE) in children with cerebral palsy (CP) and moderate or severe malnutrition during nutritional recovery. METHODS In an intervention study, thirteen subjects with CP (10 females and 3 males with a mean age of 9y11m ± 2y3m), level V of the Gross Motor Function Classification System and moderate or severe malnutrition were included. Eight were fed by nasogastric tube and five by gastrostomy. They were compared with 57 healthy participants (31 females and 26 males with mean age of 8y7m ± 10m). Anthropometric measurements, body composition and energy expenditure by bioelectrical impedance analysis (BIA) and indirect calorimetry (IC) were performed in both groups. RESULTS TEE and REE were higher in healthy children than in children with CP in kcal/d and kcal/cm/d but were lower in kcal/kg/d (p <0.001). Intensive nutritional support for four weeks in children with CP produced a significant increase in energy expenditure. CONCLUSION TEE and REE, in children with CP, are lower than in healthy children. Estimating the REE in children with CP and malnutrition is better performed in kcal/kg/d than in kcal/cm/d. Fat-free mass (FFM) is a good predictor of the REE in healthy children and children with CP.

Consenso Cultural sobre Alimentos en Adolescentes Embarazadas de Guadalajara, México

Objetivo Caracterizar la estructura semantica y el nivel de consenso cultural que manifiestan las adolescentes embarazadas que acuden a la consulta externa del Hospital Civil de Guadalajara Dr. Juan I Menchaca. Metodos Estudio cualitativo mediante entrevistas estructuradas con la tecnica de listas libres. Muestreo propositivo no aleatorizado que incluyo a 54 adolescentes embarazadas de 12 a 19 anos de edad. Resultados Los alimentos del desayuno y la cena obtuvieron un mayor grado de consenso cultural, detectandose 14 alimentos para el desayuno y 8 para la cena. Conclusion Conocer el modelo de consenso cultural de los alimentos nos permite reforzar, modificar o agregar alimentos saludables a la dieta de las adolescentes embarazadas.