Ximena Duque

Prevalence of Polycystic Ovary Syndrome and Related Disorders in Mexican Women

Background/Aims: Polycystic ovary syndrome (PCOS) has been found to affect 4–8% of women of reproductive age; however, in Mexican-Americans a prevalence of 12.8% has been reported. This study determines the prevalence of PCOS in a sample of Mexican women. Methods: This prospective cross-sectional study included 150 female Mexican volunteers aged 20–45 years. Menstrual cycles were recorded and hirsutism was graded. Pelvic ultrasound was performed and androgen levels were measured. PCOS was diagnosed by hyperandrogenism and/or hyperandrogenemia, and oligo-ovulation (NIH 1990 criteria), and also by 2 of 3 findings: oligo-ovulation, clinical and/or biochemical hyperandrogenism and polycystic ovaries (PCO) (Rotterdam 2003 criteria), excluding other disorders. Results: Nine of the 150 women were diagnosed with PCOS, a prevalence of 6.0% (95% CI: 1.9–10.1%), according to NIH criteria. The ultrasound morphology added one patient to give ten PCOS patients, a prevalence of 6.6% (95% CI: 2.3–10.9%) according to Rotterdam criteria. All PCOS patients presented oligo-ovulation, 9 had hirsutism and 7 of them had acne. Eight of the 10 PCOS patients had morphologic characteristics of PCO. Conclusion: The prevalence of PCOS in Mexican women is approximately 6.0%, similar to other populations, but lower than 12.8% reported in Mexican-American women.

Prevalence of anemia and deficiency of iron, folic acid, and zinc in children younger than 2 years of age who use the health services provided by the Mexican Social Security Institute

BackgroundIn Mexico, as in other developing countries, micronutrient deficiencies are common in infants between 6 and 24 months of age and are an important public health problem. The objective of this study was to determine the prevalence of anemia and of iron, folic acid, and zinc deficiencies in Mexican children under 2 years of age who use the health care services provided by the Mexican Institute for Social Security (IMSS).MethodsA nationwide survey was conducted with a representative sample of children younger than 2 years of age, beneficiaries, and users of health care services provided by IMSS through its regular regimen (located in urban populations) and its Oportunidades program (services offered in rural areas). A subsample of 4,955 clinically healthy children was studied to determine their micronutrient status. A venous blood sample was drawn to determine hemoglobin, serum ferritin, percent of transferrin saturation, zinc, and folic acid. Descriptive statistics include point estimates and 95% confidence intervals for the sample and projections for the larger population from which the sample was drawn.ResultsTwenty percent of children younger than 2 years of age had anemia, and 27.8% (rural) to 32.6% (urban) had iron deficiency; more than 50% of anemia was not associated with low ferritin concentrations. Iron stores were more depleted as age increased. Low serum zinc and folic acid deficiencies were 28% and 10%, respectively, in the urban areas, and 13% and 8%, respectively, in rural areas. The prevalence of simultaneous iron and zinc deficiencies was 9.2% and 2.7% in urban and rural areas. Children with anemia have higher percentages of folic acid deficiency than children with normal iron status.ConclusionIron and zinc deficiencies constitute the principal micronutrient deficiencies in Mexican children younger than 2 years old who use the health care services provided by IMSS. Anemia not associated with low ferritin values was more prevalent than iron-deficiency anemia. The presence of micronutrient deficiencies at this early age calls for effective preventive public nutrition programs to address them.

Effect of Eradication of Helicobacter Pylori and Iron Supplementation on the Iron Status of Children with Iron Deficiency

BACKGROUND AND AIMS We undertook this study to evaluate the effect of Helicobacter pylori eradication and iron supplementation on the iron nutritional status in children with iron deficiency. METHODS Seven hundred and one children from four public schools in Mexico City were screened to evaluate their iron status. Of them, 72 children with iron deficiency or with anemia were included in this study and were tested for H. pylori infection. Those infected were given eradication treatment and were randomly assigned to daily supplementation for 3 months with ferrous sulfate or placebo. Noninfected children received ferrous sulfate. At the end of the interventions, blood samples were drawn to evaluate their effects on the nutritional status of iron. RESULTS Thirty eight children with iron deficiency or anemia were infected by H. pylori at baseline. The eradication rate was 86.8%. Children in whom H. pylori eradication was achieved showed an increase of 0.37g/dL (95% CI -0.02, 0.75) on the hemoglobin mean concentration compared to the noninfected children. Children who achieved H. pylori eradication and received ferrous sulfate supplementation showed an increase of 0.47g/dL (95% CI 0.01-0.93) on the hemoglobin mean concentration compared to the noninfected children who received iron supplementation. Noninfected children supplemented with ferrous sulfate showed an increase in ferritin concentration of 11.26 ng/mL (95% CI 1.86-20.65) compared to those who were given the placebo. CONCLUSIONS Our results suggest that the eradication of H. pylori plus iron supplementation increases the pool of functional iron. Iron supplementation increases the storage of iron in school-age children with iron deficiency.

Natural History of Helicobacter pylori Infection in Mexican Schoolchildren: Incidence and Spontaneous Clearance

Objectives: The aim of the present study was to estimate the incidence and spontaneous clearance rate of Helicobacter pylori infection and the effect of some variables on these outcomes in schoolchildren. Methods: From May 2005 to December 2010, 718 schoolchildren enrolled in 3 public boarding schools in Mexico City participated in the follow-up. At the beginning of the study and every 6 months thereafter, breath samples were taken to detect H pylori infection; blood samples and anthropometric measurements were taken to evaluate nutritional status. Data on sociodemographic characteristics were collected. Results: The prevalence of H pylori infection was 38%. The incidence rate was 6.36%/year. Schoolchildren with anemia or iron deficiency at the beginning of the study (who received iron supplements) showed a higher infection acquisition rate than those with normal iron nutritional status, hazard ratio (HR) 12.52 (95% confidence interval [CI] 4.01%–39.12%), P < 0.001 and HR 2.05 (95% CI 1.09%–3.87%), P = 0.027, respectively. The spontaneous clearance rate of the infection was 4.74%/year. The spontaneous clearance rate was higher in children who had iron deficiency (who received iron supplements), HR 5.02 (95% CI 1.33%–18.99%), P = 0.017, compared with those with normal nutritional iron status. It was lower in schoolchildren with ≥2 siblings compared with schoolchildren with 1 or no siblings, HR 0.23 (95% CI 0.08%–0.63%), P = 0.004. Conclusions: H pylori infection status is dynamic in schoolchildren. Variables related to health status and infection transmission, such as iron status and number of siblings, are important for the incidence and spontaneous clearance of H pylori infection.

Association of Helicobacter pylori Infection and Height of Mexican Children of Low Socioeconomic Level Attending Boarding Schools

This study evaluated the association between Helicobacter pylori infection and height in a population of schoolchildren of a low socioeconomic level regarding growth-related micronutrient status. It was a cross-sectional study of 685 children 5-13 years of age. Height and weight were recorded, a (13)C urea breath test was performed for detection of H. pylori, and a blood sample was obtained for determination of micronutrient status. Helicobacter pylori infection was found to be associated with the height of children. Children with H. pylori infection are, on average, 1.32 cm lower (95% confidence interval [CI] = -2.22 to -0.42) in height than children without infection. There was an effect modification by age: for every one-year increase in age, height was 0.66 cm less (95% CI = -1.17 to -0.15) in children with H. pylori infection. This finding suggests that H. pylori infection has a negative effect on the growth of children.

Present and Past Helicobacter pylori Infection in Mexican School Children

In developing countries, more than 50% of children have serological evidence of Helicobacter pylori infection. However, serological tests for H. pylori did not differentiate between active and past infection. The objectives of this study were to estimate the frequency of active and past H. pylori infection utilizing functional urea breath test (UBT) and serological tests and evaluate factors associated with the infection.

Helicobacter pylori infection and serum leptin, obestatin, and ghrelin levels in Mexican schoolchildren

BackgroundThere is little information about the possible role of Helicobacter pylori infection on appetite-regulating peptides in children. This study evaluated the association between H. pylori infection and serum levels of ghrelin, leptin, and obestatin in schoolchildren.MethodsOne hundred seventy-eight schoolchildren, students at boarding schools in Mexico City, participated. H. pylori infection status was determined every 6 months for 1 year by a breath test using 13C-urea; schoolchildren with consistently positive or negative results were selected to participate. Age, sex, and body mass index (BMI) were recorded. Serum concentrations of total ghrelin, leptin, and obestatin via specific enzyme-linked immunosorbent assays were determined.ResultsSchoolchildren with H. pylori infection had lower concentration of leptin, −0.54 pg/ml (95% CI: −0.98 to −0.09), compared to the schoolchildren without infection, after adjustment by age, gender, and BMI. And the children with the infection had a median of obestatin lower in 0.99 ng/ml (95% CI: −1.93 to −0.06) compared with the uninfected children after adjustment by BMI.ConclusionAssociation was found between H. pylori infection and decreased serum concentrations of leptin and obestatin. These results suggest that in schoolchildren, H. pylori infection affects the levels of hormones implicated in regulating appetite and energy homeostasis.

Prevalence of lactose malabsorption in Mexican children: importance of measuring methane in expired air.

BACKGROUND AND AIMS To compare the prevalence of lactose malabsorption (LM) in children by analyzing hydrogen content in expired air vs. the inclusion of methane excretion. METHODS A total of 138 children (4-17 years old) attending different boarding schools in Mexico were included in this study. To measure H₂ and CH₄ in expired air, breath samples were collected before administering whole milk (240 mL for 4- to 6-year-old children and 360 mL for 7- to 17-year-old children) and at 60, 120, 180, and 240 min afterward. A coprological examination was also carried out. RESULTS Methane production prevalence was 47.8% (29.7% of the children produced methane and hydrogen, whereas 18.1% produced methane only). When measuring only exhaled hydrogen in expired air (H₂ ≥20 ppm), prevalence of LM was 31%; however, when methane concentration was considered (H₂ + (CH₄ x 2)) ≥18 ppm, prevalence increased significantly to 44%. Among children with LM, 51.6% presented intestinal parasites. CONCLUSIONS Methane should be measured in exhaled air to improve diagnosis of LM in populations with a high prevalence of methane production.

Decreased Body Mass Index in Schoolchildren After Yearlong Information Sessions With Parents Reinforced With Web and Mobile Phone Resources: Community Trial

Background The obesity pandemic has now reached children, and households should change their lifestyles to prevent it. Objective The objective was to assess the effect of a comprehensive intervention on body mass index z-score (BMIZ) in schoolchildren. Methods A yearlong study was conducted at 4 elementary schools in Mexico City. Intervention group (IG) and control group (CG) were split equally between governmental and private schools. Three educational in-person parents and children sessions were held at 2-month intervals to promote healthy eating habits and exercise. To reinforce the information, a website provided extensive discussion on a new topic every 2 weeks, including school snack menus and tools to calculate body mass index in children and adults. Text messages were sent to parents’ mobile phones reinforcing the information provided. The IG contained 226 children and CG 181 children. We measured their weight and height and calculated BMIZ at 0, 6, and 12 months. Results The CG children showed a change of +0.06 (95% CI 0.01, 0.11) and +0.05 (95% CI 0.01, 0.10) in their BMIZ at 6 and 12 months, respectively. The BMIZ of IG children decreased by -0.13 (95% CI -0.19 to -0.06) and -0.10 (95% CI -0.16 to -0.03), respectively, and the effect was greater in children with obesity. Conclusions The comprehensive intervention tested had beneficial effects, preserved the BMIZ of normal weight children, and reduced the BMIZ of children with obesity.

Effect of a Lifestyle Intervention in Children With Obesity and Nonalcoholic Fatty Liver Disease

This project showed nutritional education as an effective strategy to improve primary alterations in liver function associated with nonalcoholic fatty liver disease (NAFLD) in obese children who had NAFLD in Mexico. Researchers evaluated the effect of a 4-month nutritional counseling program on hepa