Alimentos seleccionados por los padres para los refrigerios de sus hijos en etapa de educación básica en Reynosa, Tamaulipas / Lunch box contents of elementary school children in Reynosa, Tamaulipas

Resumen Los refrigerios que consumen los niños durante el recreo complementan su dieta diaria, y pueden representar un riesgo de obesidad si los padres los preparan con base en alimentos procesados, elevados en azúcar, sal y grasa. El objetivo de este estudio fue identificar el contenido de los refrigerios empacados en casa, así como el estado nutricio de escolares de Reynosa, Tamaulipas, México. Se realizó un estudio descriptivo y transversal. Se trabajó con 769 niños de 12 escuelas públicas de educación básica. Se tomaron peso y talla. Se registraron durante una semana los refrigerios por observación directa, mediante una lista de cotejo. El 44.7 % de los escolares presentó sobrepeso u obesidad. Los alimentos contenidos en los refrigerios fueron el sándwich (50.0 %), tacos (29.5 %) y tortas (14.5 %). Las bebidas azucaradas incluyeron jugo (44 %) y agua saborizada (38.2 %). El 18.8 % llevó frutas, 13.5 % verduras y 31.6 % agua. En promedio, el contenido de energía fue de 327 kcal, por lo tanto, sobrepasaron la recomendación de calorías, e incluían alimentos no saludables (alto contenido de azúcar y grasa en relación a su aportación nutrimental), siendo necesario realizar intervenciones de educación nutricional para promover el consumo de agua y alimentos saludables dentro del entorno escolar, para mejorar la calidad de los hábitos alimenticios, tanto en escuelas de medio tiempo, como de tiempo completo, las cuales, brindan el servicio de alimentación.

Abstract School lunch supplements children's dailydiet and may pose a risk of obesity if they are prepared based on processed foods high in sugar, salt and fat. The aim of this study was to identify the content of lunch packs, as well as the nutritional status of scholars from Reynosa, Tamaulipas, Mexico. To that aim, a descriptive and transversal study was conducted. We worked with 769 children from 12 public elementary schools. Students' size and weight were taken. The contents of their lunch packs were recorded for one week by direct observation through a checklist. 44.7 % of school children were overweight or obese. The foods contained in the lunch packs were sandwich (50.0 %), tacos (29.5 %) and big sandwich (14.5 %). Sugary drinks included juice (44 %) and flavored water (38.2 %). They also contained fruits (18.8 %), vegetables (13.5 %) and water (31.6 %). On average, the energy content was 327 kcal. Therefore, they exceeded the calorie recommendation and included unhealthy foods (high content of sugar and fat in relation to their nutritional contribution). This suggests the need to implement nutrition education intervention programs to promote the consumption of drinking water and healthy foods within the school environment to improve the quality of eating habits.

Assessing the Validity of a Physical Activity Questionnaire Developed for Parents of Preschool Children in Mexico.

To assess the validity of a questionnaire developed for parents of preschool children to know their physical activity (PA) status, we compared the questionnaire results with the measures of accelerometer for children’s activities. Thirty-five preschoolers who wore the accelerometer for at least 10 hours daily on 3 weekdays and one weekend day were included in the analyses. Time spent in activities of varied intensity was calculated by applying 15-second ActiGraph count cutoffs (ACC). Parents’ perceptions of their children’s PA were associated with the percentage of vigorous and moderate physical activity recorded with ACC at r=0.62 (p=0.0001). An association was shown between the percentage of a child’s time spent in vigorous physical activity, as reported by parents, with that measured by ACC at r=0.53 (p=0.001). Results of this study suggest that the designed questionnaire might be a useful tool for assessing children’s activity while, additionally, it warrants further investigation on larger samples of children.

Beliefs about Causes and Consequences of Obesity among Women in Two Mexican Cities.

Personal beliefs might be barriers to the prevention and treatment of obesity. To assess the beliefs about causes and consequences of and possible solutions to obesity among 18-40 years old women in two Mexican cities and to analyze the association with demographic variables, we developed a questionnaire and assessed the women’s weight status. The questionnaire was applied at two outpatient healthcare centres and assessed the responses by the Likert scale. Results were analyzed by demographics, using the chi-square and Spearman correlations. One thousand one hundred adult women participated in the study. Mean age was 27.8 years, and mean BMI (kg/m2 ) was 27.05. The prevalence of overweight and obesity was 35% and 24% respectively. The most mentioned causes of obesity were eating oil and fat (4.1), fried foods (4.1), and eating too much (4.00). The most reported consequences were diseases (4.1), discrimination (3.9), and early death (3.7). The main solutions were physical activity (4.2), healthful eating (4.2), and personal motivation (4.1). Age of participants higher than 30 years, living with a partner, having more than 6 years of education, and having overweight and obesity were predictors of more knowledge about the causes, consequences, and solutions. These Mexican women from low SES had reasonably good knowledge about the causes and consequences of obesity. Although improving education might be beneficial to prevent obesity, changes in environmental contingencies are also necessary to prevent this epidemic.

Long-term randomized clinical trials of pharmacological treatment of obesity: systematic review

Introduction: Obesity has become a public health problem. The increment in energy intake and the reduction of caloric expenditure as a result of sedentary lifestyles promotes a positive energetic balance resulting in the increase of fat deposits. In response to this, the prescription of pharmacological treatments has also increased. Objective: To evaluate the long-term weight loss effectiveness of pharmacological treatments. Methodology: A systematic review was conducted on randomized clinical trials registered in Pub Med, Scielo, and EBSCOHOST from January 1st 1999 to December 31st 2008, including those with an intervention program with orlistat, sibutramine, and rimonabant equal or greater to two years. Two hundred and twelve articles were identified, 201 studies were excluded, and eleven were analyzed; seven from orlistat, two from sibutramine, and two from rimonabant. Information of design, intervention time, number of patients, age, body mass index and weight loss, difference between the intervention group versus the placebo, significance level, and methodological quality were obtained. Main findings: The percentage of weight loss with orlistat ranged between 5 and 12%, the mean weight loss was 8 kg, and a difference between IG vs. placebo of 3.7 kg. Weight loss with sibutramine ranged between 4 and 10%, the mean weight loss was 7.4 kg and a difference between the intervention group versus placebo was 5.5 kg. Weight loss with rimonabant was 7% with a mean weight loss of 7.3 kg, and the difference compared with the placebo was 4.4 kg. Conclusions: Weight loss with pharmacotherapy is modest; weight regain after interruption of treatment, adverse effects, costs and lack of evidence related to long-term morbi-mortality, do not justify the generalized use of pharmacological treatment of obesity.

Introducción: La obesidad se ha convertido en un problema de salud pública. El incremento en el consumo energético y el menor gasto calórico, debido al sedentarismo, promueve un balance energético positivo que se traduce en el incremento de depósitos grasos. En respuesta al incremento de la obesidad se ha aumentado la prescripción del tratamiento farmacológico. Objetivo: Evaluar la efectividad del tratamiento farmacológico sobre la pérdida de peso con un seguimiento igual o mayor a 2 años. Metodologia: Se realizó una revisión sistemática de estudios aleatorios registrados en PubMed, Scielo y EBSCOHOST del 1 enero de 1999 al 31 de diciembre del 2008 y se seleccionaron aquellos con un período de intervención mayor o igual a dos años con orlistat (Or), sibutramina (Sib) y rimonabant (Ri). Se identificaron 212 artículos, se excluyeron 201 estudios y se analizaron once, siete de Or, dos de Sib y dos de Ri. Se obtuvo información del diseño del estudio, el tiempo de intervención, el número de participantes, la edad, el índice de masa corporal (IMC), la pérdida de peso, la diferencia entre GI vs placebo, el nivel de significancia y la calidad metodológica. Hallazgos: El porcentaje de pérdida de peso al final de la intervención con orlistat osciló entre 5% y 12%, un promedio de pérdida de 8 kg y una diferencia entre GI vs placebo de 3.7 kg. Con sibutramina, entre 4% y 10%, el promedio de pérdida de peso fue de 7.4 kg y diferencia entre GI vs placebo de 5.5kg. Con rimonabant, se observó en promedio 7.3 kg de pérdida de peso a los 2 años, y una diferencia con el grupo placebo de 4.4 kg. El porcentaje de pérdida de peso fue de 7%. Conclusiones: La pérdida de peso con farmacoterapia es modesta, la recuperación posterior a la interrupción del tratamiento, los efectos adversos, el costo y la falta de evidencias sobre morbi-mortalidad a largo plazo, no justifican el tratamiento farmacológico generalizado de la obesidad.

¿Es sano perder peso? / Is it healthy to loose weight?

Objetivo El propósito de esta revisión es examinar el efecto a largo plazo de la pérdida de peso sobre la mortalidad. Metodología Se realizó una revisión de estudios disponibles en Pubmed centrados en el análisis del efecto de la pérdida de peso sobre la mortalidad. Se estudiaron las posibles causas de inconsistencias en diversos estudios y las posibles explicaciones biológicas. Resultados Los resultados de la mayoría de los estudios sugieren que el sobrepeso y la obesidad son un riesgo de diversas enfermedades crónicas. Sin embargo, la mayoría de estudios también sugieren que independientemente del peso, el cambio de peso (aumento o reducción) aumenta el riesgo de mortalidad, al compararlo con el mantenimiento de un peso estable. Conclusión El efecto benéfico o adverso de la pérdida de peso sobre la mortalidad puede depender de las características genéticas de los individuos, de los antecedentes pre y postnatales, del peso inicial, de la cantidad de peso perdido, del tiempo en que se logró la pérdida de peso y de las estrategias utilizadas para reducir de peso.

Objective This study was aimed at analysing the long-term effects of weight-loss on mortality. Methods Studies available in the Pubmed database regarding the effect of weight-loss on mortality were analysed. Possible causes for inconsistencies amongst different studies and the biological rationale for the available evidence were studied. Results Most studies have suggested that being overweight and obesity are common risk factors for chronic diseases. However, most studies have also suggested that, independently of weight, a change in weight (increase or reduction) increases the risk of mortality when compared to maintaining a stable weight. Conclusion The beneficial or adverse effect of weight-loss on mortality could depend on individuals' genetic characteristics, pre- and post-natal background, initial weight, the amount of weight lost, the time taken to lose weight and the strategies used for reducing weight.

Revisión de la efectividad de los ingredientes de productos alternativos para la pérdida de peso / A systematic review of the effectiveness of alternative weight-loss products' ingredients

Objetivo La alta demanda para el tratamiento de la obesidad y la poca efectividad de las terapias convencionales favorecen el consumo de productos alternativos. Evaluar ensayos clínicos aleatorios sobre la pérdida de peso con los ingredientes de los productos alternativos de mayor consumo en México. Metodología Se realizó una encuesta para valorar la prevalencia de consumo de productos alternativos para la pérdida de peso en Ensenada, Baja California. Se investigaron los productos más vendidos y se obtuvieron los componentes activos. Se revisaron ensayos clínicos aleatorios registrados en Pubmed para los componentes activos mas utilizados. Se incluyeron y analizaron aquéllos que evaluaran cambios en el peso. Resultados Treinta y seis porciento de los encuestados han utilizado algún método alternativo para la pérdida de peso (83 por ciento mujeres). Los productos más referidos fueron licuados, tés, pastillas y linaza. Se encontraron 16 ensayos clínicos aleatorios de cuatro ingredientes: Garcinia Cambodia, té verde, L-carnitina y linaza. Solamente dos estudios demostraron una pérdida de peso significativa (2 5 por ciento) entre el grupo control y el experimental. En los estudios de L-Carnitina y linaza no se encontró una diferencia significativa. Conclusión Se concluye que no hay evidencias suficientes y de calidad que justifiquen la utilización de los productos alternativos para la pérdida de peso.

Objective The high demand for obesity treatment and conventional therapies' lack of effectiveness increases the use of alternative products. This study was aimed at assessing evidence from randomised clinical trials regarding the effectiveness of alternative weight-loss products' ingredients. Methods A survey was conducted in Ensenada, Baja California, to assess the frequency of consuming alternative products used for weight reduction. The ingredients in the products most in demand were included in this review. The Pubmed database was searched for all randomised clinical trial papers including these ingredients and assessing weight loss. Results Thirty-six percent of the subjects questioned had used alternative methods for weight-loss, 83 percent of them being women. The most frequently used products were shakes, tea, pills and flaxseed/linseed. Sixteen randomised clinical trials using four ingredients were used: Garcinia cambogia, green tea, L-carnitina and flaxseed. Only two studies (green tea and Garcinia cambogia) showed significant weight-loss (25 percent) amongst control and experimental groups. There was no significant difference between the groups in the studies regarding L-carnitina and flaxseed. Conclusions There is a lack of evidence regarding quality studies justifying the use of alternative products for weight loss.

Non insulin depent diabetes mellitus metabolic control in two different health care settings in Mexico / Control metabólico de la diabetes mellitus no dependiente de insulina en niveles de atención médica en México

Objetivo. El propósito de este estudio fue valorar las prácticas de atención a la salud y el control metabólico de diabéticos tipo II en servicios de atención primaria y secundaria, atendidos por especialistas de medicina familiar, medicina interna y endocrionología. Material y métodos. Se realizó un estudio transversal en Tijuana, México, con información obtenida de cuatro clínicas de atención primaria y una clínica de atención secundaria del Instituto Mexicano del Seguro Social (IMSS). Se revisó un expediente clínico alternativamente de todos los pacientes que tenían la tarjeta especial de diabetes, desde el mes de agosto a septiembre de 1995. Resultados. Los resultados muestran que la incidencia de registro de la glucemia en ayunas fue mayor entre médicos internistas y endocrinólogos, que la observada en los expedientes atendidos por médicos familiares (p < 0.05). La edad y la duración de la diabetes la registraron con más frecuencia los especialistas de segundo nivel. El tratamiento de insulina fue utilizado con mayor frecuencia por los endrocrinólogos. No se observaron diferencias estadísticamente significativas en la glucemia en ayunas, colesterol total, índice de masa corporal, ni por los diferentes puntos de corte utilizados para glicemia en ayunas o para índice de masa corporal. Los especialistas de segundo nivel registraron con mayor frecuencia los resultados de colesterol (p < 0.05). Discusión. No se observaron diferencias significativas en el registro de medidas antropométricas o variables clínicas entre los dos grupos. Sin embargo, los hallazgos sugieren que las prácticas de atención no cumplen con los criterios establecidos en el IMSS o con el entrenamiento de los especialistas de segundo nivel. Los resultados sugieren que sería benéfico desarrollar protocolos de tratamiento específico y sistemas de vigilancia de acuerdo al presupuesto y disponibilidad de recursos de cada clínica.

Methods of nutritional assessment for determining nutritional care at the pre-school level

Prevalence of malnutrition in pre-school children may be used to determine the need for nutrition surveillance or nutritional care. That prevalence depends on the nutritional classification used. The authors consider that one of the most recommended classifications used for identifying Protein Energy Malnutrition (PEM) was developed by Waterlow. The criteria includes weight-for-height and height-for-age. Frisancho suggested that Arm Muscle Area (AMA), related to height, could provide useful measurements for assessing mass reserve, thus, in beginning stages of PEM it is worthwhile to determine those who could benefit from nutritional services. The aim of this study was to determine the percentages of pre-school children considered well nourished by Waterlow indicators, but wasted or below average using the AMA for heigh criteria. Children (881) of either sex, from 48 to 79 months of age, were studied from the Tijuana, Baja California, Mexico pre-school system. Standard anthropometric measurements were taken including wight, height, upper-arm circumference, and triceps skinfold. Arm muscle area was created from those measeurements. Using Waterlow indicators, results showed deficit of heigh-for-age alone was seen in 25.6 per cent; deficit of weight-for-height alone was observed in 1 per cent; deficit of AMC-for-height, but well nourished by Waterlow indicators was seen in 14.9 per cent. If one speculates that children with deficits of AMC-for-height could have different risks of acquiring a disease compared to those apparently normal, then 14.9 per cent of the studied sample would also need nutritional care. Thus, using these criteria, the need for nutritional surveillance and nutritional education is greater for PEM than that established exclusively using Waterlow criteria