Factores maternos y ganancia de peso en un grupo de gestantes con recién nacidos macrosómicos / Maternal Factors and Weight Gain in a Group of Pregnant Women with Macrosomic Newborns

Resumen Antecedentes: la excesiva ganancia de peso contribuye al riesgo de diabetes gestacional y sobrecrecimiento fetal. Objetivo: explorar el efecto de algunos factores sociodemográficos, gestacionales y antropométricos sobre la ganancia de peso durante la gestación en un grupo de mujeres con recién nacidos macrosómicos, atendidas en una institución de segundo nivel del departamento de Antioquia, Colombia, entre 2010 y 2017. Materiales y métodos: se realizó un estudio transversal retrospectivo con historias clínicas prenatales de 61 mujeres que tuvieron recién nacidos macrosómicos. La variable de interés fue la ganancia de peso. Para la asociación de los aspectos sociodemográficos y gestacionales con la ganancia de peso, se aplicó la prueba t de Student y la magnitud del efecto con la medida g de Hedges. Se aplicó un modelo de regresión lineal múltiple ajustado para el análisis multivariado. Resultados: se hallaron diferencias estadísticamente significativas según edad materna, IMC pregestacional, estatura materna e interconsulta a nutrición. El tamaño del efecto sobre el aumento de peso en el embarazo para cada una de estas variables fue significativo. El IMC pregestacional (p<0,001; IC95 % -7,28; -2,67) y la estatura materna (p<0,05 IC95 % 0,88; 5,87) explican el 27 % de la variabilidad de la ganancia de peso. Conclusión: factores como edad materna menor a 35 años, IMC pregestacional, estatura materna y ausencia de atención nutricional pueden repercutir en ganancias de peso por encima de lo recomendado.

Abstract Background: Excessive weight gain contributes to the risk of gestational diabetes and fetal overgrowth. Objective: to explore the effect of some sociodemographic, gestational and anthropometric factors on weight gain during pregnancy, in a group of women with macrosomic newborns, treated at a second-level institution in the department of Antioquia, between 2010 and 2017. Materials and Methods: A descriptive cross-sectional study was conducted with prenatal medical records of 61 women with macrosomic newborns. The variable of interest was weight gain. For the relationship of the sociodemographic and gestational aspects with the weight gain, the t-Student test was applied and the magnitude of the effect with the Hedges g measure. A multiple linear regression model adjusted was applied for multivariate analysis. Results: Statistically significant differences were found in maternal age, pregestational body mass index, maternal height, and nutrition consultation. The effect size on weight gain in pregnancy for each of these variables was significant. Pregestational body mass index (p<0.001, 95% CI -7.28; -2.67) and maternal height (P<0.05 95% CI 0.88; 5.87) explain 27% of the variability of weight gain. Conclusion: factors such as maternal age less than 35 years, pregestational body mass index, maternal height and lack of nutritional care, can have an impact on weight gains above the recommendations.

Lactancia materna, obesidad y síndrome metabólico en la edad escolar / Breastfeeding, obesity and metabolic syndrome at school age

INTRODUCCIÓN: La lactancia materna (LM) puede ser un factor protector de la obesidad y sus complicaciones metabólicas. OBJETIVO: Determinar la asociación entre el antecedente de amamantamiento y la presencia de obesidad, síndrome metabólico (SM) y resistencia insulínica (RI). PACIENTES Y MÉTODOS: Estudio transversal en 20 escuelas públicas de Santiago, Chile. Se evaluó antropometría, presión arterial, perfil lipídico, glicemia, insulinemia e índice HOMA. Los padres respondieron una encuesta sobre el antecedente de LM. Se definió SM según criterios de Cook y RI como HOMA > percentil 90. RESULTADOS: Se recibieron 3.278 encuestas válidas. La edad promedio fue de 11,4 ± 1 años, siendo 52,3% mujeres. La mayoría (98,2%) recibió LM, con una prevalencia de 15,9% de obesidad versus 18,6% en los que no la recibieron (p = 0,039). Hubo una tendencia no significativa a que SM y sus componentes, excepto RI, fueran más prevalentes en el grupo no amamantado. Los escolares que recibieron LM por 3-6 meses presentaron una menor prevalencia de obesidad y de algunos componentes de SM que los que recibieron menor tiempo o no la recibieron; el efecto fue inverso cuando la LM se prolongó por más de 9 meses. CONCLUSIONES: La prevalencia de obesidad fue mayor en los escolares que no fueron amamantados. Durante el primer semestre, la LM de mayor duración se asoció a menor prevalencia de obesidad y complicaciones metabólicas.

INTRODUCTION: Breastfeeding (BF) can be a protective factor against obesity and its associated metabolic complications. OBJECTIVE: To determine the association between breastfeeding history and present obesity, metabolic syndrome (MS) and insulin resistance (IR). PATIENTS AND METHODS: Cross-sectio nal study in 20 public schools in Santiago, Chile. Anthropometry and blood pressure were assessed. Blood lipids, glucose, insulin and HOMA index were measured in a fast blood sample. Parents answe red a survey on BF. MS was defined according to Cook's criteria and IR as HOMA > 90th percentile. Parents answered a survey about the antecedent of breastfeeding. Chi2 and Fischer tests were used (SSPS). RESULTS: 3,278 surveys were valid. Average age: 11.4 ± 1 years, 52.3% were female. Most of them (98.2%) were breasted, with a 15.9% prevalence of obesity versus 18.6% in the group that was not breastfed (p = 0.039). There was a non-significant trend of higher prevalence in MS and its components (except IR) in the non-breastfed group. The group breastfed from three to six months had a lower prevalence of obesity and MS components than the 0 to 3 months group ; the effect was the opposite when BF lsted longer than nine months. CONCLUSIONS: The prevalence of obesity was higher in children that did not received breastfeeding. A longer breastfeeding time during the first semester of life was associated with lower prevalence of obesity and metabolic complications.

La presión arterial es un importante marcador de ateroesclerosis subclínica en niños / Association of carotid intima media thickness with blood pressure and HDL cholesterol in children

Background: Cardiovascular risk factors must be controlled since childhood. Aim: To assess the association of carotid intima media thickness (CIMT) with the components of the metabolic syndrome in Children. Material and Methods: Cross sectional assessment of 299 children aged 11.5 ± 0.9years (58% women) with and without metabolic syndrome components. Anthropometric parameters and blood pressure were measured and a blood sample was obtained to measure blood glucose and lipids. CIMT was measured using high resolution ultrasound. Results: Ninety three percent of children were post puberal, 64% were overweight and 25% had metabolic syndrome. Mean and maximum CIMT correlated with systolic blood pressure (r = 0.21 and 0.21 respectively p < 0.01). Children with a CIMTover the 75th percentile had higher blood pressure and lower HDL cholesterol. A stepwise logistic regression accepted both variables as predictors of CIMT with odds ratios for mean CIMT of 1.46 (1.19-1-79) and 0.81 (0.7-0.94) perfive units of change, respectively. Conclusions: In this group of children systolic blood pressure and HDL cholesterol are associated to CIMT.

Relación médico-paciente en la Pontificia Universidad Católica de Chile: evaluación de una escala de medición / Evaluation of a scale to assess physician-patient relations

Background: Beneficence, respecting autonomy of patients to make their own decisions, is crucial for good physician-patient relations (PPR), a leading objective in health care. Aim: To validate a previously designed scale to assess PPR in Chile. Material and Methods: A scale with 55 questions grouped in six dimensions, was applied to a convenience sample of 146 individuals, composed by physicians, patients and medical students, at the school of medicine from the Pontificia Universidad Católica de Chile (PUC). Internal consistency (Alpha of Cronbach) of answers was analyzed. The existence of correlations between answers that may justify the application of a factorial analysis was assessed using Bartlett and Kaiser-Meyer-Olkin (KMO) tests. Factorial analysis was used to identify specific dimensions and reduce the number of questions. Results: Factorial analysis performed in 125 subjects with complete answers allowed to reduce the scale to 28 questions, grouped in six dimensions. Cronbach alpha value was 0.78. Bartlett test was highly significant (p < 0.0001), and KMO score was 0.784, considered as meritorious. Conclusions: The validated scale will allow the performance of new studies among physicians and patients, to assess and compare their respective scores.

Insulinemia e índice HOMA en niños y adolescentes chilenos / Normal plasma insulin and HOMA values among chilean children and adolescents

Background: Plasma insulin and HOMA (homeostasis model assessment) index, used to determine insulin resistance, do not have local standard values for children and adolescents in Chile. Aim: To establish the normal reference intervals for insulin and HOMA in children and adolescents aged 10-15 years, according to sex and puberal maturation. Material and Methods: A cross-sectional study of 2,153 children and adolescents from Puente Alto County was performed, during 2009 and 2010. Anthropometry and self-report of puberal maturation were assessed. Fasting glucose (hexoquinase) and insulin blood levels (chemiluminiscence), were determined and HOMA index was calculated. Percentile distributions of these variables were calculated. Results: The reference group included only subjects with normal body mass index and fasting blood glucose (n = 1,192). Girls had higher insulin and HOMA values than boys (12.5 ± 6.0 and 9.1 ± 4.9 μϋ/mL (p < 0.01) and 2.7 ± 1.4 and 2.1 ± 1,1 (p < 0.01), respectively). Subjects with Tanner I and IIpuberal stages had lower insulin and HOMA mean values than subjects with Tanner III and IV (9.0 ± 4.3 and 12.5 ± 6.2μϋ/ml (p < 0.01) and2.0 ± 1 and2.8 ± 1.4 (p < 0.01), respectively). Conclusions: The 90th percentile of insulin and HOMA distributions according to sex and maturation, was selected as the upper cut-off point to identify individuals with insulin resistance. HOMA cutoff point for Tanner I and II boys was 3.2, for Tanner I and II girls was 4.1, for Tanner III and IV boys was 4.2 and for Tanner III and IV girls was 5.0.

Influencia combinada del índice de masa corporal pregestacional y de la ganancia de peso en el embarazo sobre el crecimiento fetal / Combined influence of preconception body mass index and gestational weight gain on fetal growth

Background: The Chilean Ministry of Health has been using standards for nutritional evaluation and weight gain recommendations during pregnancy in the last 25 years. In the meantime new standards have been developed. Aim: To study the combined infl uence of preconception maternal nutritional status and gestational weight gain, using new standards to classify those parameters, on perinatal outcomes. Material and Meihods: A cohort of 11,465 healthy pregnant women was prospectively followed until term. Their pre-gestational nutritional status was classified using the body mass Índex cut-offs in use in the United States (USA). Their gestational weight gain was classified using categories proposed in a Danish study. Perinatal outcomes included were risky birth weight, i.e. < 3000 g and ≥ 4000 g, and cesarean delivery. Relative risks for those perinatal outcomes were calculated for all combined categories of pre-gestational nutritional status and gestational weight gain. Results: Relative risks of almost all gestational weight gain results were statistically significant for women having a normal pre-gestational nutritional status meanwhile all of them were not significant for underweight women. Overweight and obese women had similar relative risks valúes as normal women. However, many of them were not significant, especially in obese women. Conclusions: There is an independent and combined infl uence of preconception nutritional status and gestational weight gain on perinatal outcomes, when using standards to classify those parameters developed in the USA and Denmark, respectively.

Estimation of individual neonatal survival using birthweight and gestational age: a way to improve neonatal care.

The study was conducted to determine the combined effect of birthweight and gestational age at birth on neonatal mortality using individually-identified livebirths. Logistic regression was used for studying the interactive effect of birthweight and gestational age on the individual probability of neonatal death. All livebirths from Chile in 2000 were included in a linked file. Odds ratio models for birthweight and gestational age were developed for each sex. The probability of neonatal death by sex was presented using contour plots. The models were statistically significant, and odds ratios were different and non-linear for the effects of birthweight and gestational age. Contour plots of constant neonatal mortality according to birthweight and gestational age were presented; they were similar for each sex. A single graph for both sexes that estimates the survival potential of infants born too early or too small would improve neonatal care in developing countries.

Asociación entre la composición corporal de la embarazada y la composición corporal del recién nacido

Objetivo: estudiar la asociación entre la composición corporal de la madre al final del embarazo y la composición corporal del recién nacido. Sujetos: se estudiaron 224 embarazadas y sus recién nacidos atendidos en el servicio de salud sur-oriente de Santiago, Chile. Métodos: la composición corporal de la embarazada fue calculada a través de la técnica de dilución con deuterio descrita por Schoeller; la composición corporal del recién nacido se estimó con el método antropométrico de Dauncey. La asociación entre la composición corporal materna y del recién nacido fue estudiada por análisis de correlación y de regresión múltiple. Resultados: la masa magra y masa grasa materna (MMM y MGM, respectivamente), talla materna y la edad gestacional (EG) se correlacionaron significativamente con la MG del recién nacido (r=0,38, 0,24 , 0,15 y 0,14; p = 0,0001, 0,0002, 0,01 y 0,03, respectivamente), así como también con la MM del RN (r=0,34, 0,23, 0,25 y 0,27; p=0,0001, 0,0004, 0,0001 y 0,0001, respectivamente). El análisis de regresión mostró influencias significativas de MMM, MGM y EG sobre MG del RN (p=0,0001, 0,0008 y 0,03, respectivamente) y de MMM, MGM, EG y sexo femenino sobre la MM del RN (p=0,0001, 0,001, 0,0004 y 0,01, respectivamente); siendo la MMM mayor que la MGM en ambas regresiones lineales múltiples. Conclusión: la MMM influye más que la MGM en ambos compartimientos nutricionales del recién nacido (MM y MG del RN), lo que es compatible con observaciones recientes que asignan un importante rol en el crecimiento fetal al agua corporal total y a la expansión del volumen plasmático de la madre.

Objetivo: estudar a associação entre a correlação e a regressão múltiple. Resultados: a massa magra e massa graxa materna (MMM composição corporal da mãe ao final da gravidez e a composição corporal do recém-nascido. Sujeitos: estudaram-se 224 grávidas e seus recém-nascidos atendidos no serviço de saúde sul-oriente de Santiago, Chile. Métodos: a composição corporal da mulher grávida foi calculado através da técnica de "dilución com deuterio" descrita por Schoeller; a composição corporal do recém-nascido estimou-se com o método antropométrico de Dauncey. A associação entre a composição corporal materna e do recém-nascido foi estudada por análisise e, respectivamente, altura materna e idade gestacional (EG) correlacionaram-se MGM significativamente com a MG do recém-nascido (r= 0,38, 0,24 , 0,15 e 0,14; p = 0,0001, 0,0002, 0,01 e 0,03, respetivamente), assim como também com a MM do RN (r = 0,34, 0,23, 0,25 e 0,27; p = 0,0001, 0,0004, 0,0001 e 0,0001, respetivamente). A análise de regressão mostrou influências significativas de MMM, MGM e EG sobre MG do RN (p = 0,0001, 0,0008 e 0,03, respetivamente) e de MMM, MGM, EG e sexo feminino sobre a MM do RN (p= 0,0001, 0,001, 0,0004 e 0,01, respetivamente); sendo a MMM maior que a MGM em ambas regressões lineais múltiples. Conclusão: a MMM influi mais que a MGM em ambos compartimentos nutricionais do recém- nascido (MM e MG do RN), o que é compatível com observações recentes que indicam um importante rol no crescimento fetal à água corporal total e à expansão do volume plasmático da mãe.

Objective: to study the association between the body composition of women at the end of pregnancy and that of their respective newborn babies. Subjects: 224 pregnant women attending a public hospital in a poor urban area of Santiago, Chile. Methods: maternal body composition was determined using a deuterium dilution technique to measure total body water as described by Schoeller, fat free mass was calculated using the equations of van Raaji et al. Newborn body composition was estimated using the Dauncey anthropometric method. The association between maternal and newborn body compositions was studied using correlation and multiple regression analyses. Results: The multiple regression models showed that maternal fat free mass, maternal fat mass and gestational age influenced both newborn compartments (p<0,01), and fat free mass had a greater influence than the other variables. Conclusions: fat free maternal mass has a greater influence on newborn body composition than the fat mass. This observation is in accordance with other studies revealing an important tole in fetal growth of the maternal total body water and plasma volume expansion.

El programa chileno de alimentación escolar, 1965-1997 / The chilean school-feeding program, 1965-1997

Los autores evaluaron el programa de alimentación escolar (PAE) en una asesoría para el Ministerio de Hacienda, que estuvo destinada a la discusión del presupuesto para 1998 en el Congreso Nacional. Desde 1965 al número de desayunos y almuerzos aumenta para luego decaer (especialmente desde la segunda mitad de la decada de los 70). Se inicia una recuperación en el año 1982 para los almuerzos y en 1990 para los desayunos. En la decada de los 90 el PAE ha mejorado en el número y calidad de las raciones anuales. Los beneficiarios del PAE pertenecen a las escuelas calificadas en situación de riesgo socioeconómico y nutricional por el índice de vulnerabilidad escolar (IVE). Un problema destacable es que esta asignación se hace por escuelas según porcentaje ponderado del IVE sin considerar la gravedad de la situación nutricional individual para asignar dististos tipos de raciones. La gravedad de la situación nutricional tampoco se puede estimar adecuadamente porque el IVE utiliza la evaluación antropométrica de los niños sin consideración al desarrollo puberal. La falta de una focalización individual también afecta el control de la gestión del PAE. Se concluye con propuestas para su mejoría