Association of Alimentary Factors and Nutritional Status with Caries in Children of Leon, Mexico.

PURPOSE: To determine the association between types of food consumed, nutritional status (BMI) and caries in schoolchildren. MATERIAL AND METHODS: A cross-sectional study was performed with 224 schoolchildren 6 to 12 years of age. DMFT/ dmft indices, level of oral hygiene, nutritional status as quantified by BMI and types of food consumed were determined in all participants. Data were analysed using multiple linear regression with significance set at p < 0.05. RESULTS: Caries prevalence was 36%. In the multiple linear regression analysis adjusted for BMI, variables related to a higher number of caries were younger age and lower intake of vitamin D, calcium and fiber, with higher consumption of phosphorous and carbohydrates (R2 = 0.30; p < 0.0001 for the model). Sweetened softdrinks and chewy candy were risk factors for higher caries prevalence, while consuming milk and carrots were protectors. CONCLUSION: Caries in schoolchildren is highly prevalent in this community and is related to younger age and lower intake of vitamin D, calcium and fiber, but a higher consumption of phosphorous and carbohydrates. No relationship was found between caries and nutritional status.

Impact of air pollution on pulmonary function and respiratory symptoms in children. Longitudinal repeated-measures study.

BACKGROUND: Salamanca, Mexico occupied fourth place nationally in contaminating emissions. The aim of the study was to determine the impact of air pollution on the frequency of pulmonary function alterations and respiratory symptoms in school-age children in a longitudinal repeated-measures study. METHODS: We recruited a cohort of 464 children from 6 to 14 years of age, from two schools differing in distance from the major stationary air pollution sources. Spirometry, respiratory symptoms and air pollutants (O3, SO2, NO, NO2, NOx, PM10,) were obtained for each season. Mixed models for continuous variables and multilevel logistic regression for respiratory symptoms were fitted taking into account seasonal variations in health effects according to air pollution levels. RESULTS: Abnormalities in lung function and frequency of respiratory symptoms were higher in the school closer to major stationary air pollution sources than in the distant school. However, in winter differences on health disappeared. The principal alteration in lung function was the obstructive type, which frequency was greater in those students with greater exposure (10.4% vs. 5.3%; OR = 1.95, 95% CI 1.0-3.7), followed by the mixed pattern also more frequent in the same students (4.1% vs. 0.9%; OR = 4.69, 95% CI, 1.0-21.1). PM10 levels were the most consistent factor with a negative relationship with FVC, FEV1 and PEF but with a positive relationship with FEV1/FVC coefficient according to its change per 3-month period. CONCLUSIONS: Students from the school closer to major stationary air pollution sources had in general more respiratory symptoms than those from the distant school. However, in winter air pollution was generalized in this city and differences in health disappeared. PM10 levels were the most consistent factor related to pulmonary function according, to its change per 3-month period.

Quality of life in obese pregnant women: a longitudinal study.

OBJECTIVE: The purpose of this study was to assess the contribution of obesity on quality of a woman's life during pregnancy. STUDY DESIGN: At the Hospital of Gynecology and Obstetrics in León, Mexico, we followed-up 220 pregnant women (110 obese and 110 nonobese) who completed the 12-item short-form health survey at the beginning and during the third trimester of pregnancy. RESULTS: The mental component score was lower in obese than in nonobese women at the beginning of gestation and at the third trimester but increased in the entire group during pregnancy. The physical component score (PCS) decreased during pregnancy and was lower in obese than in nonobese pregnant women (43.5 vs 47.2; P = .01) at the third trimester. Baseline body mass index, weight gain, and complications during pregnancy were associated negatively with PCS (R2=0.11; P < .001 for the model). CONCLUSION: Baseline body mass index, weight gain, and complications during gestation are associated negatively with PCS of quality of life.

Mexican women's reasons for accepting or declining HIV antibody testing in pregnancy.

OBJECTIVE: To determine pregnant women's reasons for accepting or declining the HIV test in Leon, Mexico. DESIGN: A cross-sectional study using a face-to-face questionnaire. SETTING: The antenatal clinic at a tertiary-care referral hospital in Leon, Mexico. PARTICIPANTS: 1184 pregnant women. DATA COLLECTION: Reasons for accepting or declining the HIV antibodies test, socio-economic characteristics and risk factors for HIV were recorded. Blood samples were obtained from women who accepted to be tested, and positive serologies to HIV on duplicate enzyme-linked immunosorbent assay testing were confirmed by Western Blot assay. FINDINGS: 1009 (85.2%) women accepted the HIV antibodies test. The main reason for accepting it was that women felt the test could be beneficial to their babies (45.1%). The two main reasons for rejecting the HIV antibodies test were that women felt the test was unnecessary because their husbands did not have sexual intercourse with other women (32.6%), and because they did not have permission from their husbands for accepting the test (23.5%). None of the women tested positive for HIV antibodies (0 per 1009). KEY CONCLUSIONS: The reasons for accepting the HIV test were similar to those reported in developed countries. One important reason for declining the test was that women did not have their husband's permission. IMPLICATIONS FOR PRACTICE: The acceptance rate for HIV testing in pregnant women could be improved by counselling men on the value of their wives being tested in pregnancy.

[Maternal and fetal morbidity in obese pregnant women]. / Morbilidad materno-fetal en embarazadas obesas.

OBJECTIVE: To determine the maternal and fetal morbidity in obese pregnant women compared with non-obese pregnant women. PATIENTS AND METHODS: It was carried out a case-control study. There were included 342 patients who had a body mass index previous to the pregnancy of 18.5 to 24.9 (control group) and 342 pregnant women with body mass index > 30 (group of obese women). We registered the mother and newborns' data to evaluate their morbidity. The groups were compared with Student's t test or Mann Whitney's U test for continuous data and chi-square or Fisher exact test for categorical variables. RESULTS: We found more macrosomic newborns in the group of obese women (p = 0.003) and a higher number of caesarean sections (48.8 vs 37.4%, p = 0.003). The maternal morbidity characterized by gestational diabetes was higher in the obese ones (3.5 vs 0.58%, p = 0.015). Other variables as preterm delivery, stillbirths, malformations, admissions to the neonatal intensive care unit, as well as the development of hypertensive disorders of pregnancy were not significant. CONCLUSION: We found higher maternal and fetal morbidity in obese women. Therefore, these patients should be considered as carriers of high-risk pregnancies. This strategy could avoid complications associated to this group of patients.

Heart autonomic function in overweight adolescents.

We compared factors associated with sympathetic cardiac activity in 70 male adolescents (34 obese and 36 with appropriate weight). In fasting we measured insulin, leptin, glucose, blood pressure, and heart rate variability by power spectral analysis. Obese adolescents had higher values for systolic blood pressure, insulin, leptin, low frequency/high frequency index (LF/HF); and lower for standard deviation of all the normal RR intervals, and total power. In the multiple regression analysis, factors associated with LF/HF index were leptin and systolic blood pressure (R2 = 0.18; P = 0.004 for the model). We concluded that higher sympathetic activity in obese adolescents is related to higher leptin and systolic blood pressure levels..

Relationship between left ventricular mass and heart sympathetic activity in male obese subjects.

BACKGROUND: Pathogenesis of left ventricular hypertrophy (LVH) is multifactorial, but evidence that the sympathetic system is involved in progression of cardiovascular structural alterations in hypertension is substantial. However, the relationship between heart sympathetic activity and left ventricular mass in normotensive obese subjects has not been studied. METHODS: We studied 103 male normotensive subjects (53 obese and 50 non-obese). Left ventricular mass (LVM), heart sympathetic activity by 60 min electrocardiograph (EKG) monitoring, leptin, insulin, lipid profile, and blood pressure were measured. RESULTS: Obese subjects showed higher LVM (p=0.0002), low frequency/high frequency ratio (LF/HF) (p=0.004), systolic and diastolic blood pressure (p <0.00001 for both), insulin (p=0.00001), and leptin levels (p <0.00001) than non-obese subjects. In contrast, standard deviation (SD) of all rate-rhythm (R-R) intervals (SDNN) (p=0.0002) and total power (TP) (p=0.03) were lower in obese than in non-obese subjects. In multiple regression analysis for factors associated with LVM, body mass index (BMI) (R=0.24), systolic blood pressure (R=0.22), and LF/HF (R=0.21) were the only factors included in the model (R2=0.32, p <0.0001). CONCLUSIONS: LVM is increased in normotensive obese subjects and correlates with systolic blood pressure and heart sympathetic activity.

Homeostatic model assessment and risk for hypertension during pregnancy: a longitudinal prospective study.

The purpose of this study was to determine the association between insulin resistance and hypertension during pregnancy with the homeostatic model assessment (HOMA-IR). A longitudinal prospective study was carried out. One hundred sixty normotensive pregnant women were followed from the first trimester until delivery. HOMA-IR levels were determined each trimester. Statistical analysis included one-way analysis of variance and multivariate logistic regression. At follow-up, 134 women (83.8%) remained normotensive, 18 (11.2%) developed gestational hypertension, and 8 (5%) developed preeclampsia. At first trimester, HOMA-IR levels were higher in women who developed gestational hypertension (2.1 +/- 0.2) than in women who developed preeclampsia (1.2 +/- 0.0), or remained normotensive (1.2 +/- 0.3); p < 0.01. In the logistic regression analysis, HOMA-IR levels at first trimester were statistically significant ( p = 0.03) to predict development of gestational hypertension. Our results support the use of the HOMA-IR as an alternative index for the assessment of the risk for hypertension during pregnancy.

Leptin and heart sympathetic activity in normotensive obese and non-obese subjects.

BACKGROUND: In rats leptin increases sympathetic activity, and an inhibitory effect on leptin synthesis and release has been demonstrated for the catecholamines, both in adipocyte cell cultures and in healthy experimental animals. The aim of this study was to evaluate the relationship between leptin and heart sympathetic activity as well as changes in leptin levels after the administration of drugs that modify sympathetic activity. METHODS: We performed a randomized, blinded, before-after trial in 81 normotensive obese and non-obese subjects. They were studied before and after treatment with enalapril (5 mg every 12 hours) or clonidine (0.1 mg every 12 hours) for 7 days. RESULTS: Obese subjects had higher values for percent body fat (p < 0.0005), triglycerides (p < 0.05), leptin (p < 0.0005), and low frequency/high frequency ratio at night (LF/HFn, p = 0.05). After enalapril or clonidine treatment, leptin levels were not modified. Both drugs significantly diminished the systolic and diastolic blood pressures. In the obese group, clonidine and enalapril diminished the LF/HFn ratio (p < 0.05). The LF/HF index showed a univariate correlation with body mass index, leptin, systolic blood pressure, insulin, age and triglyceride levels. In the multiple regression analysis for factors associated with the LF/HF ratio, only leptin, age and insulin were included in the model. The r2 of the model was 0.3 (p = 0.0003). CONCLUSIONS: A higher level of heart sympathetic activity is found in normotensive obese as compared with non-obese subjects. Both clonidine and enalapril reduced heart sympathetic activity in obese subjects without a change in fasting leptin levels.

Sympathetic activity and response to ACE inhibitor (enalapril) in normotensive obese and non-obese subjects.

BACKGROUND: Angiotensinogen has been proposed as a possible link between obesity and hypertension because the adipocyte produces angiotensinogen and contains the enzymes required for its conversion. Moreover, sympathetic overactivity has been reported in obese subjects. The aim of this study was to compare heart sympathetic activation and serum angiotensinogen levels in obese and non-obese normotensive subjects, their relationship, and the effect of a drug that modifies the renin-angiotensin system. METHODS: Serum angiotensinogen, leptin, lipids, glucose, and insulin levels were measured and 24-h electrocardiograph monitoring was carried out in 41 (20 non-obese and 21 obese) volunteers before and after administration of 5 mg enalapril twice/day for 7 days. RESULTS: Obese subjects had higher values than non-obese subjects for % body fat (35.1+/-4.6 vs. 30.5+/-5.2; p=0.005), triglycerides (1.93+/-0.9 vs. 1.25+/-0.7 g/L, p=0.002), insulin (114.8+/-82.5 vs. 45.9+/-22.2 pmol/L), leptin (31.4+/-20.4 vs. 14.1+/-11.2 ng/mL, p=0.002), and LF/HFn index (4.3+/-2.9 vs. 2.2+/-1.3, p<0.005). Enalapril increased angiotensinogen levels only in the non-obese group (4.2+/-3.9 vs. 9.7+/-5.4 ng/mL, p=0.001) and diminished the LF/HFn index (4.3+/-2.9 vs. 3.0+/-1.4, p=0.007) in the group of obese subjects. There was no association between angiotensinogen levels and sympathetic activity. CONCLUSIONS: Higher level of sympathetic activity was found in normotensive obese as compared with non-obese subjects. Enalapril treatment reduced heart sympathetic activity in obese subjects but did not change angiotensinogen levels.

Comparación del HOMA IR con el modelo mínimo para medir sensibilidad a la insulina en el síndrome de ovarios poliquísticos / Comparison of HOMA-IR with minmod for measure insulin sensitivity in policystic ovary syndrome

Introducción. - El síndrome de ovarios poliquísticos (SOP) es la alteración más común en mujeres en edad reproductiva. Estas mujeres presentan resistencia a la insulina independientemente de la obesidad; y la resistencia a la insulina se reconoce como un factor de riesgo para desarrollar diabetes mellitus tipo 2, hipertensión arterial y enfermedad cardiovascular. Propósito. En este estudio evaluamos la correlación entre una sola medición en ayuno para sensibilidad a la insulina (Modelo homeostático) y el Modelo-mínimo en este síndrome. Métodos . Se estudiaron 33 pacientes con diagnóstico de SOP y edad promedio de 22.7 ñ 6.2 años e Indice de Masa Corporal (IMC) 29.1 ñ 5.4 a quienes se les efectuó la prueba de tolerancia iv a la glucosa (modelo-mínimo). Resultados. El 51.5 por ciento (17 pacientes) tuvo sensibilidad a la insulina menor de 1.5 x 10 -4 min. -1 µU -1 mL -1. El grupo con IMC > de 27 (20 mujeres obesas), presentó mayor resistencia a la insulina que aquellas con IMC = de 27 (p= 0.004). La correlación entre sensibilidad a la insulina (Si) del Modelo Mínimo y HOMA IR fue significativa con p = 0.0001 y R RANK = -0.76 para todo el grupo de estudio; R RANK = -0.77 para las pacientes con IMC = 27 (p=0.00006) y R RANK = -0.43 para aquellas con IMC = 27 (p = 0.13). Conclusión. El HOMA IR es una prueba útil para medir la sensibilidad a la insulina en el grupo de las mujeres obesas o con sobrepeso y SOP, pero no en las delgadas.

Mortalidad de la mujer en edad fértil en Costa Rica, 1987-1989 / Mortality among women of childbearing age in Costa Rica, 1987-1989

El objetivo de este estudio descriptivo fue detectar diferencias regionales en la mortalidad de las mujeres de 15 a 44 años de edad, especialmente la debida a causas prevenibles. El área de estudio estuvo conformada por las regiones de salud de Costa Rica. Las muertes de mujeres de 15 a 24, de 25 a 34 y de 35 a 44 años de edad registradas de 1987 a 1989, y obtenidas del Registro Nacional de Defunciones, se agruparon por causas prevenibles y no prevenibles y por regiones. La tasa nacional de mortalidad de las mujeres de 15 44 años fue 6,9 por 10 000 mujeres. Las cifras más elevadas se registraron en la región Huetar Atlántica (10,05) y Brunca (8,29), y la más baja, en la Central de Occidente (4,38). El 44,4 por ciento de la mortalidad fue prevenible, principalmente por medidas de prevención secundaria o por un conjunto de medidas. Las menores proporciones de mortalidad prevenible se encontraron en las regiones Central Norte y Brunca (35,2 por ciento y 36,7 por ciento respectivamente) y la más elevada, en la Central de Occidente (64 por ciento, 7 por ciento). Las muertes no prevenibles en gran parte correspondieron a causas dificilmente evitables y al resto de causas no contempladas en otros rubros de la Clasificación Internacional de Taucher. Las mal definidas representaron 1,2 por ciento del total de muertes del período estudiado. En casi todas las regiones fuera de la meseta central la mortalidad total y prevenible fue más alta, lo que puede deberse a su menor grado de desarrollo socieconómico, infraestructura y acceso a los servicios de salud. También puede influir la mayor subordinación de la mujer en áreas rurales. Esta situación puede cambiar utilizando mejor los recursos disponibles y aumentando la calidad de los servicios. Se recomienda continuar este tipo de estudios, para monitorizar las tendencias de la mortalidad de las mujeres (AU)

Mortalidad de la mujer en edad fértil en Costa Rica, 1987-1989 / Mortality among women of childbearing age in Costa Rica, 1987-1989

El objetivo de este estudio descriptivo fue detectar diferencias regionales en la mortalidad de las mujeres de 15 a 44 años de edad, especialmente la debida a causas prevenibles. El área de estudio estuvo conformada por las regiones de salud de Costa Rica. Las muertes de mujeres de 15 a 24, de 25 a 34 y de 35 a 44 años de edad registradas de 1987 a 1989, y obtenidas del Registro Nacional de Defunciones, se agruparon por causas prevenibles y no prevenibles y por regiones. La tasa nacional de mortalidad de las mujeres de 15 44 años fue 6,9 por 10 000 mujeres. Las cifras más elevadas se registraron en la región Huetar Atlántica (10,05) y Brunca (8,29), y la más baja, en la Central de Occidente (4,38). El 44,4 por ciento de la mortalidad fue prevenible, principalmente por medidas de prevención secundaria o por un conjunto de medidas. Las menores proporciones de mortalidad prevenible se encontraron en las regiones Central Norte y Brunca (35,2 por ciento y 36,7 por ciento respectivamente) y la más elevada, en la Central de Occidente (64 por ciento, 7 por ciento). Las muertes no prevenibles en gran parte correspondieron a causas dificilmente evitables y al resto de causas no contempladas en otros rubros de la Clasificación Internacional de Taucher. Las mal definidas representaron 1,2 por ciento del total de muertes del período estudiado. En casi todas las regiones fuera de la meseta central la mortalidad total y prevenible fue más alta, lo que puede deberse a su menor grado de desarrollo socieconómico, infraestructura y acceso a los servicios de salud. También puede influir la mayor subordinación de la mujer en áreas rurales. Esta situación puede cambiar utilizando mejor los recursos disponibles y aumentando la calidad de los servicios. Se recomienda continuar este tipo de estudios, para monitorizar las tendencias de la mortalidad de las mujeres (AU)