Risk factors associated with sarcopenia in elderly persons in military Hospital Central de la Defensa «Gómez Ulla»

Antecedents and objectives: Sarcopenia is a syndrome characterized by the progressive and generalized decrease in skeletal muscle mass, strength and decreased physical performance. Associated factors are age, diet, sedentary lifestyle and chronic diseases. Very few studies have been conducted on the epidemiology of sarcopenia in hospitalized elderly. The objective of the study was to describe the prevalence of sarcopenia and identify the associated factors among elderly patients hospitalized in Madrid, Spain.Material y Methods:A cross-sectional study was conducted at the Hospital Central de la Defensa “Gómez Ulla” during the period from March to September 2018. 295 patients with ages greater than or equal to 65 participated. Sarcopenia was defined according to the EWGSOP2 criterion measuring muscle mass, muscle strength and functionality.Results:The prevalence of sarcopenia was 28.5% (95% CI 23.3-33.7), without significant differences between men and women. The Body Mass Index, hospital stay, alcohol consumption, smoke, physical activity, frequency of physical activity and strength of muscle mass, muscle strenght and funcionality presented an association with the sarcopenia.Conclusions:The prevalence was higher than other studies. The body mass index was significantly higher in subjects with sarcopenia. A higher proportion of smoking was found in subjects without sarcopenia. Likewise, an association was found between physical exercise and a lower prevalence of sarcopenia. (AU)

Antecedentes y objetivos: La sarcopenia es un síndrome caracterizado por la disminución progresiva y generalizada de la masa muscular esquelética, la fuerza y ​​la disminución del rendimiento físico. Los factores asociados son la edad, la dieta, el sedentarismo y las enfermedades crónicas. Se han realizado muy pocos estudios sobre la epidemiología de la sarcopenia en ancianos hospitalizados. El objetivo del estudio fue describir la prevalencia de sarcopenia e identificar los factores asociados entre pacientes ancianos hospitalizados en Madrid, España.Material y Métodos:Se realizó un estudio transversal en el Hospital Central de la Defensa «Gómez Ulla» durante el periodo de marzo a septiembre de 2018. Participaron 295 pacientes con edades mayores o iguales a 65 años. La sarcopenia se definió según el criterio EWGSOP2 que mide la masa muscular, la fuerza muscular y la funcionalidad.Resultados:La prevalencia de sarcopenia fue del 28,5 % (IC 95 % 23,3-33,7), sin diferencias significativas entre hombres y mujeres. El índice de masa corporal, estancia hospitalaria, consumo de alcohol, tabaquismo, actividad física, frecuencia de actividad física y fuerza de masa muscular, fuerza muscular y funcionalidad presentaron asociación con sarcopenia.Conclusiones:La prevalencia fue superior a otros estudios. El índice de masa corporal fue significativamente mayor en sujetos con sarcopenia. Se encontró una mayor proporción de fumadores en sujetos sin sarcopenia. Asimismo, se encontró asociación entre el ejercicio físico y una menor prevalencia de sarcopenia. (AU)

Comparative study of different SARS-CoV-2 diagnostic techniques.

The rapid spread of SARS-CoV-2 led to the necessity of developing diagnostic tests for rapid virus detection. Many commercial platforms have appeared and have been approved for this purpose. In this study, 95 positive and 5 negative retrospective samples were analyzed by 4 different commercial RT-qPCR kits (TaqMan 2019nCoV Assay, Allplex™SARS-COV-2 Assay, FTD SARS-COV-2 Assay and qCOVID-19). The Hologic Aptima SARS-COV-2 and the Clart-COVID-19 system were also tested. serial dilutions of SARS-COV-2 standard control were included for sensitivity analysis. Among the qPCR tested qCOVID19 and Allplex™SARS-COV-2 Assay were both able to detect all the clinical samples included in the study. All four qPCR evaluated showed high sensitivity for samples with Ct<33. Clart-COVID-19 microarrays detected all samples and controls used in this study whereas Hologic Aptima Panther failed with one of the clinical samples. However, the main problem with this system was the number of invalidated samples despite avoiding the use of medium with guanidine isothiocyanate as recommended by the manufacturer. All the techniques tested were of value for SARS-CoV-2 detection.

Compliance with preventive measures against malaria of personnel treated in the centre of international vaccination of the Minister of Defence (Spain).

OBJECTIVE: This study evaluated the compliance with preventive measures against malaria of the personnel treated in the Spanish Defence International Vaccination Centre (CVI). METHODS: A retrospective study was conducted from November to December 2017. The population was 534 individuals. All were treated in CVI, prior to their deployment on endemic areas of malaria, with prevention measures type C and D. A questionnaire of 23 items was elaborated. RESULTS: The percentage of response to the questionnaire was 36.9% (n=194), 100% were male. Air conditioner was the most used protection measure 93.8% (IC 95% 90.4-97.2). Only 35.5% (95% CI: 28.8-42.2) of them, showed good adherence to medication. The factors that influenced in the adherence were the country and the length of deployment. It was not established a direct relationship between the occurrence of adverse reactions and low adherence to treatment. CONCLUSIONS: The general protection measures against malaria were met in a high percentage, whilst the use of chemoprophylaxis was very low. These epidemiological data allowed us to know the validity of the health education that is provided in the traveller's care consultation. It also allowed being aware of the possibilities of infection and import of malaria by personnel of the Spanish Armed Forces. The traveller's office will reinforce the importance of taking the adequate chemo-prophylaxis trough conferences and informative diptychs..

On the use of ultrasonic dental scaler tips as cleaning technique of microfiltration ceramic membranes.

The use of ultrasonic dental scaler (UDS) tips has been investigated for cleaning ceramic membranes fouled when filtering cactus juice. Thin and long tips having a larger coverage exhibited the best performance for removing the cake layer deposited on the membrane surface. Such tips cleaned an area equivalent to almost one third of total area of the membrane surface. However, the cleaned area could be increased notoriously if the membrane were placed in rotatory disc holder. The resistance-in series model and atomic force microscopy (AFM) technique helped to reveal the effect of the UDS tips as cleaning process of ceramic membranes. The reversible resistances estimated for UDS tips were 58% and 17% lower than the ones obtained by chemical cleaning at transmembrane pressures of 0.3 bar and 0.5 bar, respectively. This was corroborated by microscope images, which showed the detachment of cake layer of the membrane surface. Results of this work showed that UDS tips are an innovative option as cleaning strategy for filtration membranes.

[Proinflammatory state in obese children]. / Estado proinflamatorio en niños obesos.

INTRODUCTION: Obesity is a chronic disease that affects adults as well as children and is associated with insulin resistance, type 2 diabetes and cardiovascular disease. One of the reasons for the presence of low-grade inflammation in these patients could be that adipose tissue of the obese produces proin flammatory molecules that favor the development of atherosclerosis. OBJECTIVE: To determine serum levels of soluble CD40 ligand (sCD40L), monocyte chemoattractant protein 1 (MCP-1), interleukin 6 (IL-6), Tumor Necrosis Factor alpha (TNF-α) and high sensitivity CRP (hsCRP), in an obese chil dren population compared to a control group, also to analyze the correlation of these molecules with the anthropometric and metabolic variables. PATIENTS AND METHOD: A cross-sectional, observational study was carried out on 37 obese children, aged 8 to 12 years, and 20 children with normal weight. Serum levels of sCD40L, MCP-1, IL-6, TNF-α and hsCRP were determined. Data were expressed as the median and interquartil range and Spearman coefficient was used to investigate correlations between variables. RESULTS: Compared to the control group, obese children presented significantly higher values of sCD40L, MCP-1, IL-6, TNF-α, and hsCRP than control group. Body mass index and waist circumference correlated positively with sCD40L and MCP-1. CONCLUSION: Elevated levels of the studied molecules studied suggest the presence of low-grade inflammation associated with obesity in this population.

Estado proinflamatorio en niños obesos / Proinflammatory state in obese children

INTRODUCCIÓN: La presencia de un estado de inflamación de bajo grado en niños obesos, se debería, entre otros factores, a que el tejido adiposo de los obesos produce moléculas proinflamatorias que contribuyen al desarrollo de aterosclerosis. OBJETIVO: Determinar en una población de niños obesos los niveles séricos de ligando CD-40 soluble (sCD40L), proteína quimioatractante de monocitos 1 (MCP-1), interleuquina 6 (IL-6), Factor de Necrosis tumoral a (TNF-a) y Proteína C Reactiva ultrasensible (PCR-us), comparados con un grupo control y analizar la correlación de estas moléculas con las variables antropométricas y metabólicas. PACIENTES Y MÉTODO: Estudio transversal de 37 niños obesos de 8 a 12 años y 20 niños con peso normal. A todos los pacientes se les realizó una historia clínica consignando edad, peso, talla, IMC, circunferencia de cintura, estadios de Tanner y antecedentes familiares. Se determinaron los niveles séricos de sCD40L, MCP-1, IL-6, TNF-a y PCR-us mediante ELISA, PCR-us por quimioluminiscencia, glucemia, insulina plasmática, perfil lipídico y se calculó el índice HOMA. Los datos se expresaron como la mediana y rango intercuartil y se utilizó el coeficiente de Spearman para investigar las correlaciones entre variables. RESULTADOS: Los niños obesos presentaron valores significativamente mayores de sCD40L, MCP-1, IL-6, TNF-a, PCR-us que los niños controles. El índice de masa corporal y la circunferencia de cintura se correlacionaron positivamente con sCD40L y MCP-1. CONCLUSIÓN: Los niveles elevados de las moléculas estudiadas sugieren la presencia de inflamación de bajo grado asociada a obesidad en esta población.

INTRODUCTION: Obesity is a chronic disease that affects adults as well as children and is associated with insulin resistance, type 2 diabetes and cardiovascular disease. One of the reasons for the presence of low-grade inflammation in these patients could be that adipose tissue of the obese produces proin flammatory molecules that favor the development of atherosclerosis. OBJECTIVE: To determine serum levels of soluble CD40 ligand (sCD40L), monocyte chemoattractant protein 1 (MCP-1), interleukin 6 (IL-6), Tumor Necrosis Factor alpha (TNF-Α) and high sensitivity CRP (hsCRP), in an obese chil dren population compared to a control group, also to analyze the correlation of these molecules with the anthropometric and metabolic variables. PATIENTS AND METHOD: A cross-sectional, observational study was carried out on 37 obese children, aged 8 to 12 years, and 20 children with normal weight. Serum levels of sCD40L, MCP-1, IL-6, TNF-Α and hsCRP were determined. Data were expressed as the median and interquartil range and Spearman coefficient was used to investigate correlations between variables. RESULTS: Compared to the control group, obese children presented significantly higher values of sCD40L, MCP-1, IL-6, TNF-Α, and hsCRP than control group. Body mass index and waist circumference correlated positively with sCD40L and MCP-1. CONCLUSION: Elevated levels of the studied molecules studied suggest the presence of low-grade inflammation associated with obesity in this population.

Factores de riesgo cardiovascular en niños con diabetes tipo 1 y su relación con el control de la glucemia / Cardiovascular risk factors in children with type 1 diabetes and their relationship with the glycemic control

Diabetics have an increased risk of cardiovascular disease (CVD). The objective of this work was to evaluate the cardiovascular risk factors in infant-juvenile type 1 diabetics and their association with the degree of glycemic control. A total of 52 patients, aged 5-15 years, were studied and compared with 37 control subjects. The degree of glycemic control, lipid profile, plasma fibrinogen, microalbuminuria and blood pressure were investigated. The patients were grouped in diabetics with good glycemic control [DGGC, glycosilated hemoglobin (HbA1c) < 8%] and poor glycemic control [DPGC, HA1c > or = 8%]. Diabetic patients presented incremented values of total cholesterol (4.1 +/- 0.9 vs. 3.1 +/- 0.7 mmol/l, p = 0.0008), LDL-cholesterol (2.4 +/- 0.9 vs. 1.7 +/- 0.7 mmol/l, p = 0.0001), HDL-cholesterol (1.2 +/- 0.3 vs. 1.0 +/- 0.2 mmol/l, p = 0.0002), with respect to control group. Eighty three per cent of diabetics showed a poor glycemic control. There were not significant differences in lipid profile between DGGC and DPGC, excepting HDL-cholesterol which was higher in DPGC group (p = 0.007). Plasma fibrinogen levels were similar in diabetics and controls, but they were higher in DPGC than in DGGC (265 +/- 46 vs. 229 +/- 22 mg/dl, p = 0.02). Three patients with microalbuminuria and none with hypertension were detected. In these patients the most pronounced risk factors for CVD were dyslipidemia and hyperglycemia, which justify the need for the early detection of these factors as well as strict metabolic control.

Factores de riesgo cardiovascular en niños con diabetes tipo 1 y su relación con el control de la glucemia / Cardiovascular risk factors in children with type 1 diabetes and their relationship with the glycemic control

Diabetics have an increased risk of cardiovascular disease (CVD). The objective of this work was to evaluate the cardiovascular risk factors in infant-juvenile type 1 diabetics and their association with the degree of glycemic control. A total of 52 patients, aged 5-15 years, were studied and compared with 37 control subjects. The degree of glycemic control, lipid profile, plasma fibrinogen, microalbuminuria and blood pressure were investigated. The patients were grouped in diabetics with good glycemic control [DGGC, glycosilated hemoglobin (HbA1c) < 8%] and poor glycemic control [DPGC, HA1c > or = 8%]. Diabetic patients presented incremented values of total cholesterol (4.1 +/- 0.9 vs. 3.1 +/- 0.7 mmol/l, p = 0.0008), LDL-cholesterol (2.4 +/- 0.9 vs. 1.7 +/- 0.7 mmol/l, p = 0.0001), HDL-cholesterol (1.2 +/- 0.3 vs. 1.0 +/- 0.2 mmol/l, p = 0.0002), with respect to control group. Eighty three per cent of diabetics showed a poor glycemic control. There were not significant differences in lipid profile between DGGC and DPGC, excepting HDL-cholesterol which was higher in DPGC group (p = 0.007). Plasma fibrinogen levels were similar in diabetics and controls, but they were higher in DPGC than in DGGC (265 +/- 46 vs. 229 +/- 22 mg/dl, p = 0.02). Three patients with microalbuminuria and none with hypertension were detected. In these patients the most pronounced risk factors for CVD were dyslipidemia and hyperglycemia, which justify the need for the early detection of these factors as well as strict metabolic control.(AU)

[Prevalence of fibrocystic disease of breast in patients with endometriosis]. / Prevalencia de mastopatía fibroquística en pacientes con endometriosis.

The prevalence of fibrocystic breast disease in patients with endometriosis, was determined. This was a prospective cross-sectional study. The 43 women were diagnosed as having endometriosis by laparoscopy. In these patients, during their control period, a deliberate search for clinical and ultrasonography data on fibrocystic breast disease was carried out. The average age was 28 years, ranging between 18 and 36 years. From 43 the patients with endometriosis, 37% of them were diagnosed with fibrocystic breast disease. The group of age more frequent was between 30 and 34 years in 37.5%, and 31% between 20 and 24 years of age. 43% of the patients with both diseases had antecedent of pregnancy and 25% had menstrual alterations. The prevalence of fibrocystic breast disease in patients with endometriosis was 37%, thus observing a strong evidence of association between both pathologies.

Vagus nerve afferent and efferent innervation of the rat uterus: an electrophysiological and HRP study.

To determine a possible brainstem connection with the uterus, a study with electrophysiological techniques and horseradish peroxidase (HRP) tracing was performed in the rat. Neurons of the nucleus of the tractus solitarius decreased in discharge frequency during cervicovaginal distension. HRP injections into the uterine walls resulted in the appearance of labelled cells in the nodose ganglion and in the dorsal motor nucleus of the vagus nerve. The results demonstrate a direct bidirectional vagal complex-uterus connection via the vagus nerve. Results are discussed in terms of a complex uterus control system in which the paraventricular nucleus might play an integrative role.

[Chronic subdural hematoma and transient neurologic deficits]. / Hématomes sous-duraux chroniques et déficits neurologiques transitoires.

Three cases of chronic subdural hematoma (CSDH) revealed by transient neurological accidents are reported. Although well-known this condition is rare: 1 to 9 p. 100 of CSDHs. Questioning may bring out a history of cranial injury and headache, even minor ones, which are unusual in transient ischemic accidents (TIA). Transient phenomena, such as motor aphasia or speech interruption, point to the diagnosis, especially in male patients over 60 years of age. The finding at electroencephalography of a delta activity more than 48 hours after a TND should exclude the diagnosis of TIA until a CT scan is performed. Since the causes of neurological deficits regressing within less than 24 hours may be ischemia as well a hemorrhage or tumour, the term of transient neurological accident (TNA) should preferably be used, and an emergency CT scan should be performed for diagnostic and therapeutic purposes. Owing to the possibility of another concomitant cause of TNA, the finding of a subdural haematoma should not deter from pursuing cardiovascular examinations. The mechanism of TNA probably involves a vascular factor, as suggested by I-123 IMP cerebral SPECT which shows an intercritical decrease in cerebral blood flow and/or an epileptic factor.

[Diagnostic value of exercise tomoscintigraphy with thallium 201 in patients with complete left branch block]. / Valeur diagnostique de la tomoscintigraphie d'effort au thallium 201 chez les patients porteurs d'un bloc de branche gauche complet.

Eighteen patients with rate-dependent (n = 5) or chronic (n = 13) left bundle branch block underwent thallium 201 exercise SPECT and selective coronary arteriography. 15 patients showed significant septal or anteroseptal perfusion defects on the exercise scintigrams, but in only 4 of them did the coronary disease involve the left anterior descending artery (LAD) (n = 3) or the left main coronary artery (n = 1). Among patients with normal scintigrams, one had right coronary artery stenosis. Test performance in detecting individual coronary artery stenosis greater than 70 p. 100 was: sensitivity 80 p. 100 (4/5) and specificity 15 p. 100. In patients with left bundle branch block, T1 201 SPECT was indeterminate for LAD disease due to reversible septal perfusion defect. We conclude that the usefulness of stress thallium 201 SPECT in patients with left bundle branch block is very limited.

[Development of left intraventricular thrombi. Monitoring by two-dimensional echocardiography and scintigraphy with indium 111-labelled platelets]. / Evolution des thrombi intraventriculaires gauches. Surveillance par échocardiographie bidimensionnelle et scintigraphie aux plaquettes marquées à l'indium 111.

Two-dimensional echocardiography and indium 111-labelled platelet scintigraphy have proved helpful in the diagnosis of left intraventricular thrombosis. In this study, both methods were used to investigate the time-related changes undergone by such thrombi in 30 patients (26 with myocardial infarction, 4 with dilated cardiomyopathy) who presented with left intraventricular thrombosis diagnosed by echocardiography and systematically explored by indium scintigraphy. These 30 patients were divided into 2 groups depending on whether the initial scintigraphy was positive (group I, 19 patients) or negative (group II, 11 patients). The follow-up (mean 21.6 months) was clinical and paraclinical, with control echocardiography repeated at 1.5 and 8.5 months in both groups and control scintigraphy at 1.5 month in group I patients. At the 1.5 month echocardiography, the intraventricular thrombosis persisted in 14/16 examinations in group I patients and in only 2/10 examinations in group II patients (p less than 0.01). At the 1.5 month scintigraphy, performed in 16/19 group I patients, this examination had become negative in 8 cases, whereas the 2D-echocardiography remained positive. During the follow-up period 4 patients in group I had an embolic accident, as against none of the group II patients (p less than 0.01); 3 of these 4 patients had persistent uptake at control scintigraphy. At echocardiography, only a protrusion image seemed to be predictive, as it was present in 3 of 4 patients with embolic accident.(ABSTRACT TRUNCATED AT 250 WORDS)

Indium-111 platelet scintigraphy in carotid disease.

Forty-five patients (35 men, 10 women) undergoing carotid surgery had Indium-111 platelet scintigraphy as part of their preoperative work-up. Imaging was performed within three hours after injection of the Indium-111. A second series of views was obtained 24 hours later and repeated at 24 hour intervals for two days. Of 54 scintigrams, 22 were positive and 32 negative. Positive results were defined as a twofold or more increase in local activity on a visualized carotid after 24 hours. The sensitivity of the method was 41%, intraoperatively, and the specificity, 100%. The low sensitivity places this method behind sonography and duplex-scanning for screening patients for surgery. We believe that indications for platelet scintigraphy are limited to: 1. Repeated transient ischemic attacks in the same territory with minimal lesions on arteriography and non-homogeneous plaque on duplex scan; 2. Symptomatic patients being treated medically as a possible argument for surgery; 3. Determining therapeutic policy for patients having experienced a transient ischemic attack with a coexisting intracardiac thrombus.

[Prevalence of thinness and excessive fatness in a group of school children of the city of Cordoba, Argentina]. / Prevalencia de delgadez y gordura excesiva en un grupo de escolares de la ciudad de Cordoba, Argentina.

Findings of a nutritional evaluation study, using triceps skinfold, are reported. The study was carried out in 1,615 school-children from 5 to 12 years, pertaining to the low socioeconomic status of the city of Córdoba, Argentina. Measurements were done during the years 1983 and 1984 by Center's examiners with a Lange caliper, according to international anthropometric methodology. Interintra observer technical error was found to be within tolerance limits reported by other authors. Local standards were used to determine the prevalence of thinness and excessive fatness, by comparing them to tricep skinfold of each child, and selecting those children where this parameter presented values less than or equal to 10th percentile and fatness greater than or equal to 90th percentile. Furthermore, comparison between median triceps skinfold of the examined group, the local standards and Frisancho's norms for US population was also made. Results revealed that: a) the prevalence of thinness (19.9%) was almost twice the percentage expected for a normal population; in contrast, occurrence of excessive fatness (6.4%) was found to be below the expected value; b) prevalence of thinness was not statistically associated to age nor sex; c) frequency of excessive fatness was significantly higher in the 8-11 year-old male group (8, 9%, p much less than 0.0005) and in the girls group (10.8%), P much less than 0.005) the prevalence of fatness in girls increased with age, and figures revealed that from eight years onwards this exceeded the expected percentage, and d) median triceps skinfold of the group under study was generally below local and foreign norms. It is concluded that potential or real nutrition problems as those mentioned above, may be grossly identified using the triceps skinfold as the single anthropometric indicator.

Prevalencia de obesidad en un grupo de escolares de bajo nivel socioeconómico / Prevalence of obesity in a group of school children of a low socioeconomic level

Con el objeto de poner de relieve el valor de la semiología antropométrica en la identificación de niños obesos y en riesgo de obesidad, se presentan los resultados de un estudio efectuado en 804 escolares de 4 a 12 años de bajo nivel socioeconómico de la ciudad de Córdoba. Como criterio diagnóstico básico de obesidad se adopta > del 120% del Peso para la Talla. Además para valores comprendidos entre el 110 y el 120% del Peso para la Talla se utilizan el Pliegue de Tríceps y/o Area Grasa como indicadores complementarios a fin de diferenciar entre niños potencial y realmente obesos. Los resultados muestran que: 1) Las situaciones de riesgo son más frecuentes (8,5%) que las de obesidad propiamente dicha (6,3%) y dentro de esta última los mayores porcentajes de prevalencia corresponden a los estadios leves; 2) Existe un claro predominio del sexo femenino sobre el total de obesos; 3) La gran mayoría de los niños obesos y en riesgo de obesidad tienen talla normal, lo cual hace presumir que en el grupo estudiado la etiología exógena es la más frecuente. Finalmente, se enfatiza la necesidad de incluir la valoración antropométrica de esta forma de malnutrición entre las actividades de salud escolar a los fines de una adecuada incorporación de los niños obesos y en riesgo a los programas de asistencia alimentaria y de educación física y nutricional

Prevalencia de obesidad en un grupo de escolares de bajo nivel socioeconómico / Prevalence of obesity in a group of school children of a low socioeconomic level

Con el objeto de poner de relieve el valor de la semiología antropométrica en la identificación de niños obesos y en riesgo de obesidad, se presentan los resultados de un estudio efectuado en 804 escolares de 4 a 12 años de bajo nivel socioeconómico de la ciudad de Córdoba. Como criterio diagnóstico básico de obesidad se adopta > del 120% del Peso para la Talla. Además para valores comprendidos entre el 110 y el 120% del Peso para la Talla se utilizan el Pliegue de Tríceps y/o Area Grasa como indicadores complementarios a fin de diferenciar entre niños potencial y realmente obesos. Los resultados muestran que: 1) Las situaciones de riesgo son más frecuentes (8,5%) que las de obesidad propiamente dicha (6,3%) y dentro de esta última los mayores porcentajes de prevalencia corresponden a los estadios leves; 2) Existe un claro predominio del sexo femenino sobre el total de obesos; 3) La gran mayoría de los niños obesos y en riesgo de obesidad tienen talla normal, lo cual hace presumir que en el grupo estudiado la etiología exógena es la más frecuente. Finalmente, se enfatiza la necesidad de incluir la valoración antropométrica de esta forma de malnutrición entre las actividades de salud escolar a los fines de una adecuada incorporación de los niños obesos y en riesgo a los programas de asistencia alimentaria y de educación física y nutricional (AU)