Newborns from Mothers Who Intensely Consumed Sucralose during Pregnancy Are Heavier and Exhibit Markers of Metabolic Alteration and Low-Grade Systemic Inflammation: A Cross-Sectional, Prospective Study.

Robust data in animals show that sucralose intake during gestation can predispose the offspring to weight gain, metabolic disturbances, and low-grade systemic inflammation; however, concluding information remains elusive in humans. In this cross-sectional, prospective study, we examined the birth weight, glucose and insulin cord blood levels, monocyte subsets, and inflammatory cytokine profile in 292 neonates at term from mothers with light sucralose ingestion (LSI) of less than 60 mg sucralose/week or heavy sucralose intake (HSI) of more than 36 mg sucralose/day during pregnancy. Mothers in the LSI (n = 205) or HSI (n = 87) groups showed no differences in age, pregestational body mass index, blood pressure, and glucose tolerance. Although there were no differences in glucose, infants from HSI mothers displayed significant increases in birth weight and insulin compared to newborns from LSI mothers. Newborns from HSI mothers showed a substantial increase in the percentage of inflammatory nonclassical monocytes compared to neonates from LSI mothers. Umbilical cord tissue of infants from HSI mothers exhibited higher IL-1 beta and TNF-alpha with lower IL-10 expression than that found in newborns from LSI mothers. Present results demonstrate that heavy sucralose ingestion during pregnancy affects neonates' anthropometric, metabolic, and inflammatory features.

Ten-Week Sucralose Consumption Induces Gut Dysbiosis and Altered Glucose and Insulin Levels in Healthy Young Adults.

Sucralose consumption alters microbiome and carbohydrate metabolism in mouse models. However, there are no conclusive studies in humans. Our goals were to examine the effect of sucralose consumption on the intestinal abundance of bacterial species belonging to Actinobacteria, Bacteroidetes, and Firmicutes and explore potential associations between microbiome profiles and glucose and insulin blood levels in healthy young adults. In this open-label clinical trial, volunteers randomly drank water, as a control (n = 20), or 48 mg sucralose (n = 20), every day for ten weeks. At the beginning and the end of the study, participants were subjected to an oral glucose tolerance test (OGTT) to measure serum glucose and insulin every 15 min for 3 h and provided fecal samples to assess gut microbiota using a quantitative polymerase chain reaction. Sucralose intake altered the abundance of Firmicutes without affecting Actinobacteria or Bacteroidetes. Two-way ANOVA revealed that volunteers drinking sucralose for ten weeks showed a 3-fold increase in Blautia coccoides and a 0.66-fold decrease in Lactobacillus acidophilus compared to the controls. Sucralose consumption increased serum insulin and the area under the glucose curve compared to water. Long-term sucralose ingestion induces gut dysbiosis associated with altered insulin and glucose levels during an OGTT.

Chronic sucralose consumption induces elevation of serum insulin in young healthy adults: a randomized, double blind, controlled trial.

BACKGROUND: Non-nutritive sweeteners (NNS) are widely consumed by humans due to their apparent innocuity, especially sucralose. However, several studies link sucralose consumption to weight gain and metabolic derangements, although data are still contradictory. OBJECTIVE: To determine the effect of acute and chronic consumption of sucralose on insulin and glucose profiles in young healthy adults. MATERIAL AND METHODS: This was a randomized, parallel, double-blind, placebo-controlled trial conducted in healthy young adults from 18 to 35 years old, without insulin resistance. A hundred thirty seven participants were randomized into three groups: a) volunteers receiving 48 mg sucralose, b) volunteers receiving 96 mg sucralose, and c) controls receiving water as placebo. All participants underwent a 3-h oral glucose tolerance test (OGTT) preceded by consuming sucralose or placebo 15 min before glucose load, at two time points: week zero (Wk0) and week ten (Wk10). Serum insulin and glucose were measured every 15 min during both OGTTs. RESULTS: Compared to Wk0, consumption of sucralose for 10 weeks provoked 1) increased insulin concentrations at 0 min (7.5 ± 3.4 vs 8.8 ± 4.1 µIU/mL; p = 0.01), 30 min (91.3 ± 56.2 vs 110.1 ± 49.4 µIU/mL; p = 0.05), 105 min (47.7 ± 24.4 vs 64.3 ± 48.2 µIU/mL; p = 0.04) and 120 min (44.8 ± 22.1 vs 63.1 ± 47.8 µIU/mL; p = 0.01) in the 48 mg sucralose group; 2) increased blood glucose at - 15 min (87.9 ± 4.6 vs 91.4 ± 5.4 mg/dL; p = 0.003), 0 min (88.7 ± 4 vs 91.3 ± 6 mg/dL; p = 0.04) and 120 min (95.2 ± 23.7 vs 106.9 ± 19.5 mg/dL; p = 0.009) in the 48 mg sucralose group; 3) increased area under the curve (AUC) of insulin in both 48 and 96 mg sucralose groups (9262 vs 11,398; p = 0.02 and 6962 vs 8394; p = 0.12, respectively); and 4) reduced Matsuda index in the 48 mg sucralose group (6.04 ± 3.19 vs 4.86 ± 2.13; p = 0.01). CONCLUSIONS: These data show that chronic consumption of sucralose can affect insulin and glucose responses in non-insulin resistant healthy young adults with normal body mass index (between 18.5 and 24.9 kg/m2), however, the effects are not consistent with dose; further research is required. CLINICAL TRIAL REGISTRY: NCT03703141.

Fluoxetine for adults who are overweight or obese.

BACKGROUND: Fluoxetine is a serotonin reuptake inhibitor indicated for major depression. It is also thought to affect weight control: this seems to happen through appetite changes resulting in decreased food intake and normalisation of unusual eating behaviours. However, the benefit-risk ratio of this off-label medication is unclear. OBJECTIVES: To assess the effects of fluoxetine for overweight or obese adults. SEARCH METHODS: We searched the Cochrane Library, MEDLINE, Embase, LILACS, the ICTRP Search Portal and ClinicalTrials.gov and World Health Organization (WHO) ICTRP Search Portal. The last date of the search was December 2018 for all databases, to which we applied no language restrictions . SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing the administration of fluoxetine versus placebo, other anti-obesity agents, non-pharmacological therapy or no treatment in overweight or obese adults without depression, mental illness or abnormal eating patterns. DATA COLLECTION AND ANALYSIS: Two review authors independently screened abstracts and titles for relevance. Screening for inclusion, data extraction and risk of bias assessment was performed by one author and checked by the second. We assessed trials for the overall certainty of the evidence using the GRADE instrument. For additional information we contacted trial authors by email. We performed random-effects meta-analyses and calculated the risk ratio (RR) with 95% confidence intervals (95% CI) for dichotomous outcomes and the mean difference (MD) with 95% CI for continuous outcomes. MAIN RESULTS: We identified 1036 records, scrutinized 52 full-text articles and included 19 completed RCTs (one trial is awaiting assessment). A total of 2216 participants entered the trials, 1280 participants were randomly assigned to fluoxetine (60 mg/d, 40 mg/d, 20 mg/d and 10 mg/d) and 936 participants were randomly assigned to various comparison groups (placebo; the anti-obesity agents diethylpropion, fenproporex, mazindol, sibutramine, metformin, fenfluramine, dexfenfluramine, fluvoxamine, 5-hydroxy-tryptophan; no treatment; and omega-3 gel). Within the 19 RCTs there were 56 trial arms. Fifteen trials were parallel RCTs and four were cross-over RCTs. The participants in the included trials were followed up for periods between three weeks and one year. The certainty of the evidence was low or very low: the majority of trials had a high risk of bias in one or more of the risk of bias domains.For our main comparison group - fluoxetine versus placebo - and across all fluoxetine dosages and durations of treatment, the MD was -2.7 kg (95% CI -4 to -1.4; P < 0.001; 10 trials, 956 participants; low-certainty evidence). The 95% prediction interval ranged between -7.1 kg and 1.7 kg. The MD in body mass index (BMI) reduction across all fluoxetine dosages compared with placebo was -1.1 kg/m² (95% CI -3.7 to 1.4; 3 trials, 97 participants; very low certainty evidence). Only nine placebo-controlled trials reported adverse events. A total of 399 out of 627 participants (63.6%) receiving fluoxetine compared with 352 out of 626 participants (56.2%) receiving placebo experienced an adverse event. Random-effects meta-analysis showed an increase in the risk of having at least one adverse event of any type in the fluoxetine groups compared with placebo (RR 1.18, 95% CI 0.99 to 1.42; P = 0.07; 9 trials, 1253 participants; low-certainty evidence). The 95% prediction interval ranged between 0.74 and 1.88. Following fluoxetine treatment the adverse events of dizziness, drowsiness, fatigue, insomnia and nausea were observed approximately twice as often compared to placebo. A total of 15 out of 197 participants (7.6%) receiving fluoxetine compared with 12 out of 196 participants (6.1%) receiving placebo experienced depression. The RR across all fluoxetine doses compared with placebo was 1.20 (95% CI 0.57 to 2.52; P = 0.62; 3 trials, 393 participants; very low certainty evidence). All-cause mortality, health-related quality of life and socioeconomic effects were not reported.The comparisons of fluoxetine with other anti-obesity agents (3 trials, 234 participants), omega-3 gel (1 trial, 48 participants) and no treatment (1 trial, 60 participants) showed inconclusive results (very low certainty evidence). AUTHORS' CONCLUSIONS: Low-certainty evidence suggests that off-label fluoxetine may decrease weight compared with placebo. However, low-certainty evidence suggests an increase in the risk for dizziness, drowsiness, fatigue, insomnia and nausea following fluoxetine treatment.

Six Month Polypill Therapy Improves Lipid Profile in Patients with Previous Acute Myocardial Infarction: The Heart-Mex Study.

BACKGROUND: Acute myocardial infarction (AMI) is a leading cause of death in Mexico. Atherogenic lipid profile is a key component in AMI. Thus, it is imperative to find drug therapies able to reduce atherogenic lipids in AMI patients and prevent subsequent myocardial infarctions. AIM OF THE STUDY: To investigate the effect of polypill (Sincronium®) alone or combined with beta blockers (BB) and/or thiazide diuretics (TD) on total cholesterol, triglycerides, low-density lipoproteins (LDL), high-density lipoproteins (HDL), and cardiovascular risk markers in a Mexican population with AMI. METHODS: Secondary AMI-prevention patients (n = 256) were included in the study and categorized into three groups depending on the drug scheme, as follows: polypill (n = 150), polypill+BB (n = 91), and polypill + BB + TD (n = 15). Lipid profile and cardiovascular risk markers were evaluated in each patient before and 6 months after drug therapy. RESULTS: The Wilcoxon-matched pairs signed rank test showed significant ∼25-30% reductions in total cholesterol, triglycerides, and LDL in the polypill group as compared to polypill + BB and polypill + BB + TD groups. On the contrary, HDL was significantly increased in polypill and polypill + BB groups. Polypill therapy showed more marked reductions in blood pressure, atherogenic index, Framingham risk score, and vascular age with respect to polypill + BB and polypill + BB + TD groups. CONCLUSION: This study demonstrates for the first time that polypill therapy without being combined with BB and TD is effective to improve the atherogenic lipid profile and cardiovascular risk markers in AMI patients. Further studies are needed to examine the efficacy of polypill in reducing the occurrence of a second AMI in the Mexican population.

A Single 48 mg Sucralose Sip Unbalances Monocyte Subpopulations and Stimulates Insulin Secretion in Healthy Young Adults.

Sucralose is a noncaloric artificial sweetener that is widely consumed worldwide and has been associated with alteration in glucose and insulin homeostasis. Unbalance in monocyte subpopulations expressing CD11c and CD206 hallmarks metabolic dysfunction but has not yet been studied in response to sucralose. Our goal was to examine the effect of a single sucralose sip on serum insulin and blood glucose and the percentages of classical, intermediate, and nonclassical monocytes in healthy young adults subjected to an oral glucose tolerance test (OGTT). This study was a randomized, placebo-controlled clinical trial. Volunteers randomly received 60 mL water as placebo (n = 20) or 48 mg sucralose dissolved in 60 mL water (n = 25), fifteen minutes prior to an OGTT. Blood samples were individually drawn every 15 minutes for 180 minutes for quantifying glucose and insulin concentrations. Monocyte subsets expressing CD11c and CD206 were measured at -15 and 180 minutes by flow cytometry. As compared to controls, volunteers receiving sucralose exhibited significant increases in serum insulin at 30, 45, and 180 minutes, whereas blood glucose values showed no significant differences. Sucralose consumption caused a significant 7% increase in classical monocytes and 63% decrease in nonclassical monocytes with respect to placebo controls. Pearson's correlation models revealed a strong association of insulin with sucralose-induced monocyte subpopulation unbalance whereas glucose values did not show significant correlations. Sucralose ingestion decreased CD11c expression in all monocyte subsets and reduced CD206 expression in nonclassical monocytes suggesting that sucralose does not only unbalance monocyte subpopulations but also alter their expression pattern of cell surface molecules. This work demonstrates for the first time that a 48 mg sucralose sip increases serum insulin and unbalances monocyte subpopulations expressing CD11c and CD206 in noninsulin-resistant healthy young adults subjected to an OGTT. The apparently innocuous consumption of sucralose should be reexamined in light of these results.

Review of complementary feeding practices in Mexican children / Revisión de las prácticas de alimentación complementaria en niños mexicanos

Background: The early introduction of food is consistent with a significant increase in the prevalence of overweight and obesity, particularly in children, partly because of the resulting changes in feeding patterns. The purpose of this study was to describe the complementary feeding practices of Mexican children younger than two years of age. Methods: Medline, Lilacs and manual methods were used to search for studies that assessed feeding practices in children younger than two years of age in Mexico. The following terms were used: complementary feeding, supplementary feeding, Mexico and weaning. Data on complementary feeding practices, including the age of nitiation, the type of foods eaten, the frequency of food intake and the reasons for starting complementary feeding, were collected. The information gathered was subjected to qualitative analysis, and the data are presented as proportions in the tables. Results: The seven studies included in this evaluation revealed that children were introduced to complementary feeding before the age of 6 months. Although fruits were the foods most commonly provided when complementary feeding began, processed juices, soft drinks and fried snacks were also offered. The intake of these products increased as the children grew older and coincided with a low intake of foods containing high-biological value protein, particularly red meats. Conclusions: The results of the included studies showed that during complementary feeding, infants receive high-energy density foods, whereas the intake of foods that provide animal protein and iron in particular is low. In addition, common conditions associated with complementary feeding include overweight, obesity, malnutrition, and anemia, which may contribute to health problems (AU)

Antecedentes: El inicio de la alimentación complementaria temprana coincide con un aumento significativo en la prevalencia de sobrepeso y obesidad especialmente en los niños, lo cual se debe entre otras causas a los cambios en los patrones de alimentación que se han experimentado. El objetivo del estudio fue describir las prácticas de alimentación complementaria en niños mexicanos. Métodos: Se realizó una búsqueda de los estudios que evaluaron las prácticas alimentarias en menores de 2 años en México en Medline, Lilacs y de forma manual con los siguientes términos: alimentación complementaria, alimentación suplementaria, México, ablactación y destete. Se recabó la edad de inicio de la alimentación complementaria, tipo de alimento consumido, frecuencia de consumo de los alimentos y motivo por el que iniciaban la alimentación complementaria. Se realizó un análisis cualitativo de la información recolectada y los datos en las gráficas son mostrados como proporciones. Resultados: Se incluyeron 7 estudios que mostraron que los niños inician la alimentación complementaria antes de los 6 meses predominantemente con frutas, aunque también consumieron jugos industrializados, refrescos y frituras. El consumo de estos productos aumenta con el crecimiento de los niños, aunado a un bajo consumo de alimentos con proteína de alto valor biológico, especialmente las carnes rojas. Conclusiones: Los resultados de los estudios incluidos mostraron que los menores reciben alimentos con alta densidad energética, mientras que es bajo el consumo de aquellos que aportan proteína animal y hierro en particular, lo que puede contribuir a problemas de salud como sobrepeso, obesidad, desnutrición y anemia (AU)

Bone mineral density after bariatric surgery. A systematic review.

PURPOSE: Bone regulation system may be affected after bariatric surgeries, but procedures impact differently to bone mineral density (BMD) and measures restraining bone loss are frequently neglected until clinical consequences become manifest. This is a systematic review aimed to elucidate whether BMD loss is comparable after different bariatric surgeries. MATERIALS AND METHODS: A search of morbid obese adults, undergone to bariatric surgery, with BMD measured by dual-energy X-ray absorptiometry at baseline and after surgery studies was performed in several databases. Studies were assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement and COCHRANE Risk of Bias tool. The random model was selected for meta-analysis; heterogeneity was analyzed with T(2), inconsistency (I(2) > 50%) and Chi(2) (p < 0.10). Level of evidence and strength of recommendations were summarized using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE System). RESULTS: Twelve studies met the selection criteria. After one year, reduction in total BMD in patients with mixed surgical procedures was significant: -0.03 g/cm(2) (CI 95% 0.00 to -0.06, p < 0.05). BMD was reduced by -0.12 g/cm(2) (CI 95% -0.10 to -0.15, p < 0.001) in the hip, -0.07 g/cm(2) (CI 95% -0.03 to -0.11, p < 0.001) in the column, and -0.03 g/cm(2) (IC 95% -0.02 to -0.04, p < 0.001) in the forearm, but not in restrictive surgeries. Studies included showed high heterogeneity and low quality of evidence. CONCLUSIONS: Patients undergone to mixed bariatric surgery had significant higher BMD deterioration as demonstrated in this review, suggesting that more attention for preventing fractures is required.

Obesity prevalence in Mexico: impact on health and economic burden.

OBJECTIVE: Along with other countries having high and low-to-middle income, Mexico has experienced a substantial change in obesity rates. This rapid growth in obesity prevalence has led to high rates of obesity-related diseases and associated health-care costs. DESIGN: Micro-simulation is used to project future BMI trends. Additionally thirteen BMI-related diseases and health-care costs are estimated. The results are simulated for three hypothetical scenarios: no BMI reduction and BMI reductions of 1 % and 5 % across the population. SETTING: Mexican Health and Nutrition Surveys 1999 and 2000, and Mexican National Health and Nutrition Survey 2006. SUBJECTS: Mexican adults. RESULTS: In 2010, 32 % of men and 26 % of women were normal weight. By 2050, the proportion of normal weight will decrease to 12 % and 9 % for males and females respectively, and more people will be obese than overweight. It is projected that by 2050 there will be 12 million cumulative incidence cases of diabetes and 8 million cumulative incidence cases of heart disease alone. For the thirteen diseases considered, costs of $US 806 million are estimated for 2010, projected to increase to $US 1·2 billion and $US 1·7 billion in 2030 and 2050 respectively. A 1 % reduction in BMI prevalence could save $US 43 million in health-care costs in 2030 and $US 85 million in 2050. CONCLUSIONS: Obesity rates are leading to a large health and economic burden. The projected numbers are high and Mexico should implement strong action to tackle obesity. Results presented here will be very helpful in planning and implementing policy interventions.

Review of complementary feeding practices in Mexican children.

BACKGROUND: The early introduction of food is consistent with a significant increase in the prevalence of overweight and obesity, particularly in children, partly because of the resulting changes in feeding patterns. The purpose of this study was to describe the complementary feeding practices of Mexican children younger than two years of age. METHODS: Medline, Lilacs and manual methods were used to search for studies that assessed feeding practices in children younger than two years of age in Mexico. The following terms were used: complementary feeding, supplementary feeding, Mexico and weaning. Data on complementary feeding practices, including the age of initiation, the type of foods eaten, the frequency of food intake and the reasons for starting complementary feeding, were collected. The information gathered was subjected to qualitative analysis, and the data are presented as proportions in the tables. RESULTS: The seven studies included in this evaluation revealed that children were introduced to complementary feeding before the age of 6 months. Although fruits were the foods most commonly provided when complementary feeding began, processed juices, soft drinks and fried snacks were also offered. The intake of these products increased as the children grew older and coincided with a low intake of foods containing high-biological value protein, particularly red meats. CONCLUSIONS: The results of the included studies showed that during complementary feeding, infants receive high-energy density foods, whereas the intake of foods that provide animal protein and iron in particular is low. In addition, common conditions associated with complementary feeding include overweight, obesity, malnutrition, and anemia, which may contribute to health problems.

Antecedentes: El inicio de la alimentación complementaria temprana coincide con un aumento significativo en la prevalencia de sobrepeso y obesidad especialmente en los niños, lo cual se debe entre otras causas a los cambios en los patrones de alimentación que se han experimentado. El objetivo del estudio fue describir las prácticas de alimentación complementaria en niños mexicanos. Métodos: Se realizó una búsqueda de los estudios que evaluaron las prácticas alimentarias en menores de 2 años en México en Medline, Lilacs y de forma manual con los siguientes términos: alimentación complementaria, alimentación suplementaria, México, ablactación y destete. Se recabó la edad de inicio de la alimentación complementaria, tipo de alimento consumido, frecuencia de consumo de los alimentos y motivo por el que iniciaban la alimentación complementaria. Se realizó un análisis cualitativo de la información recolectada y los datos en las gráficas son mostrados como proporciones. Resultados: Se incluyeron 7 estudios que mostraron que los niños inician la alimentación complementaria antes de los 6 meses predominantemente con frutas, aunque también consumieron jugos industrializados, refrescos y frituras. El consumo de estos productos aumenta con el crecimiento de los niños, aunado a un bajo consumo de alimentos con proteína de alto valor biológico, especialmente las carnes rojas. Conclusiones: Los resultados de los estudios incluidos mostraron que los menores reciben alimentos con alta densidad energética, mientras que es bajo el consumo de aquellos que aportan proteína animal y hierro en particular, lo que puede contribuir a problemas de salud como sobrepeso, obesidad, desnutrición y anemia.

Association between Apolipoprotein E Variants and Obesity-Related Traits in Mexican School Children.

BACKGROUND/AIM: Genetic variation in apolipoprotein E (ApoE) has a key role in lipid metabolism. However, its contribution to the amount and distribution of body fat is under investigation. The aim of this study was to analyze the association between genetic variation in ApoE and obesity-related traits in Mexican school children. MATERIAL AND METHODS: Anthropometric, body composition and physical activity measures were conducted using standard methods in 300 children (177 girls/123 boys) who fulfilled the inclusion criteria. DNA was isolated from saliva. ApoE genotypes were analyzed by allelic discrimination. The association between variation in ApoE and anthropometric and body composition measures was investigated using the General Linear Model. RESULTS: The mean±SD values for age, body mass index (BMI) and waist circumference (WC) were 9.05±0.80 years, 19.01±3.83 and 67.98±10.97 cm, respectively. Approximately 46% of the participants were overweight or obese. A significant association between ApoE isoforms and WC was found after controlling for age, sex and the percentage of physical activity (p=0.025). Significant main effects were found for vigorous physical activity and light physical activity influencing the adiposity-related BMI (p<0.001) and WC (p=0.044), respectively. CONCLUSIONS: Variation in ApoE and physical activity intensity were associated with adiposity-related phenotypes in Mexican school children.

Integrating genomic analysis with the genetic basis of gene expression: preliminary evidence of the identification of causal genes for cardiovascular and metabolic traits related to nutrition in Mexicans.

Whole-transcriptome expression profiling provides novel phenotypes for analysis of complex traits. Gene expression measurements reflect quantitative variation in transcript-specific messenger RNA levels and represent phenotypes lying close to the action of genes. Understanding the genetic basis of gene expression will provide insight into the processes that connect genotype to clinically significant traits representing a central tenet of system biology. Synchronous in vivo expression profiles of lymphocytes, muscle, and subcutaneous fat were obtained from healthy Mexican men. Most genes were expressed at detectable levels in multiple tissues, and RNA levels were correlated between tissue types. A subset of transcripts with high reliability of expression across tissues (estimated by intraclass correlation coefficients) was enriched for cis-regulated genes, suggesting that proximal sequence variants may influence expression similarly in different cellular environments. This integrative global gene expression profiling approach is proving extremely useful for identifying genes and pathways that contribute to complex clinical traits. Clearly, the coincidence of clinical trait quantitative trait loci and expression quantitative trait loci can help in the prioritization of positional candidate genes. Such data will be crucial for the formal integration of positional and transcriptomic information characterized as genetical genomics.

Dietary and physical activity/inactivity factors associated with obesity in school-aged children.

Diet and physical activity (PA) are essential components of nutritional status. Adequate nutrition and an active lifestyle are key factors during childhood, because food habits track into adulthood. Children spend more time in school than in any other environment away from home. Studying the diet factors and patterns of PA that affect obesity risk in children during school hours and the complete school day can help identify opportunities to lower this risk. We directly measured the time children spent performing moderate to vigorous PA (MVPA) at school, compared the amount and intensity of PA during school hours with after-school hours, and tried to determine if diet behaviors and PA or inactivity were associated with excess weight and body fat. This cross-sectional study included 143 normal-weight (NLW) and 48 obese children aged 8-10 y. Diet data were obtained from two 24-h recalls. Body composition was measured by bioimpedance. Screen time and sports participation data were self-reported. NLW children drank/ate more dairy servings than the obese children, who consumed more fruit-flavored water than the NLW group. Consumption of soft drinks, sugar-added juices, and fresh juices was low in both groups. Children were less active during school hours than after school. MVPA was lower during school hours in the obese group than in the NLW group. Schools, parents, and authorities should be more involved in promoting strategies to improve the dietary habits and PA levels of school-aged children, because this group is not achieving the recommended level of daily MVPA.

Economic Evaluation of Bariatric Surgery in Mexico Using Discrete Event Simulation.

OBJECTIVES: Morbid obesity represents high costs to health institutions in controlling associated comorbidities. It has been shown that bariatric surgery resolves or improves comorbidities, thus reducing resource utilization. This analysis estimated the total costs of treating morbid obesity and related comorbidities through conventional treatment compared to bariatric surgery under the Mexican public health system perspective. METHODS: An economic evaluation model was developed by using discrete event simulation. One hundred fifty patients were created in each arm, with considered comorbidities allocated randomly. Preoperative comorbidity prevalences and bariatric surgery's efficacy for resolving them were obtained from published literature. Comorbidity treatment costs were obtained from the 2007 Mexican Institute of Social Security diagnosis-related group list and publications from the National Institute of Public Health. Only 12 patients were operated each month on the surgical arm. Complications associated with comorbidities were not considered. The considered time frame for simulation was 10 years, with a 4.5% annual discount rate. RESULTS: Return on investment, or cost breakeven point, for bariatric surgery was obtained after 6.8 years. Total costs for the surgical group were 52% less than conventional treatment group costs after 10 years. Bariatric surgery reduced the cost of treating type 2 diabetes, hypertension, and hypercholesterolemia by 59%, 53%, and 65%, respectively. Return on investment for bariatric surgery in patients with type 2 diabetes as the only comorbidity was 4.4 years. CONCLUSIONS: Despite conservative assumptions, investment in bariatric surgery is recouped in 6.8 years, generating relevant potential savings in the treatment of morbidly obese patients. In high-risk subpopulations, return on investment time is shorter.