Fortified food supplementation in children with reduced dietary energy and micronutrients intake in Southern Mexico.

BACKGROUND: Nutritional supplements are an important source of complementary food for young children, since they may either complement or substitute nutrients obtained from other food sources. Assessing how the introduction of different types of supplements modifies the consumption of other food sources may help in designing supplementation programs that aim to improve the nutrition of vulnerable populations. The objetive is to quantify dietary energy and nutrient intake among children aged 6-12 months who received one of three nutritional supplements. METHODS: A cluster-randomized trial was conducted from 2005 to 2007. Urban communities were randomly allocated to one of three intervention groups receiving one of the following: a milk-based fortified food, micronutrient powders, or syrup. Each supplement was fortified with equal amounts of micronutrients. Dietary intake was estimated using a food frequency questionnaire (FFQ) to reflect the average consumption over the month prior to the interview. Children between 6 and 12 months of age were recruited. Median regression was performed with adjusted standard errors for clustered data, and the linear predictors for the median included the study group, study stage and their interaction. Adjusted medians by study group and study stage were obtained as post-estimations. RESULTS: No statistically significant differences between study groups were observed at baseline. After four months of supplementation, the children in the fortified food group had a smaller increase in median dietary energy (183.7 kcal, CI95%: 59.9, 307.5) and dietary protein (6.6 g, CI95%: 2.6, 10.6) intake from their home diet than those in the syrup group (p < 0.05). These differences remained significant after adjusting for group differences at baseline. Regarding covariate-adjusted median changes from baseline to follow-up at 10 months, the children in the fortified food group had a smaller median increase in dietary energy intake than those in the syrup group (698 vs 915 kcal), with a difference of 217.9 kcal (CI95%: 20.4, 415.4). CONCLUSION: Children in the fortified food group consumed less dietary energy, protein, and micronutrients than those in the micronutrient powder and syrup groups. It is possible that absolute nutrient intake may be overestimated by the FFQ, but this possibility does not compromise the ability to compare study groups. Given the observed differences in dietary energy consumption among the three supplemented groups, it can be concluded that supplementation with micronutrient powders is an adequate option for urban children who have met their minimum energy and protein requirements.

[Barriers and facilitators for physical activity during pregnancy and postpartum in women living in poverty of Mexico]. / Barreras y facilitadores para actividad física durante el embarazo y posparto en mujeres pobres de México.

OBJECTIVE: To explore perceptions of healthcare providers and beneficiaries of Oportunidades program on physical activity during pregnancy and post-partum; and identify current reported practices related to counseling on physical activity in the primary healthcare services in Mexico. MATERIALS AND METHODS: A mixed methods approach was used which is part of a nutrition intervention of the Oportunidades program. Qualitative information was collected through interviews (50=women; 34=providers) and quantitative information was collected by questionnaires (n=88 women; n=64 provider; n=111 observations during consultation). RESULTS: The main barriers were: a) individual (lack of time and social support to childcare); b) sociocultural (gender bias derived from peer groups or family and lack of instructors), and c) environmental (lack of safe and adequate physical places). Only 38% of beneficiary women reported having been counseled on physical activity vs 63.4% of providers who reported having counseled on physical activity (p=0.002). CONCLUSION: There is a need to train healthcare providers and to promote physical activity during pregnancy and post-partum for reducing associated biases.

Barreras y facilitadores para actividad física durante el embarazo y posparto en mujeres pobres de México / Barriers and facilitators for physical activity during pregnancy and postpartum in women living in poverty of Mexico

Objetivo. Explorar percepciones de proveedores de salud y beneficiarías del Programa Oportunidades sobre la práctica de actividad física durante el embarazo y posparto, e identificar características de la consejería sobre el tema en el primer nivel de atención en salud. Material y métodos. Estudio de métodos mixtos que forma parte de una intervención en nutrición del Programa Oportunidades. La información cualitativa se colectó por entrevista (50 mujeres; 34 proveedores de salud) y se obtuvo información cuantitativa a partir de un cuestionario (n=88 mujeres; n=64 proveedores; n=111 observaciones de consulta). Resultados. Se documentaron barreras a) individuales: falta de tiempo y de apoyo social; b) socioculturales: prejuicios de pares y familiares, y falta de instructores, y c) ambientales: falta de espacios físicos seguros y apropiados. 38% de las mujeres reporta haber recibido consejería sobre el tema versus 63.4% de proveedores que reportan haberla dado (p=0.002). Conclusiones. Urgen capacitación a proveedores y promoción de la actividad física que eliminen los prejuicios asociados al tema durante el embarazo y posparto.

Objective.To explore perceptions of healthcare providers and beneficiaries of Oportunidades program on physical activity during pregnancy and post-partum; and identify current reported practices related to counseling on physical activity in the primary healthcare services in Mexico. Materials and methods. A mixed methods approach was used which is part of a nutrition intervention of the Oportunidades program. Qualitative information was collected through interviews (50=women; 34=providers) and quantitative information was collected by questionnaires (n=88 women; n=64 provider; n=111 observations during consultation). Results. The main barriers were: a) individual (lack of time and social support to childcare); b) sociocultural (gender bias derived from peer groups or family and lack of instructors), and c) environmental (lack of safe and adequate physical places). Only 38% of beneficiary women reported having been counseled on physical activity vs 63.4% of providers who reported having counseled on physical activity (p=0.002). Conclusion. There is a need to train healthcare providers and to promote physical activity during pregnancy and post-partum for reducing associated biases.

Prenatal determinants of cord blood total immunoglobulin E levels in Mexican newborns.

Asthma and allergic diseases have increased worldwide; however, etilogic factors for this increase are still poor. Prenatal consumptions of fatty acids are hypothesized, although few clinical trials in developing countries have been performed. This study was designed to identify predictors of immunoglobulin E (IgE) levels in cord blood of Mexican newborns. Total IgE was measured in umbilical cord blood from 613 infants whose mothers participated in a double-blind randomized controlled trial of 400 mg of docosahexaenoic acid or placebo from 18 to 22 weeks gestation through delivery. During pregnancy, information on sociodemographic characteristics, environmental exposures, and perceived maternal stress were obtained; a maternal blood sample was also collected to determine atopy via specific IgE levels. Logistic regression models were used to identify the main prenatal predictors of detectable total IgE levels in cord blood. IgE was detectable in cord blood from 344 (53.7%) infants; the main predictors in multivariate analyses were maternal atopy (odds ratio [OR] = 1.69; 95% CI, 1.19-2.42; p < 0.05) and pesticide use in the home (OR = 1.49; 95% CI, 1.04-2.14; p < 0.05). When stratified by maternal atopy, season of birth was a significant predictor in the atopic group only (OR = 2.48; 95% CI, 1.00-6.16; p < 0.05), and pesticide use was a significant predictor for infants born to nonatopic mothers (OR = 1.64; 95% CI, 1.07-2.51; p < 0.05). No differences were seen in the proportion of infants with detectable IgE by treatment group. Prenatal supplementation with omega-3 polyunsaturated fatty acid did not alter the detectable cord blood IgE levels. Maternal atopy and pesticide use during pregnancy are strong predictors of cord blood IgE levels in newborns. Clinical trial NCT00646360, www.clinicaltrials.gov.

Compliance to micronutrient supplementation in children 3 to 24 months of age from a semi-rural community in Mexico

OBJECTIVE: To identify associated factors to compliance for multiple micronutrient (MM) or iron and vitamin A (IVITA) supplementation, in children (3 to 24 months old). MATERIALS AND METHODS: A database (n=465 children) from a randomized, controlled, clinical trial, carried out in a semi-rural setting in Mexico, was analyzed. The compliance rate of MM and IVITA supplements was calculated. Adequate compliance rate (AC>80%), and its association with children and households characteristics, was determined. RESULTS: The compliance mean was high (MM:78.2%, IVITA:80.1%; p<0.05). The odds of AC were 59% greater in the children of IVITA than with MM group, although the estimate was only marginally significant (p=0.052). Maternal education (p<0.001), child birth weight (p=0.003), and children with cough (p<0.001) or fever (p=0.024) were significantly associated with AC and significantly marginal was maternal indigenous (p=0.071). CONCLUSION: The high AC was consistent with others efficacy studies. More research is needed to document physiological, cultural, social and operative factors affecting compliance with supplementation.

OBJETIVO: Identificar factores asociados con el cumplimiento del consumo de suplementos con micronutrimentos múltiples (MM) o con hierro y vitamina A (FEVITA) en niños (<24 meses de edad). MATERIAL Y MÉTODOS: Información de un ensayo clínico aleatorizado, doble ciego en una localidad semirrural en México. Se calculó el porcentaje de cumplimiento (n=465 niños), cumplimiento adecuado (CA: >80%) y su asociación con varias características. RESULTADOS: El cumplimiento fue alto (MM: 78.2%, FEVITA: 80.1%; p<0.05). Los momios de CA fueron 59% mayores en niños del grupo FEVITA que en MM (p=0.052). Escolaridad materna (p<0.001), peso al nacer del niño (p=0.003), porcentaje de tiempo con tos (p<0.001) y con fiebre (p=0.024) y marginalmente, la condición indígena materna (p=0.071) se asociaron con el CA. CONCLUSIONES: La alta tasa de cumplimiento fue consistente con otros estudios. Es necesaria mayor investigación sobre factores fisiológicos, culturales, sociales y operativos relacionados con el cumplimiento del consumo de suplementos.

Compliance to micronutrient supplementation in children 3 to 24 months of age from a semi-rural community in Mexico.

OBJECTIVE: To identify associated factors to compliance for multiple micronutrient (MM) or iron and vitamin A (IVITA) supplementation, in children (3 to 24 months old). MATERIALS AND METHODS: A database (n=465 children) from a randomized, controlled, clinical trial, carried out in a semi-rural setting in Mexico, was analyzed. The compliance rate of MM and IVITA supplements was calculated. Adequate compliance rate (AC>80%), and its association with children and households characteristics, was determined. RESULTS: The compliance mean was high (MM:78.2%, IVITA:80.1%; p<0.05). The odds of AC were 59% greater in the children of IVITA than with MM group, although the estimate was only marginally significant (p=0.052). Maternal education (p<0.001), child birth weight (p=0.003), and children with cough (p<0.001) or fever (p=0.024) were significantly associated with AC and significantly marginal was maternal indigenous (p=0.071). CONCLUSION: The high AC was consistent with others efficacy studies. More research is needed to document physiological, cultural, social and operative factors affecting compliance with supplementation.

Effect of prenatal multiple micronutrient supplements on maternal weight and skinfold changes: a randomized double-blind clinical trial in Mexico.

BACKGROUND: Recent trials of prenatal multivitamin-mineral supplements have yielded mixed findings for outcomes such as birth size, but the benefits of prenatal multivitamin-mineral supplements for maternal outcomes are unknown. OBJECTIVE: The main objective of this study was to examine the effect of prenatal multiple micronutrient supplements (MM) compared to iron only (FE) supplements on changes in maternal weight and body composition during pregnancy and the early postpartum period. METHODS: A randomized double-blind clinical trial was conducted in semi-rural Mexico. Women received either MM or FE supplements, 6 days per week from early pregnancy to delivery. Anthropometric measurements were obtained at recruitment, 26 and 37 weeks pregnancy, and 1 month postpartum. Women in both groups were similar at recruitment except that body-mass index (BMI) was greater in the FE group. RESULTS: Mean weight gain during pregnancy was significantly greater (-0.6 kg) in the MM group (n = 283) compared to the FE group (n = 287), but not after adjusting for maternal BMI at recruitment. Overweight women in the MM group gained 0.53 kg between recruitment and 1 month postpartum, whereas those in the FE group lost 0.63 kg; there were no differences between experimental groups among non-overweight women (p =.06 for interaction). CONCLUSIONS: Compared to iron supplements, MM supplements did not increase weight gain during pregnancy after adjusting for baseline differences in BMI but may lead to greater postpartum weight retention among overweight women.