Secondary Malnutrition and Nutritional Intervention in Cholestatic Liver Diseases in Infants.

We aimed to conduct an updated review on the pathophysiology, diagnosis, and nutritional intervention of CCLD and secondary malnutrition in infants. Protein-energy malnutrition, impaired linear growth, fat-soluble vitamin deficiencies, and hepatic osteodystrophy can occur in up to 80% of cases. The proposed pathophysiological mechanisms include insufficient energy intake, lipid- and fat-soluble vitamin malabsorption, increased energy expenditure, altered intermediate metabolism, hormonal dysregulation, and systemic inflammation. The current approach to diagnosis is the identification of the deviation of growth parameters, body composition, and serum concentration of micronutrients, which determines the type and magnitude of malnutrition. Currently, liver transplantation is the best therapeutic alternative for the reversal of nutritional impairment. Early and effective portoenteroanatomosis can extend survival in patients with biliary atresia. Medical and dietary interventions in some storage and metabolic diseases can improve liver damage and thus the nutritional status. A proportion of patients with biliary atresia have fat-soluble vitamin deficiencies despite receiving these vitamins in a water-soluble form. With aggressive enteral nutrition, it may be possible to increase fat stores and preserve muscle mass and growth. The nutritional issues identified in the pre- and post-transplantation stages include muscle mass loss, bone demineralization, growth retardation, and obesity, which seems to correspond to the natural history of CCLD. Due to the implications for the growth and development of infants with CCLD with this complex malnutrition syndrome, innovative projects are required, such as the generation of prediction and risk models, biomarkers of growth and body composition, and effective strategies for nutritional prevention and intervention.

[Stunting, overweight and obesity during the nutrition transition in schoolchildren of Arandas, Jalisco, Mexico]. / Desmedro, sobrepeso y obesidad durante la transición nutricia en escolares de Arandas, Jalisco, México.

BACKGROUND: Nutrition transition provokes changes in the nutritional status of individuals subjected to the interaction of various environmental factors; therefore, the aim was to demonstrate that nutrition transition is associated with socioeconomic changes, eating habits and physical activity, potentially involved in stunting, overweight and obesity of schoolchildren. METHODS: Case-control study. 102 participants from the Instituto Alteño para el Desarrollo de Jalisco (cases) and 194 from the elementary school system (controls), aged 5 to 12 years, were included. Dependent variables were these indexes weight/age (Z), height/age (Z), BMI (Z). Independent variables were the socioeconomic and demographic characteristics. Student's t test, chi square, odds ratio (OR) and 95% confidence intervals (95% CI) were estimated. RESULTS: Family income was low (p = 0.031) and unstable job was higher in cases: OR = 4.1, 95% CI = 2.8-6.0. The frequency of stunting was higher in cases (9.9% vs. 5.9%). The combination of overweight/obesity was higher in controls (27.3% vs. 16.8%), OR = 1.85, 95% CI = 1.0-3.4. CONCLUSIONS: The nutritional status of children of Arandas, Jalisco, has been modified by an accelerate nutrition transition, provoked by socioeconomic, educational and demographic factors that might have influence on the persistence of stunting and an increasing prevalence of overweight/obesity.

INTRODUCCIÓN: la transición nutricia (TN) propicia cambios en el estado de nutrición de los individuos sometidos a la interacción de diversos factores ambientales; por tanto, el objetivo fue demostrar que la TN se asocia a cambios socioeconómicos, en los hábitos de alimentación y en la actividad física, potencialmente implicados en el desmedro, el sobrepeso y la obesidad en escolares. MÉTODOS: estudio de casos (n = 102) del Instituto Alteño para el Desarrollo de Jalisco y controles (n = 194) de escuelas públicas del municipio, de cinco a doce años de edad. Las variables dependientes fueron los índices peso/edad (Z), talla/edad (Z), IMC/E (Z). Las variables independientes fueron las características socioeconómicas y demográficas. Se utilizaron las pruebas t de Student, chi cuadrada y razón de momios (RM) con intervalos de confianza al 95% (IC 95%). RESULTADOS: el ingreso familiar mensual fue menor (p = 0.031) y el trabajo eventual fue más común en los casos, RM = 4.1, IC 95% = 2.8-6.0. La frecuencia de desmedro fue mayor en los casos (9.9% frente a 5.9%). La combinación de sobrepeso/obesidad fue mayor en los controles (27.3% frente a 16.8%), RM = 1.85, IC 95% = 1.0-3.4. CONCLUSIÓN: el estado nutricio de los niños de Arandas parece estar modificándose por una transición nutricia acelerada por cambios socioeconómicos, demográficos y educacionales que influyen en la persistencia de desmedro y en una creciente prevalencia de sobrepeso y obesidad.

[Factors associated with physical activity and body mass index among schoolchildren from Arandas, Jalisco, Mexico]. / Factores asociados a la actividad física y el índice de masa corporal en escolares de Arandas, Jalisco, México.

BACKGROUND: In 2015, Mexico was the top country for childhood obesity. The objective was to identify the association between physical activity and sedentary lifestyle with the social and demographic characteristics of families of schoolchildren in Arandas, Jalisco, Mexico. METHODS: In a cross-sectional study, 192 schoolchildren were randomly selected. Body mass index (BMI), active and sedentary behaviors, and socio-demographic characteristics of families were obtained. Logistic regression models with the included variables were constructed. RESULTS: Males living in not-crowding houses [OR 6.12 (2.17-17.25), p = 0.001], whose mothers were housewives [OR 2.44 (1.00, 5.94), p = 0.05], practiced more physical activity. Active transport to school was more common in schoolchildren whose fathers had lower income [OR 3.13 (1.27, 7.7), p = 0.013] and employment as peasant or mason [OR 5.12 (1.13, 23.3), p = 0.034]. Schoolchildren of nuclear families spent more hours watching television [OR 2.69 (1.10, 6.58), p = 0.03]. The frequency of outdoor playing was higher in males whose fathers had unstable employment [OR 2.93 (1.06, 8.1), p = 0.038] and low education [OR 2.94 (0.96, 8.98), p = 0.059]. CONCLUSION: Families with lower socioeconomic strata (less educated parents, unstable employment and family overcrowding) are more associated with active activities that do not require active economic spending.

Introducción: en 2015, México ocupaba el primer lugar mundial en obesidad infantil. El objetivo fue identificar la asociación entre conductas activas y sedentarias con características sociodemográficas de la familia en escolares de Arandas, Jalisco, México. Métodos: en estudio transversal se seleccionaron aleatoriamente 192 escolares. Se obtuvieron el índice de masa corporal (IMC), las conductas activas y sedentarias, y las características sociodemográficas de las familias. Se construyeron modelos de regresión logística con las variables incluidas. Resultados: los varones en condiciones de no hacinamiento (razón de momios [RM] 6.12, intervalo de confianza al 95% [IC 95%] 2.17-17.25, p = 0.001) cuyas madres se dedicaban al hogar (RM 2.44, IC 95% 1.00-5.94, p = 0.05) refirieron que practicaban actividad física con más frecuencia. El transporte activo hacia la escuela fue más común en hijos de padres con menor ingreso económico (RM 3.13, IC 95% 1.27-7.7, p = 0.013) y con empleo de albañil o campesino (RM 5.12, IC 95% 1.13-23.3, p = 0.034). Los escolares provenientes de familias nucleares pasaron más horas frente al televisor (RM 2.69, IC 95% 1.10-6.58, p = 0.03). La frecuencia de juegos en la calle fue significativamente mayor en varones cuyos papás tuvieron un empleo inestable (RM 2.93, IC 95% 1.06-8.1, p = 0.038) y baja escolaridad (RM 2.94, IC 95 % 0.96-8.98, p = 0.059). Conclusión: las familias con estrato socioeconómico más bajo se asociaron con mayor frecuencia a actividades activas que no requieren un gasto económico.