Impact of integrated preventive and curative health package on nutritional status of children under 2 years of age in the health area of Tama, Tahoua region (Niger).

Background: Niger, relevant in light of current political coup, is one of the countries with the worst human development indicators, characterized by high fertility rates and extremely high infant mortality rates. Food insecurity in the region is alarming, leading to high malnutrition rates in children. This study aimed to evaluate an integral preventive-curative health program targeting children aged under 2 years in the health area of Tama, district of Bouza, Tahoua. Methodology: Anthropometric follow-up data of 6,962 children aged under 2 years were included in this study. These children received complete vaccination and malaria chemoprevention, and those older than 6 months received nutritional supplementation with a small quantity of lipid-based nutrient supplements. Fundamental growth indicators (height-for-age, weight-for-height, weight-for-age, and middle-upper arm circumference) and the Composite Index of Anthropometric Failure were calculated at the beginning and end of the program (mean time spent in the program: 14.5 ± 6.6 months) The evolution of these indicators was compared with those of a sample from a vertical vaccination program conducted in the neighboring region of Madarounfa on similar dates. Results: The proportion of children without anthropometric failure decreased from 59.5 to 40.2% (p < 0.001), with the categories that included stunting increasing the most. When analyzing the anthropometric indicators according to the months of compliance with the program, there was a slight improvement in the indicators of acute malnutrition, whereas those of chronic malnutrition worsened significantly. However, when compared with the Madarounfa sample, the children in the present study registered a significantly lower worsening in all three indicators: height-age (-0.46 vs. -2.44; p < 0.001), weight-height (+0.31 vs. -0.55; p < 0.001) and weight-age (-0.03 vs. -1.63; p < 0.001) difference. Conclusion: The comprehensive preventive-curative health program slightly slows the worsening of cumulative malnutrition in the early years of life in complex contexts, such as southern Niger.

Differences in wasting assessment through Middle-Upper Arm Circumference (MUAC) adjusted by sex, age and geographic origin for children aged 6-59 months: New reference based on anthropometric surveys from 22 low-and-middle-income countries.

OBJECTIVES: The Middle Upper Arm Circumference (MUAC) bracelet is a widely used instrument in public health assessments and humanitarian assistance projects. The WHO guidelines present a universal cut-off point of 115 mm to determine whether a child has severe acute malnutrition. The objective of this study is to analyze the existing differences in the MUAC for boys and girls aged between 6 and 59 months, from 22 countries distributed in three different continents, in contrast to the use of this single cut-off point. In addition, the creation of MUAC growth charts is presented for reference use. MATERIALS AND METHODS: This study was carried out with a database developed by Action Against Hunger, composed, after the data pre-processing phase, of 97 921 individuals without anthropometric failure from African, Asian, and American continents. MUAC measurements were compared between countries, dividing by sex and age groups. A k-means method was used to create country clusters to allow comparisons and the variability was resumed using a Principal Component Analysis. For each cluster, growth curves were created and smoothed using the LOESS method. RESULTS: Our research has revealed the existence of differences in the MUAC between countries in both, males and females, although with different trends. The evidence was confirmed with the creation of two clusters using the k-means method, which, when graphically represented by the Principal Component Analysis, showed that the MUAC was clearly different. There were also differences between males and females within each cluster, where growth curves did not overlap in any age group. CONCLUSIONS: All statistical analysis indicate that there are differences in the MUAC values for children without anthropometric failure between countries, but also between sexes. With this research, a new reference is proposed that consider the existing variability between human populations to improve the precision in the determination of severe acute malnutrition in children.

Public Health Implications of Wasting and Stunting Relationship in Children under Five Years Highly Vulnerable to Undernutrition in Guatemala: The REDAC Study.

(1) Background: Guatemala is the Latin American country with the highest prevalence of childhood stunting. Short height can bias the diagnosis of wasting when using the weight-for-height indicator. The aim of this study was to evaluate the diagnostic concordance of the anthropometric indicators of wasting and the relationship between wasting and stunting in children from highly vulnerable communities in Guatemala. (2) Methods: The sample consisted of 13,031 anthropometric records of children under five years of age (49.5% girls, average age of 27.9 months), including weight, height, and mid-upper arm circumference (MUAC), collected in March-August 2019. The proportions of stunting, underweight, and wasting, assessed by three different indicators, as well as their concurrence through the Composite Index of Anthropometric Failure were calculated. (3) Results: Stunting affected 73% of the sample, and 74.2% showed anthropometric failure. Wasting varied by indicator (weight-for-height: 2.8%; MUAC: 4.4%; MUAC-for-age: 10.6%). Concordance between MUAC and weight-for-height was very low (Kappa: 0.310; sensitivity: 40.9%). MUAC identified more wasted children in the stunted group (53.6% vs. 26.5%), while the opposite occurred in the non-stunted group (34.8% vs. 46.7%). (4) Conclusion: The presence of stunting affected the diagnosis of wasting, and both indicators should be included as diagnostic criteria for screening campaigns and in the treatment of moderate to acute wasting in vulnerable populations affected by multiple forms of undernutrition.

Variation of the cormic index since the onset of summer school camps in Spain (1887) up to present days.

OBJECTIVES: To assess a secular change in proportion between lower limbs and torso, we analyzed the evolution of cormic index in schoolchildren attending summer camps organized by the Spanish National Pedagogic Museum between 1887 and 1924, also comparing to later studies up to the present. SUBJECTS AND METHODS: Unpublished primary data for height and sitting height were collected from 805 individuals of both sexes. Data were pooled in cohorts according to age and year of measurement. Additionally, the analysis included comparison with published data from both national and international populations. RESULTS: Among males, a noteworthy decrease of the cormic index is perceived from the first to the last camps, while in females this is only seen for the group under 11 years old. With data from published Spanish references (1900-2019) a decrease is observed for the male series but is not evident for females. Cormic index values from the camps overlap among the international references, despite the former being from much earlier years. CONCLUSION: The cormic index decreased among Spanish male children along the decades.

Hand grip strength in boys and girls from summer school camps in Spain, 1900-1925. A comparison with 21st century data.

OBJECTIVES: The Spanish National Pedagogic Museum (Museo Pedagógico Nacional, MPN), founded by La Institución Libre de Enseñanza, organized the first summer school camps in Spain and their initiative was followed by other institutions in this country. MPN prepared anthropological forms for those sojourns, which included information about both metric and physiological measurements of the schoolchildren. The aim of the current work is to analyze hand grip strength data and to compare them with recent values. METHODS: The initial sample included 2418 schoolchildren from 6 to 16 years old (1467 males, 951 females) attending the camps, but after preliminary analyses, the study was restricted to 1073 boys and 818 girls in the 1900-1925 interval. Three time periods were established and 13 categories of height at camp entry, every 5 cm. Normality tests were run as well as contrasts of means, and both average values and percentiles were calculated for hand grip strength in both hands, as a function of age and height categories. RESULTS: The 1900-1925 interval was chosen since there were no significant differences among hand grip data within that period. Results show that children attending the camps had dynamometry values in both hands well below the current ones, both with reference to their height and to their age. CONCLUSIONS: Camp attendees displayed very low values of height and hand grip strength in both hands. Both are significantly lower than contemporary values, manifesting a secular effect.

Historical recollection of anthropometric data from schoolchildren attending summer camps from 1887 to 1934 in Spain: Interpretations and comparison with coetaneous and modern references.

OBJECTIVES: Around the aim of gaining knowledge on the secular trends in nutritional status of the Spanish population, we found a collection of historical records compiled by La Institución Libre de Enseñanza and their alumni association along 47 years. These data had been collected from boys and girls attending summer camps, with a policy of improving health of children with unfavorable socioeconomic conditions. The objective is to extract all possible information about growth changes, and eventually any interpretation related to status of the originating families. MATERIALS AND METHODS: Primary data were collected from both unpublished manuscripts containing the original records and publications of the organizing institutions. They had been gathered from 86 summer camps in Spain from 1887 to 1934. In these camps, detailed anthropometric data were collected from every attendee, including body height and weight. The sample population amounts to 1,791 boys and 1,281 girls, between 7 and 16 years of age. RESULTS: Body height and weight, pooled by camp year, age and sex, displayed variable secular increases. A similar observation appears for the body mass index (BMI). As a complement, a comparison was done to contemporary published references from both Spanish and international studies. DISCUSSION: Height, weight, and BMI from the camps may be judged as retardation of growth and malnutrition by modern standards but it is not the case when coetaneous references are considered: no overall significant differences were found with respect to several publications from Spanish and European populations.

Comparative study of mid-upper arm circumference, arm muscle area and arm fat area percentiles in Argentinean and US children aged 4-14 years.

INTRODUCTION: Background: mid-upper arm circumference (MUAC), subcutaneous fat and muscle measurements are an alternative method to diagnose overweight and evaluate growth as well as protein and energy reserves. Aim: to compare MUAC, arm muscle area (AMA) and arm fat area (AFA) measurements of Argentinean boys and girls (Sa) with reference curves for US boys and girls (R). Subjects and methods: data from 22,736 school-children aged 4-14 years from six Argentinean provinces were collected. MUAC and triceps skinfold thickness were measured and the derived AMA and AFA measures were calculated. Analyses were performed with GAMLSS using the R software. Differences in mean values of Sa and R were compared in percentiles 3, 50 and 97. Results: mean values of MUAC and AMA in boys and girls were higher in R than in Sa at all ages; conversely, AFA values were lower. Conclusions: our results confirm differences in upper arm anthropometry of Argentinean school-children with respect to the US reference. The higher adipose tissue and lower skeletal muscle mass observed in Argentinean children could be partly associated with the different ethnic origin of both populations. However, differences should be interpreted in the context of an obesogenic environment, which has favored a calorie-protein imbalance.

INTRODUCCIÓN: Antecedentes: la medición de la circunferencia del brazo (MUAC), así como la estimación de la grasa subcutánea y muscular constituyen un método alternativo para diagnosticar el sobrepeso y evaluar el crecimiento y las reservas proteicas y energéticas. Objetivo: comparar las mediciones de MUAC, área muscular (AMA) y área grasa (AFA) del brazo de niños y niñas argentinos (Sa) con curvas de referencia para niños y niñas de Estados Unidos (R). Sujetos y métodos: se recopilaron datos de 22,736 escolares de 4 a 14 años de edad de seis provincias argentinas. Se obtuvieron medidas de MUAC y pliegue subcutáneo tricipital y se calcularon AMA y AFA. Los análisis se realizaron con GAMLSS utilizando el software R. Las diferencias en los valores medios de Sa y R se compararon para los percentiles 3, 50 y 97. Resultados: a todas las edades los valores medios de MUAC y AMA en niños y niñas fueron más altos en R que en Sa; por el contrario, los valores de AFA fueron más bajos. Conclusiones: nuestros resultados confirman la existencia de diferencias en la antropometría mesobraquial de los niños argentinos con respecto a los de la referencia. La mayor cantidad de tejido adiposo y menor de tejido muscular observada en los niños argentinos de ambos sexos puede ser parcialmente asociada con el diferente origen étnico de ambas poblaciones. Sin embargo, las diferencias podrían interpretarse en el contexto de un ambiente obesogénico, el cual habría favorecido el desbalance proteico-calórico.

Describing the children's body shape by means of Geometric Morphometric techniques.

INTRODUCTION: Large shape variations take place during the growth process of children, including quantitative mass and size increase plus qualitative changes in their body shape. The aim of the present study is to apply Geometric Morphometric techniques in order to visualize and quantify such body shape differences in healthy children aged 6-59 months with optimal nutritional status. MATERIALS AND METHODS: Anthropometrical measurements of weight, height, and middle-upper arm circumference were used to assess nutritional status on a sample of 258 Senegalese (n = 154) and Spanish (n = 104) children. A set of 36 anatomical and/or osteologically-based landmarks were identified on the body of the children along with 108 semi-landmarks used to capture curvature attributes on the frontal view of the body image. A specific method was developed to place and photograph children, as well as to locate landmarks, treat images and calculate semi-landmarks. Shape differences among children were analyzed in terms of age, sex, and population origin, taking into consideration allometry effects. RESULTS: Our results indicate significant differences in shape and size for all the three factors under study before removing size effect (p < .0001), and in shape after the size correction (p < .01). Only the ontogenetic effect persisted in the size of studied individuals after size-effects correction (p < .0001). Morphometric significant differences were described regarding age for PC1 and population origin in PC2 before removing size effect. Between-population morphometric differences were sorted along PC1 after size correction. DISCUSSION: Geometric Morphometric techniques are useful to study morphometric changes in the anterior whole-body view of children under 5 years old, allowing a precise description of shape changes observed when age and population origin are considered.

Influence of malnutrition upon all-cause mortality among children in Swaziland.

OBJECTIVE: To analyze the effect of the type of malnutrition, sex, age and the presence of edema upon all-cause mortality in children under 5 years of age. MATERIAL AND METHODS: A cross-sectional study was conducted during 2010 and 2011 in Swaziland. Sex, age, weight and height were taken to classify nutritional status according to the 2006 WHO growth standards: stunting (low height for age), wasting (low weight for height or low body mass index for age) and underweight (low weight for age). The sample (309 boys and 244 girls under 5 years of age) was analyzed by sex and age groups (under and equal/over 12 months). The association between variables was evaluated using the χ2 test. Cox regression analysis (HR, 95% CI) was used to assess the likelihood of mortality. RESULTS: The mortality risk in malnourished children under one year of age was lower among females and increased in the presence of severe edema. Wasting combined with underweight increased the mortality risk in children under 12 months of age 5-fold, versus 11-fold in older children. The combination of stunting, wasting and underweight was closely associated to mortality. Stunting alone (not combined with wasting) did not significantly increase the mortality risk. CONCLUSIONS: Sex, severe edema and wasting are predictors of mortality in malnourished children. Regardless of these factors, children with deficiencies referred to weight for height and weight for age present a greater mortality risk in comparison with children who present stunting only.

Influence of malnutrition upon all-cause mortality among children in Swaziland / Influencia de la malnutrición en la mortalidad por todas las causas en menores de Suazilandia

Objective: To analyze the effect of the type of malnutrition, sex, age and the presence of edema upon all-cause mortality in children under 5 years of age. Material and methods: A cross-sectional study was conducted during 2010 and 2011 in Swaziland. Sex, age, weight and height were taken to classify nutritional status according to the 2006 WHO growth standards: stunting (low height for age), wasting (low weight for height or low body mass index for age) and underweight (low weight for age). The sample (309 boys and 244 girls under 5 years of age) was analyzed by sex and age groups (under and equal/over 12 months). The association between variables was evaluated using the χ2 test. Cox regression analysis (HR, 95% CI) was used to assess the likelihood of mortality. Results: The mortality risk in malnourished children under one year of age was lower among females and increased in the presence of severe edema. Wasting combined with underweight increased the mortality risk in children under 12 months of age 5-fold, versus 11-fold in older children. The combination of stunting, wasting and underweight was closely associated to mortality. Stunting alone (not combined with wasting) did not significantly increase the mortality risk. Conclusions: Sex, severe edema and wasting are predictors of mortality in malnourished children. Regardless of these factors, children with deficiencies referred to weight for height and weight for age present a greater mortality risk in comparison with children who present stunting only (AU)

Objetivo: Analizar el efecto del tipo de malnutrición, de la edad, el sexo y la presencia de edema sobre la mortalidad en menores de cinco años. Material y métodos: Estudio transversal llevado a cabo durante 2010 y 2011 en Suazilandia. Se tomaron el sexo, la edad en meses, la talla y el peso y se clasificó el estado nutricional de los menores considerando: desnutrición crónica (stunting o baja talla para la edad), aguda (wasting o bajo peso para la talla o bajo índice de masa corporal para la edad) y bajo peso para la edad (underweight) de acuerdo a los estándares de crecimiento de la OMS del 2006. La muestra (309 niños, 244 niñas, menores de 5 años) se analizó por sexo y edad considerando separadamente los menores y mayores de 12 meses. La asociación entre variables se evaluó utilizando el test de χ2 y la regresión de Cox (HR 95% CI) fue utilizada para determinar la probabilidad de muerte. Resultados: El riesgo de muerte en los menores malnutridos menores de un año es menor en las niñas y aumenta significativamente con la presencia de edema severo. La desnutrición aguda combinada con el bajo peso multiplica por cinco el riesgo de mortalidad en los menores de 12 meses y por once en los mayores de un año. La combinación de desnutrición crónica, aguda y bajo peso está estrechamente asociada a la mortalidad. La malnutrición crónica por sí sola no incrementa significativamente el riesgo de muerte. Conclusiones: El sexo, la severidad del edema y la desnutrición aguda son predictores de mortalidad. Con independencia de estos factores, los menores con déficit de peso para la talla o de peso para la edad presentan mayor riesgo de mortalidad que los menores que padecen únicamente desnutrición crónica (AU)

Migration and nutritional status of Tarahumara schoolchildren from Chihuahua State (México).

OBJECTIVE: The Tarahumara ethnic group is composed of indigenous people from the Sierra Madre Occidental of Mexico. Conditions of isolation and poverty compel them to migrate to the city in search of better opportunities. This work aims to explore the influence of migration on the growth and nutritional status of Tarahumara schoolchildren. METHODS: One hundred Tarahumara students were analyzed (50 rural with a mean age of 9.78 ± 1.25 years; 50 urban aged 10.0 ± 1.04 years), comparing anthropometric indicators and body composition (T-Student, U-Mann-Whitney Tests). RESULTS: Twenty percent of rural girls and 35% of rural boys showed stunted growth compared to only 9% of the urban girls (no stunted growth among urban boys). Migrants showed greater body size, skinfold thickness, and fat percentage. Weight excess, understood as an increase in the prevalence of overweight and obesity, was detected in 17.8% of urban boys and 13.6% of urban girls compared to 10.0% of boys and 3.3% of girls of the rural series. CONCLUSION: Migration reduces stunting and increases adiposity.

Subscapular and triceps skinfolds reference values of Hispanic American children and adolescents and their comparison with the reference of Centers for Disease Control and Prevention (CDC) / Valores de referencia para los pliegues adiposos subescapular y tricipital de niños y adolescentes hispanoamericanos y su comparación con la referencia de los centros para el control y prevención de enfermedades (CDC)

Introduction: the assessment of the skinfold thickness is an objective measure of adiposity. Therefore, it is a useful tool for nutritional diagnosis and prevention of metabolic risk associated with excess fat in chilhood and adolescence. Objective: to provide percentiles of subscapular and triceps skinfolds for Hispanic American schoolchildren and compare them with those published by the Centers for Disease Control and Prevention (CDC) from United States, that it have been commonly used as a reference in most of these countries. Methods: subscapular and triceps skinfolds were measured in 9.973 schoolchildren 4-19 aged from Spain, Argentina, Cuba, Venezuela and Mexico with Holtain caliper with 0.2 mm accuracy. Percentiles were obtained with the LMS statistical method and were presented in tables divided in stages of 6 months and in curves graphics. The difference between Hispanic American and CDC mean values were provided for P3, P50 and P97 in mm and also were graphically represented. Results: skinfolds measurements obviously increased with age in both sexes but, in boys, this increase is much more marked in highest percentiles between 8 and 13 years; this maximum is reached earlier than what occurs in CDC reference. In both sexes, all percentiles analized in Hispanic American schoolchildren were higher than the CDC reference except P97 up to 10 or 13 years that was notably smaller. Conclusions: the skinfolds percentiles of Hispanic American children and adolescents differ from CDC that are usually used as reference. The values of subscapular and triceps skinfolds provided in this study, could be applied to populations of a similar ethnic background, especially in comparative studies of body composition (AU)

Introducción: la evaluación del grosor de los pliegues subcutáneos es una medida objetiva de la adiposidad. Es por tanto una herramienta útil para el diagnóstico nutricional y la prevención del riesgo metabólico asociado al exceso de grasa en la infancia y adolescencia. Objetivo: proporcionar valores percentilares de los pliegues adiposos subcutáneos subescapular y tricipital para escolares hispanoamericanos y compararlos con los valores publicados por los Centros para el Control y Prevención de Enfermedades (CDC) de los Estados Unidos, que comunmente se emplean como referencia en estos países. Métodos: se midió el pliegue subescapular y tricipital en 9.973 escolares entre 4 y 19 años procedentes de España, Argentina, Cuba, Venezuela y México con un calibre Holtain de 0,2 mm de precisión. Los percentiles fueron calculados mediante el método estadístico LMS y presentados en tablas divididas en intervalos de seis meses y en gráficos de curvas. La diferencia entre los valores medios hispanoamericanos y los valores del CDC se muestran para el P3, P50 y P97 en mm, y también gráficamente. Resultados: las medidas de los pliegues subcutáneos se incrementan obviamente con la edad pero, en niños, este incremento es mucho más marcado en los percentiles superiores entre los 8 y 13 años; este máximo es alcanzado antes que en la referencia del CDC. En ambos sexos, todos los percentiles analizados fueron superiores en los escolares hispanoamericanos, exceptuando el P97 por encima de los 10 o 13 años, donde resultó notablemente inferior. Conclusiones: los percentiles de pliegues adiposos de los niños y adolescentes hispanoamericanos difieren de la referencia del CDC. Los valores del pliegie subescapular y tricipital proporcionados en este estudio podrían ser aplicados en poblaciones de similar origen étnico, especialmente en estudios comparativos de la composición corporal (AU)

Altitude effect on birth weight and prematurity in the Province of Catamarca (Argentina).

OBJECTIVES: To analyze the effect of altitude on weight and prematurity at birth in the Province of Catamarca (Argentina), between the years 1994 and 2003. METHODS: Records of 22,628 newborns were collected from the vital statistics of the census of Catamarca. Weight was recategorized to include low birth weight (<2,500 g), and gestational age was divided into births that had occurred before or after 37 weeks (preterm or at term births). Altitude was also recategorized (<1,500 m, 1,500-2,000 m, and > 2,000 m). Nonparametric statistical tests were performed. RESULTS: Differences were found in birth weight between sexes and in the incidence of low birth weight depending on altitude. This pattern changed according to gestational age, because those sexual differences were nonexistent or lower in preterm neonates with certain advantages for females. Moreover, it was found that the effects of hypoxia were not reflected in birth weight until later stages of intrauterine development. CONCLUSIONS: To be female appears to be a benefit under conditions of prematurity and high altitude. The increased incidence of prematurity due to altitude increase may reflect an adaptive advantage of preterm birth under these conditions.

Influencia del desayuno sobre el exceso ponderal en población infantil y adolescente de Madrid / Influence of breakfast on overweight and obesity in child and adolescent population from Madrid

Introducción: En los últimos años, el exceso de peso se ha incrementado considerablemente en la población infantil y adolescente española. Este hecho se ha visto especialmente asociado con la aparición de nuevos hábitos alimentarios, como la ausencia del desayuno, la calidad de éste o el abandono de la denominada dieta mediterránea. Objetivos: Determinar el Índice de Masa Corporal (IMC) de un grupo de escolares y contrastarlo con estudios similares. Analizar la ausencia/presencia del desayuno, la composición del mismo y la calidad de la dieta en general. Relacionar los hábitos alimentarios mencionados anteriormente con la condición nutricional de los estudiantes. Métodos: Se calculó el IMC (kg/m2) de 986 madrileños de 9 a 15 años. Se estableció el porcentaje de sujetos correspondientes a cada una de las categorías nutricionales propuestas por la International Obesity Task Force (IOTF). Los datos de exceso ponderal obtenidos se compararon con los de otros estudios españoles, que habían utilizado los mismos estándares de referencia. Asimismo, se determinó la alimentación en general de los escolares, a partir de la encuesta Kidmed. Del mismo modo, se estudió la existencia o no del hábito de desayunar y los componentes alimenticios de dicha ingesta. Se relacionaron dichos datos con la condición nutricional de los escolares y se establecieron comparaciones mediante la prueba de Chi-Cuadrado. Resultados: Respecto al exceso de peso se constata, por un lado, que es inferior en la serie femenina (26,4%) que en la masculina (31,5%) y, por otro, que hay mayor número de escolares con sobrepeso (22,9%) que con obesidad (5,8%). La ausencia del hábito de desayunar es superior en las chicas (7,5%) que en los varones (4,9%). La presencia de dicha costumbre está asociada significativamente con mayores porcentajes de bajo peso o normopeso, en escolares de 11 a 13 años. Igualmente resulta significativa la relación entre el consumo de lácteos en el desayuno y los bajos niveles de IMC, pero esto no ocurre en el caso de los cereales. Discusión: Hay coincidencia con otros estudios en diversos aspectos: que el tanto por ciento de sujetos con sobrepeso es superior al de obesidad; que al aumentar la edad de los escolares crece el porcentaje de los que no desayunan y que hay concordancia entre la dieta de alta calidad y un menor IMC. Del mismo modo, los resultados son parecidos en que existe relación entre el consumo de lácteos en el desayuno y el exceso ponderal, aunque no resulta significativa y, sin embargo, no hay asociación en el caso de los cereales. En cambio, los datos resultan algo dispares con otros trabajos, al diferenciar los dos sexos, respecto al superávit de peso o al porcentaje de que los que no desayunan. Conclusiones: Existe mayor número de escolares con sobrepeso que con obesidad. El exceso ponderal es superior en el sexo masculino. El porcentaje de chicas que prescinde de la primera comida diaria es inferior al de los chicos. El IMC disminuye en los sujetos que desayunan. El hábito de no desayunar aumenta con la edad. La ingestión de lácteos en el desayuno está ligada a un mayor porcentaje de bajo peso o normopeso, hecho que no ocurre en el caso de los cereales. La mayoría de los estudiantes que siguen una dieta de alta calidad no presentan superávit de peso (AU)

Introduction: In the last years, the percentage of overweight and obese children and teenagers has increased among the Spanish population. This fact is closely associated with the acquisition of new alimentary habits. Aims: The primary aim of this study was to determine the Body Mass Index (BMI) in a group of schoolchildren and to compare the results to those of similar studies. Also, an association between both having breakfast and the quality of this meal, and the nutritional status of the children was investigated. Methods: This study comprises a sample of 986 school boys and schoolgirls who lived in Madrid and were aged 9 to 15 years old. Several anthropometric measures were taken in these children, including height and weight, which were used to calculate their BMI. The percentage of subjects from each category was established following the criteria of the International Obesity Task Force (IOTF). The results were compared with other Spanish studies. Also, the feeding behavior of children and teens was determined from the Kidmed test. Presence or absence of breakfast was related to nutritional condition and comparisons were assessed by chi-square test. Results: The results of this study reveal that the percentage of overweight children (22,9%) is higher than that of obese children (5,8%), and that both measures are higher in boys (31,5%) compared to girls (26,4%). On the other hand 7,5 % of girls do not have breakfast daily, whereas 4,9% of boys have this habit. Also, the results indicate that the habit of breakfasting is associated with higher values of low and normal weight, and this association is statistically significant in the age group including children 11 to 13 years old, and more specifically among girls these ages. Finally, the study shows that taking dairy products as part of breakfast is related to a lower prevalence of obesity at all ages analyzed, however, no significant relationship was found between having cereals at breakfast and a lower BMI. Discussion: There is general agreement with other studies in various aspects: the percentage of overweight subjects exceeds that of obese subjects; the older the schoolchildren are, the higher is the percentage of them who skip breakfast and there is a link between diet quality and lower BMI. In the same way, similar results are obtained about the relationship between the consumption of milk at breakfast and excessive weight, although not significant. However, there is no such association in the case of cereals. Instead, data is somewhat disparate with other works, if is differentiated by sex, regarding a surplus of weight or the percentage of those who do not eat breakfast. Conclusions: There are more overweight schoolchildren than obese schoolchildren. Excessive weight is more frequent in males. The percentage of girls who dispenses with the first daily meal is lower than that of boys. BMI decreases in subjects who eat breakfast. The habit of skipping breakfast increases with age. Ingestion of milk at breakfast is linked to a higher percentage of underweight or normal weight, a fact that does not occur in the case of cereals. Most students pursuing high quality diet have no surplus weight (AU)

Composición corporal, estado nutricional y alimentación en escolares Tarahumaras urbanos y rurales de Chihuahua, México / Body composition, nutritional status and diet in rural and urban Tarahumara schoolchildren in Chihuahua, México

Introducción: El grupo indígena tarahumara es el más numeroso en el Estado de Chihuahua y es una de las etnias más deprimidas económicamente del país, razón por la cual, tienden a abandonar la sierra para asentarse en la ciudad modificando sus hábitos de vida. Objetivo: Comparar el estado nutricional de escolares Tarahumaras rurales y urbanos a través de un análisis de su composición corporal y alimentación. Métodos: Se evaluaron 50 niños Tarahumaras rurales y 50 niños Tarahumaras urbanos con media de edad entre los 9-10 años. Se tomaron diversas medidas antropométricas que permitieron valorar el tamaño, composición corporal de los escolares, así como su somatotipo. Se realizó un análisis de la alimentación mediante recordatorio de 24 horas en dos días de la semana. Resultados: Los escolares urbanos mostraron valores significativamente mayores en la mayoría de medidas antropométricas. No hubo diferencias estadisticamente significativas para el estado nutricional aunque el porcentaje de sobrepeso y obesidad de los Tarahu - mara urbanos superó en un 10% a los rurales. El porcentaje de grasa y el componente endomorfico del somatotipo fue mucho más elevado en los niños rurales. La alimentación de ambos grupos difiere principalmente durante el fin de semana, cuando los niños rurales dejan la escuela y comen en sus hogares. Los niños urbanos consumieron de media más calorías, proteinas, grasas y colesterol que los rurales, los cuales, tienen más elevado el consumo de carbohidratos. Conclusiones: Los niños Tarahumaras urbanos muestran un mayor tamaño corporal y adiposidad reflejo de una alimentación más rica en calorías y grasas (AU)

Introduction: The Tarahumara indigenous group is the largest in the State of Chihuahua but it is the most economically depressed in the country which is why they tend to leave the mountains to settle in the city and change their ethnic lifestyles. Objective: To compare the nutritional status of rural and urban Tarahumara schoolchildren through an analysis of their body composition, and nutrition. Method: 50 rural Tarahumara children and 50 urban Tarahumara children with a mean age between 9-10 years were evaluated. Various anthropometric measures that allowed assessing their size, body composition, and somatotype were taken. A diet analysis was conducted through surveys of 24-hour recall two days a week. Results: The urban schoolchildren showed signifi - cantly higher values in most anthropometric measures. There were no statistically significant differences in the nutritional status although the percentage of overweight and obesity in urban Tarahumara children ex - ceeded 10% from those in rural areas. The percentage of fat and endomorphic somatotype component was much higher in rural children. The diet of the two groups differed mainly during the weekend, when rural children leave school and eat at home. Urban children consumed on average more calories, protein, fat and cholesterol than their rural counterparts, who have a higher carbohydrate intake. Conclusions: Urban Tarahumara children show a larger body size and adiposity, which reflects a diet rich in calories and fat (AU)

Diferencias alimentarias y de actividad física en escolares mestizos y Tarahumaras de la ciudad de Chihuahua (México) / Food and physical activity differences in mestizos and Tarahumara schoolchildren from Chihuahua city (México)

El estilo de vida es diferente en el medio urbano que en el entorno rural. Se dispone de escasa información sobre el cambio en los hábitos de alimentación y actividad física que experimentan los escolares Tarahu - maras al migrar a la ciudad. Objetivo: Comparar la dieta habitual, la actividad fí- sica y el estado de nutrición de escolares mestizos y Tarahumaras que radican en la ciudad de Chihuahua. Método: Se realizó un estudio descriptivo, trans - versal y comparativo en 111 escolares, (61 mestizos y 50 Ta rahumaras) de ambos sexos entre 6 y 14 años de edad, procedentes de tres escuelas públicas y dos escuelas indígenas de la ciudad de Chihuahua. Se aplicaron cuestionarios de auto reporte de alimentación (recordatorio de 24 horas) para dos días, uno entre semana y otro de fin de semana, un cuestionario de actividad física desarrollado por el grupo de investigación EPINUT, y mediciones antropométricas según protocolo de la Sociedad Internacional para el avance de la Cineantropometría (ISAK por sus siglas en inglés). Resultado: El consumo calórico es similar en ambos grupos (2036.5±709 kcal/día mestizos vs. 1938.1±849 kcal/día Tarahumara). El porcentaje de consumo de macronutrimentos no difiere significativamente entre grupos, sin embargo, el consumo de colesterol es mayor en escolares mestizos (318.3±199 mg/día vs. 226.2±203 mg/día; p< 0.05), al igual que el consumo de grasas saturadas (29.4±14.7 mg/día vs. 19.9±14.4 mg/día; p<0.05) aunque sólo los mestizos exceden las recomendaciones diarias para este grupo de edad. Respecto a la actividad física escolar, el 6% de los Tarahumara realiza más de 4 hr/sem y el 54% menos de 2 hr/sem, lo que contrasta con el 87.1% de los mestizos con una actividad menor a 2 hr/sem. La prevalencia de niños mestizos que realizaron actividad física extra-escolar por más de 4 hr/sem fue del 19.4% frente al 8% en los Tarahumaras. La actividad física recreativa fue menor a 2hr/sem en el 26.5% de los Tarahumaras en comparación con el 46.8% de los mestizos; sin embargo, fue mayor a 4 hr/sem en el 44.9% de los Tarahumaras. Respecto a las actividades sedentarias, el 44.6% de los mestizos ve TV de 1 a 7 hr/sem en comparación con el 26.1% de los Tarahu - mara; el 35.2% de los niños mestizos juega a videojuegos entre 1 a 7 hr/sem mientras que el 58.7% de los niños Tarahumara no usan estos dispositivos; el 50% de los mestizos emplean la computadora de 1 a 7 hr /sem, y el 60% de los Tarahumara no la usan. El tiempo semanal de hora/pantalla dedicado por parte de los mestizos es de 19.09hr y, por parte de los Tarahumara, es de 14.17hr. La prevalencia de sobrepeso y obesidad combinados es de 39.3% en mestizos vs. 16% en Tarahumaras (p<0.05). Discusión y conclusiones: Ambos grupos estudiados tienen una dieta similar, respecto al consumo caló- rico y los macronutrimentos, no así en ingesta de colesterol y grasas saturadas donde el consumo en la muestra Tarahumara es menor. Hay más prevalencia de sobrepeso y obesidad en los niños mestizos vinculada a una mayor actividad sedentaria por semana, mientras que la actividad física recreativa es mayor en los Tarahumara (AU)

There is evidence that lifestyle is different in urban or rural areas, although there are limited data on the change in diet and physical activity habits that happen in the Tarahumara indigenous people that migrate to the city. Objective: To compare the habitual diet, physical activity and nutritional status between Tarahumara children and mestizos who live in the city of Chihuahua. Method: A descriptive, cross-sectional and comparative study in 111 schoolchildren, (61 mestizos and 50 Tarahumaras), girls and boys between 6 and 14 years old was performed from three public schools and two indigenous schools in Chihuahua City. Self-reported questionnaires supply (24 hr recall) for two days, one weekday and one weekend, a physical activity questionnaire from EPINUT research group own creation, and anthropometric measurements were applied according to the protocol of the International Society for the Advan - cement the Kinanthropometry (ISAK). Result: The caloric intake was similar in both groups (2036.5 ± 709 kcal/day in mestizos vs. 1938.1 ± 849 kcal/day in Tarahumara). The percentage of macronutrients did not differ significantly between groups. Cholesterol intake is higher in urban schoolchildren (318.3 ±199 mg/day vs. 226.2 ±203 mg/day; p=0.01) and also the consumption of saturated fats (29.4 ±14.7 mg/day vs.19.9 ±14.4 mg/day; p=0.01) although only the mestizos group exceed the daily recommendations for this age group. The 6% of the Tarahumara children practice school physical activity more than 4hr/wk, 54% less than 2hr/wk contrasting with the 87.1% of mestizos which practice less than 2hr/wk. Extra school physical activity was performed more than 4hr/wk by the 19.4% of mestizos vs. 8% of Tarahumara. Recreational phy sical activity performed by Tarahumara lasts less than 2hr/wk in the 26.5% of them compared with 46.8% of mestizos; 44.9% of Tarahu mara children practiced more than 4hr/wk of it. In relation to sedentary activities, 44.6% of mestizo children watch TV for 1-7 hr/wk compared to 26.1% of the Tarahu mara; the use of videogames for 1-7 hr/wk was 35.2% in mestizos and the 58.7% of Tarahumara children didn’t use any of these devices; the use of computers during 1-7 hr/wk was 50% in mestizos in contrast to 60% of Tarahumara that didn’t used them never. The week ly time using any electronic displays was 19.1hr in mestizos vs. 14.2hr in Tarahumara. The combined prevalence of overweight and obesity was 39.3% in mestizos vs. 16% in Tarahumara (AU)

[Utility of self-reported anthropometric data for evaluation of obesity in the Spanish population; study EPINUT-ARKOPHARMA]. / Utilidad de los datos antropométricos auto-declarados para la evaluación de la obesidad en la población española; estudio EPINUT-ARKOPHARMA.

INTRODUCTION: Epidemiological studies frequently use weight and height collected by questionnaires, but the inaccuracy of self-reported data may bias the evaluation result. The aim of this study is to validate the self-report in Spanish adult population emphasizing the effect of age and nutritional status of the subjects. METHODS: The sample consist of 9,294 adults (8,072 women and 1,222 men) recruited from dietetic counselling centers dependents of Arkopharma laboratories in 46 Spanish provinces. Weight and height were asked and subsequently measured, calculating differences between self-reported and real parameters. Error in the estimation of body mass index (BMI) was evaluated considering the effect of age and nutritional status (T-test and multiple linear regression). Correlation between the classification based on self-reported BMI and anthropometric was analyzed using the Kappa test. RESULTS AND DISCUSSION: Using the self-reported data, BMI was underestimated (2.62% in men, 3.10% in women). The error increases with age and extreme nutritional categories. The agreement between self-reported and real BMI in the nutritional assessment was good and correctly classified 74.71% of the males and 89.5% of women (Kappa: 0.695 and 0.782 respectively). CONCLUSIONS: Considering the effect of age and nutritional status on the self-awareness of body size, we recommend caution in the use of questionnaires for epidemiological assessment.

Introducción: En epidemiología es frecuente recabar el peso y talla mediante cuestionario, pero la inexactitud de los datos auto-referidos puede sesgar el resultado de la evaluación. El objetivo es validar el auto-reporte en población adulta española enfatizando el efecto de la edad y la condición nutricional de los sujetos. Material y métodos: La muestra consta de 9.294 adultos (8.072 mujeres y 1.222 varones) reclutados en centros de orientación dietética dependientes de los laboratorios Arkopharma en 46 provincias españolas. Se preguntaron peso y talla midiéndose posteriormente y calculando las diferencias entre parámetros auto-referidos y reales. Se evaluó el error en la estima del Índice de Masa Corporal (IMC) considerando el efecto de la edad y la condición nutricional (T de Student y regresión lineal múltiple). Se analizó la concordancia entre la clasificación realizada a partir del IMC auto-referido y antropométrico mediante el test de Kappa. Resultados y discusión: Utilizando datos auto-referidos, el IMC se infravalora (2,62% en varones; 3,10% en mujeres). El error aumenta con la edad y en las categorías nutricionales extremas. El acuerdo en la evaluación nutricional a partir del IMC auto-referido y real es bueno, clasificándose de manera correcta el 74,71% de los varones y el 89,5 % de las mujeres (Kappa: 0,695 y 0,782 respectivamente). Conclusiones: Teniendo en cuenta el efecto de la edad y de la condición nutricional sobre el auto-conocimiento del tamaño corporal, se recomienda cautela en el empleo de cuestionarios encaminados a la valoración epidemiológica.

Anthropometric parameters in screening for excess of adiposity in Argentinian and Spanish adolescents: evaluation using receiver operating characteristic (ROC) methodology.

BACKGROUND: Various anthropometric parameters have been proposed for defining overweight in adolescence, but few studies have evaluated their diagnostic accuracy in comparative terms, using samples from different regions. AIM: To compare the performance of anthropometric parameters in determining the excess of adiposity in Argentinian and Spanish adolescents. SUBJECTS AND METHODS: The sample is composed of 1781 Argentinian and 1350 Spanish subjects, aged 12-17 years. Excess adiposity was defined as percentage BF in the 90th percentile or higher. ROC curves established the validity of parameters to define excess adiposity. RESULTS: Descriptive statistics showed differences between the Argentinian and Spanish samples. ROC curves indicate that all the parameters analysed had, in the Spanish and Argentinian samples, a positive and elevated association with excess of adiposity. The waist-to-height ratio had the highest value of the area under ROC curve (AUC), while conicity index and waist-to-hip ratio had the lowest. CONCLUSIONS: Differences exist with respect to size and body composition between the Argentinian and Spanish samples. ROC curves reflect a general pattern of variation. Waist-to-hip ratio and conicity index are less desirable in the diagnosis of excess adiposity and the most desirable is waist-to-height ratio.

Utilidad de los datos antropométricos auto-declarados para la evaluación de la obesidad en la población española; estudio EPINUT-ARKOPHARMA / Utility of self-reported anthropometric data for evaluation of obesity in the spanish population; study epinut-arkopharma

Introducción: En epidemiología es frecuente recabar el peso y talla mediante cuestionario, pero la inexactitud de los datos auto-referidos puede sesgar el resultado de la evaluación. El objetivo es validar el auto-reporte en población adulta española enfatizando el efecto de la edad y la condición nutricional de los sujetos. Material y métodos: La muestra consta de 9.294 adultos (8.072 mujeres y 1.222 varones) reclutados en centros de orientación dietética dependientes de los laboratorios Arkopharma en 46 provincias españolas. Se preguntaron peso y talla midiéndose posteriormente y calculando las diferencias entre parámetros auto-referidos y reales. Se evaluó el error en la estima del Índice de Masa Corporal (IMC) considerando el efecto de la edad y la condición nutricional (T de Student y regresión lineal múltiple). Se analizó la concordancia entre la clasificación realizada a partir del IMC auto-referido y antropométrico mediante el test de Kappa. Resultados y discusión: Utilizando datos auto-referidos, el IMC se infravalora (2,62% en varones; 3,10% en mujeres). El error aumenta con la edad y en las categorías nutricionales extremas. El acuerdo en la evaluación nutricional a partir del IMC auto-referido y real es bueno, clasificándose de manera correcta el 74,71% de los varones y el 89,5 % de las mujeres (Kappa: 0,695 y 0,782 respectivamente). Conclusiones: Teniendo en cuenta el efecto de la edad y de la condición nutricional sobre el auto-conocimiento del tamaño corporal, se recomienda cautela en el empleo de cuestionarios encaminados a la valoración epidemiológica (AU)

INTRODUCTION: Epidemiological studies frequently use weight and height collected by questionnaires, but the inaccuracy of self-reported data may bias the evaluation result. The aim of this study is to validate the self-report in Spanish adult population emphasizing the effect of age and nutritional status of the subjects. METHODS: The sample consist of 9,294 adults (8,072 women and 1,222 men) recruited from dietetic counselling centers dependents of Arkopharma laboratories in 46 Spanish provinces. Weight and height were asked and subsequently measured, calculating differences between self-reported and real parameters. Error in the estimation of body mass index (BMI) was evaluated considering the effect of age and nutritional status (T-test and multiple linear regression). Correlation between the classification based on self-reported BMI and anthropometric was analyzed using the Kappa test. RESULTS AND DISCUSSION: Using the self-reported data, BMI was underestimated (2.62% in men, 3.10% in women). The error increases with age and extreme nutritional categories. The agreement between self-reported and real BMI in the nutritional assessment was good and correctly classified 74.71% of the males and 89.5% of women (Kappa: 0.695 and 0.782 respectively).CONCLUSIONS: Considering the effect of age and nutritional status on the self-awareness of body size, we recommend caution in the use of questionnaires for epidemiological assessment (AU)

Precisión diagnóstica del índice cintura-talla para la identificación del sobrepeso y de la obesidad infantil / Diagnostic accuracy of waist to height ratio in screening of overweight and infant obesity

Fundamento y objetivo: Estudiar la sensibilidad y especificidad del índice cintura altura como indicador de sobrepeso y obesidad en la edad pediátrica y obtener puntos de corte para simplificar el diagnóstico. Se analizaron dos mil trescientos diecinueve niños en edad escolar entre 6 y 14 años: Sujetos y métodos. Se tomaron medidas antropométricas (altura, peso, circunferencia de cintura y pliegues cutáneos de espesor), y de la cintura y la altura (WHR), se calcularon el IMC y porcentaje de grasa. Prueba de ANOVA se utilizó para evaluar el comportamiento de las variables antropométricas durante el período de crecimiento. Se aplicó análisis de la curva ROC (Receiver Operating Characteristics) con WHR como variable de contraste y el sobrepeso y la obesidad como variable criterio. El sobrepeso y la obesidad fueron definidos por los estándares del IMC y referencias adiposidad. Los valores de sensibilidad y especificidad se obtuvieron áreas bajo la curva (AUC), los intervalos de confianza del 95%, y los puntos de corte-offs. El procedimiento estadístico y gráfico se realizó con el programa SPSS ® 18.0. Resultados: WHR no varía con la edad. AUC varió 0,786 a 0,953 lo que indica que el RHO tiene un alto poder predictivo para identificar los sujetos previamente clasificado como con sobrepeso u obesos usando ambos criterios considerados. Conclusión: WHR resultó ser un predictor adecuado y eficaz del sobrepeso y la obesidad en los niños entre 6 y 14 años. Puntos de cortes de WHR que identifican a la obesidad son: 0,51 en hombres y 0,50 en mujeres. Para el, la gama cortes sobrepeso entre 0,47 y 0,48 en función del sexo y la variable criterio (AU)

Background and objective: To explore the sensitivity and specificity of waist to height index as indicator of overweight and obesity in pediatric age and to obtain cut-off points to simplify the diagnosis. Subjects and methods: Two thousand and three hundred and nineteen schoolchildren between 6 and 14 years were analyzed. Anthropometric measures were taken (height, weight, waist circumference and skinfolds thickness), and waist to height ratio (WHR), BMI and fat percentage were calculated. ANOVA test was used to evaluate the performance of anthropometric variables during the growth period. ROC curve analysis (Receiver Operating Characteristics) was applied using WHR as test variable and overweight and obesity status as criterion variable. Overweight and obesity were defined by BMI standards and adiposity references. The sensitivity and specificity values, areas under the curve (AUC), confidence intervals 95%, and cut-offs points were obtained. The statistical and graphical procedure was performed using SPSS® 18.0. Results: WHR does not vary with age. AUC ranged from 0.786 to 0.953 indicating that the WHR has a high predictive power to identify the subjects previously classified as overweight or obese using both considered criteria. Conclusión: WHR proved to be an appropriate and effective predictor of overweight and obesity in children between 6 and 14 years. Cut-offs points of WHR that identify obesity are: 0.51 in males and 0.50 in girls. For the overweight, cut-offs range between 0.47 and 0.48 depending on sex and the criterion variable (AU)