Quality of nutritional care during pregnancy: folic acid and vitamin D supplementation

Backgrounds: Folic acid (FA) and vitamin D supplementation is recommended during pregnancy. Quality nutritional care during pregnancy should include the supplementation of these vitamins. Therefore, the aim of this study was to assess the quality of nutritional care regarding supplementation during pregnancy in primary health care units in six states of Mexico (Estado de México, Oaxaca, Yucatán, Chihuahua, Veracruz and Chiapas). Methods: A mixed study was conducted. An indicator (formed by two sub-indicators) to assess the quality of nutritional care focused on FA and vitamin D supplementation in pregnancy was developed and validated. To assess the quality of care, a sample of 97 health units (HUs) was estimated considering the total number of HUs in the selected states. To ensure the representativeness of the following strata: rurality, care for the indigenous population, and size of the HU; at least one unit was assigned to each stratum by simple random sampling. A trained team performed a random sample of 30 pregnancy clinical records in each HU; the records and the nutritional control cards were reviewed to assess whether the recommendations of the indicator were met. The percentage of compliance with the indicator was estimated. It was considered that an evaluated record complied with the indicator if it complied with its two sub-indicators. A traffic light system was used to present the results: good quality was considered as green (compliance ≥90%); poor quality as yellow (compliance 71% - 89%) and bad quality as red (compliance ≤70%). In addition, semi-structured interviews were conducted with health professionals and an observation guide was applied in health units. Results: A total of 95 HU were assessed. Of the 794 cases evaluated, only one met the two sub-indicators. A bad quality of nutritional care focused on supplementation during pregnancy was observed in the six states and in all HUs. It was identified that most HUs did not have a nutritionist and doctors and nurses recognized that they did not have the knowledge to give nutritional recommendations. Conclusions: It is necessary to implement actions aimed at improving the capacities of health professionals regarding the quality of nutritional care

El arte de la disección a través del tiempo.

Los cambios culturales, los avances en la ciencia y las nuevas tendencias en la educación médica han ocasionado modificaciones en las técnicas de disección y enseñanza de la anatomía, pues hasta hoy es impartida en las escuelas de medicina. En la actualidad, existe una forma regulada y legal de obtener cadáveres para la enseñanza e investigación; sin embargo, el papel de la disección ha sido objeto de debate en los últimos 30 años. La disección se analiza desde diversos puntos de vista: el educativo, el bioético y el de valores humanos; además, cuenta con variadas opiniones de profesores y estudiantes. Su práctica en algunas universidades de Estados Unidos y Europa muestra la situación actual y la tendencia de disección como herramienta de aprendizaje

Metabolomic Phenotype of Hepatic Steatosis and Fibrosis in Mexican Children Living with Obesity

Background and Objectives: Metabolic-dysfunction-associated steatotic liver disease or MASLD is the main cause of chronic liver diseases in children, and it is estimated to affect 35% of children living with obesity. This study aimed to identify metabolic phenotypes associated with two advanced stages of MASLD (hepatic steatosis and hepatic steatosis plus fibrosis) in Mexican children with obesity. Materials and Methods: This is a cross-sectional analysis derived from a randomized clinical trial conducted in children and adolescents with obesity aged 8 to 16 years. Anthropometric and biochemical data were measured, and targeted metabolomic analyses were carried out using mass spectrometry. Liver steatosis and fibrosis were estimated using transient elastography (Fibroscan® Echosens, Paris, France). Three groups were studied: a non-MASLD group, an MASLD group, and a group for MASLD + fibrosis. A partial least squares discriminant analysis (PLS-DA) was performed to identify the discrimination between the study groups and to visualize the differences between their heatmaps; also, Variable Importance Projection (VIP) plots were graphed. A VIP score of \u3e1.5 was considered to establish the importance of metabolites and biochemical parameters that characterized each group. Logistic regression models were constructed considering VIP scores of \u3e1.5, and the receiver operating characteristic (ROC) curves were estimated to evaluate different combinations of variables. Results: The metabolic MASLD phenotype was associated with increased concentrations of ALT and decreased arginine, glycine, and acylcarnitine (AC) AC5:1, while MASLD + fibrosis, an advanced stage of MASLD, was associated with a phenotype characterized by increased concentrations of ALT, proline, and alanine and a decreased Matsuda Index. Conclusions: The metabolic MASLD phenotype changes as this metabolic dysfunction progresses. Understanding metabolic disturbances in MASLD would allow for early identification and the development of intervention strategies focused on limiting the progression of liver damage in children and adolescents

Relative risk (RR) of macrosomia by state, Mexico, 2020.

Relative risk (RR) of macrosomia by state, Mexico, 2020.</p

FM incidence in live births in Mexico at the state level in males, 2020.

FM incidence in live births in Mexico at the state level in males, 2020.</p

Incidence of fetal macrosomia according to maternal and newborn characteristics.

Incidence of fetal macrosomia according to maternal and newborn characteristics.</p

National and state incidence of fetal macrosomia, Mexico 2020.

National and state incidence of fetal macrosomia, Mexico 2020.</p

FM incidence in live births in Mexico at the state level in females, 2020.

FM incidence in live births in Mexico at the state level in females, 2020.</p

Validation of the Childhood Family Mealtime Questionnaire in Mexican Adolescents with Obesity and Their Caregivers

Background: Childhood obesity is a significant public health concern in Mexico, with far-reaching implications for the nation’s healthcare system and economy. In light of this challenge, our study sought to validate the Childhood Family Mealtime Questionnaire (CFMQ) in Mexican adolescents living with obesity and their primary caregivers. Methods: A sample of 56 adolescents ages 13 to 17 years and their primary caregivers from one pediatric obesity clinic participated in the study. We conducted a comprehensive assessment of the CFMQ’s consistency, reliability, and construct validity among all participants. Internal consistency was determined using Cronbach’s α, and the questionnaire’s reliability was assessed through test–retest and intraclass correlation coefficients. Construct validity was assessed through an exploratory factor analysis. Results: Our findings confirmed strong internal consistency and reliability for both adolescents and caregivers. Construct validity was established through exploratory factor analysis, refining the questionnaire while preserving its original seven dimensions. This validation of the CFMQ highlights its applicability in evaluating family mealtime experiences in this context, providing valuable insights into the dynamics that influence adolescent nutrition and health. Conclusion: The CFMQ proves to be a reliable tool for assessing family mealtime experiences in Mexican adolescents living with obesity and their caregivers who seek care at third-level public hospitals

Low quality of maternal and child nutritional care at the primary care in Mexico: an urgent call to action for policymakers and stakeholders

Abstract Background Maternal and child malnutrition represents a public health problem in Mexico Primary care (PC) is responsible for introducing women and children under five to the health system, detecting diseases on time, and providing medical services, including pharmacological treatment if necessary. Providing these services with quality is essential to improve maternal and child health. This study evaluated the quality of nutritional care during preconception, pregnancy, postpartum, infancy, and preschool age at the PC health units across six Mexican states between 2020 and 2021. Methods We conducted a cross-sectional study with a mixed approach in units of the Secretary of Health to assess the quality of nutritional care during preconception, pregnancy, postpartum, childhood, and preschool age. The level of quality was calculated by the percentage of compliance with 16 indicators that integrated a Quality Index of Maternal and Child Nutritional Care (ICANMI, by its Spanish acronym). Compliance by indicator, by life stage, and overall was categorized using the following cut-off points: poor quality (≤ 70%), insufficient quality (71-89%), and good quality (≥ 90%). The perceptions of the barriers and facilitators that affect maternal and child nutrition were evaluated through semi-structured interviews with health professionals (HP) and users. All qualitative instruments were developed with a gender and intercultural perspective. Results Considering the whole sample studied, maternal and child nutritional care quality during the five life stages evaluated was bad (compliance: ≤12%), reflected in the ICANMI, which had a compliance of 8.3%. Principal barriers identified to providing high-quality nutritional care were the lack of knowledge and training of health professionals, shortages of equipment, medicine, personnel, and materials, the disappearance of the social cash transfer program Prospera, the absence of local indigenous language translators to support communication between doctor and patient, and the persistence of machismo and other practices of control over women. Conclusions These findings underscore the need for initiatives to improve the quality of nutritional care in PC facilities across Chihuahua, State of Mexico, Veracruz, Oaxaca, Chiapas, and Yucatan. It is necessary for government and health authorities, along with various stakeholders, to collaboratively devise, implement, and assess intercultural and gender-oriented policies and programs geared towards ensuring the health infrastructure and enhancing the training of health professionals to diagnose and treat the prevalence and occurrence of diverse forms of malnutrition in both maternal and child populations