Diseño y aplicación de instrumentos para el Diagnóstico Nutricional en Países en Vías de Desarrollo

INTRODUCCIÓN Los países cuyos ingresos son bajos o medios, como los que podemos hallar en América Latina, están experimentando una rápida transición epidemiológica y nutricional. Estos cambios están mediados por la urbanización y la adopción de estilos de vida occidentales, representados principalmente por cambios en los hábitos alimentarios y la reducción de la actividad física, lo que está generando, entre otras situaciones, un aumento de las tasas de obesidad. En la actualidad, Perú se encuentra en un estado de transición nutricional intermedio entre la tercera fase (remisión de la hambruna) y la cuarta (enfermedades degenerativas), al persistir el problema de la desnutrición infantil e incrementarse el del sobrepeso y la obesidad en niños y mujeres. El estudio se llevó a cabo en Iquitos, en el Centro Poblado de Pueblo Libre, que es un barrio muy deprimido ubicado en la zona periurbana y que sufre inundaciones entre los meses de febrero y junio. Esta localización le confiere un carácter de transición entre las comunidades cercanas a los ríos de la selva y la propia ciudad OBJETIVOS • OBJETIVO GENERAL: Evaluación nutricional de la población residente en el Sector 12 de Pueblo Libre • OBJETIVOS ESPECÍFICOS: Evaluar mediante parámetros antropométricos la situación nutricional del Sector 12 de Pueblo Libre, Identificar el aporte nutricional de la dieta habitualmente seguida por estos pobladores, conocer el valor nutricional de los principales platos consumidos por los pobladores de esta área y proponer alternativas alimentarias que sean eficaces y adaptadas a su cultura y entorno. MATERIAL Y MÉTODOS Se diseñó un estudio de prevalencia que se llevó a cabo entre Junio y Noviembre de 2012. Se realizó un muestreo aleatorio estratificado por edad y género con un tamaño muestral final de 217 individuos. A todos ellos se les hizo estudio antropométrico (talla, peso, IMC, complexión, perímetros y pliegues) para evaluar el estado nutricional. También se recogieron datos sobre hábitos alimentarios a través de entrevistas, observación de la preparación de las comidas y 80 de los participantes cumplimentaron 3 recordatorios de 24 horas, 2 en días laborales y otro en festivo. RESULTADOS 1. Un 6% de individuos en el grupo de menores de 5 años, padece una desnutrición aguda, y cerca de un 40% desnutrición crónica. En el grupo de 5 a 17 años, el 40.8% se ve afectado por carencias nutricionales fundamentalmente de tipo crónicas. El colectivo de mujeres mayores de 17 años presenta una mayor prevalencia de sobrepeso/obesidad que podría estar mediada fundamentalmente por factores socioculturales y de cuestión de género. 2. Este problema creciente de la obesidad parece relacionarse con el consumo de platos con alta densidad energética y con elevado contenido en grasas. La mayoría de los platos consumidos o sus guarniciones presentan una preparación frita, con un significativo aporte de lípidos en los platos. El sodio también es aportado en cantidades excesivas por los platos estudiados, fundamentalmente por el uso de sal como condimento además de salsa de soja y glutamato monosódico. 3. La comunidad estudiada presenta una alta prevalencia de hipertensión, por lo que el exceso de sal supone un elemento coadyuvante a la misma. 4. Los recordatorios de 24h evidencian un desequilibro en el aporte de micronutrientes con una elevada ingesta de proteínas y lípidos, pero baja en hidratos de carbonos. En cuanto a los elementos inorgánicos, se...BACKGROUND Low-­‐middle incomes countries, such as we find in Latin America, are experiencing a rapid epidemiological and nutritional transition. These changes are mediated by urbanization and the adoption of western lifestyles, defined by changes in eating habits and physical activity reduction. This situation is generating an increase in obesity rates. Currently, Peru is undergoing a nutritional state defined by the remission of famine and the increase of degenerative diseases, because the problem of child malnutrition persists meanwhile the overweight and obesity in children and women are increasing. The study was carried out in Iquitos, in Pueblo Libre, a slum located in a peri-­‐urban area and suffers flooding between February and June. This location gives it a transition between the communities near the rivers of the jungle and the city. AIMS GOAL: Nutritional assessment of the community living in Pueblo Libre (Sector 12) SPECIFIC OBJETIVES: To assess the nutritional status of this population, using anthropometric measures. To identify the nutritional characteristics of the diet usually followed by these people. To know the nutritional value of the main consumed dishes by the inhabitants of this area and propose alternative food that are effective and tailored to their culture and environment. METHODS A cross-­‐sectional study was carried out from June to November of 2012. We performed a stratified random sampling by age and gender. The sample size was 217. Anthropometric variables (height, weight, BMI, complexion, perimeters and folds) were measured to assess nutritional status. We also collected data on dietary habits through interviews, observation of preparing meals and 80 participants completed three 24-­‐hour recalls, 2 on weekdays and one on holiday. RESULTS 1. 6% of individuals in the group of children under 5 years suffer from acute malnutrition, and nearly 40% are stunting. In the group of 5-­‐17 years, 40.8% is affected by nutritional deficiencies, primarily chronic type. The group of women over 17 has a higher prevalence of overweight/obesity that may be mediated primarily by sociocultural and gender. 2. The growing problem of obesity seems to be associated to the consumption of energy-­‐dense food with high fat content. Most of the dishes consumed or its garnishes have a fried preparation, with a significant contribution of lipids on the plates. Sodium is also supplied in excessive quantities for dishes studied mainly by the use of salt as well as seasoning soy sauce and monosodium glutamate. 3. The community studied has a high prevalence of hypertension, so that excess of sodium intake is a contributory element to it. 4. 24h-­‐recalls showed an imbalance in the supply of micronutrients and high protein and fat intake, but low carbon hydrates. Inorganic elements like iron (except in some age groups of men), calcium and potassium are poorly in meals. We also found an excessive ingestion of sodium (all groups exceeding the recommended maximum). Vitamins are poorly provided too, unless specific exceptions suitably vitamin C and B12..

Buenas prácticas de innovación docente en la Universidad de Córdoba

El programa se basa en el uso de un nuevo soporte para impartir la asignatura de Nutrición y Genética en el grado de Enfermería, que no es otro que el foro. Con su puesta en marcha se propugna la generación de temas de debate entre el alumnado, se facilita el autoaprendizaje y el trabajo en equipo, además de fomentar un estilo de vida saludable, basado en una dieta equilibrada, el ejercicio físico y el abandono de hábitos tóxicos

The Effects of the Pilates Method on Pelvic Floor Injuries during Pregnancy and Childbirth: A Quasi-Experimental Study

The perineal injuries suffered during childbirth have a great impact on the quality of life of the female population. Evidence suggests that the Pilates method is used by pregnant women to improve the physical and psychological outcomes of pregnancy. The aim of this study was to investigate the influence of the Pilates Method during pregnancy on the incidence and degree of intrapartum perineal trauma. A quasi-experimental study was carried out between November 2018 and December 2019 at different health centers in two health districts. Participants were 72 pregnant women attending the antenatal program, who were assigned to a Pilates group or a control group (48 and 24 pregnant women, respectively). The main outcome measurement was perineal trauma during childbirth. After participating in the Pilates program, the women in the experimental group were significantly less likely to suffer perineal trauma in spontaneous deliveries compared to the women in the control group. After evaluating these results, it is concluded that health center managers should promote the training of midwives in the prevention and treatment of pelvic floor injuries during pregnancy and should consider strategies to enhance adhesion and participation with respect to pelvic floor exercise programs throughout pregnancy by means of Apps and other digital media specifically aimed at this phase

An Approach to Early Detection of Metabolic Syndrome through Non-Invasive Methods in Obese Children

Background: Metabolic Syndrome (MetS) has a high prevalence in children, and its presence increases in those with a high BMI. This fact confirms the need for early detection to avoid the development of other comorbidities. Non-invasive variables are presented as a cost-effective and easy to apply alternative in any clinical setting. Aim: To propose a non-invasive method for the early diagnosis of MetS in overweight and obese Chilean children. Methods: We conducted a cross-sectional study on 221 children aged 6 to 11 years. We carried out multivariate logistic regressions, receiver operating characteristic curves, and discriminant analysis to determine the predictive capacity of non-invasive variables. The proposed new method for early detection of MetS is based on clinical decision trees. Results: The prevalence of MetS was 26.7%. The area under the curve for the BMI and waist circumference was 0.827 and 0.808, respectively. Two decision trees were calculated: the first included blood pressure (≥104.5/69 mmHg), BMI (≥23.5 Kg/m2) and WHtR (≥0.55); the second used BMI (≥23.5 Kg/m2) and WHtR (≥0.55), with validity index of 74.7% and 80.5%, respectively. Conclusions: Early detection of MetS is possible through non-invasive methods in overweight and obese children. Two models (Clinical decision trees) based on anthropometric (non-invasive) variables with acceptable validity indexes have been presented. Clinical decision trees can be applied in different clinical and non-clinical settings, adapting to the tools available, being an economical and easy to measurement option. These methods reduce the use of blood tests to those patients who require confirmation

New Simplified Diagnostic Decision Trees for the Detention of Metabolic Syndrome in the Elderly

Background: A new simplified method for the detention of metabolic syndrome (MetS) is proposed using two variables (anthropometric and minimally invasive). Methods: A study of MetS prevalence was made on a sample of 361 older people. The anthropometric variables analyzed were: blood pressure, body mass index, waist circumference (WC), waist–height ratio, body fat percentage, and waist–hip ratio. A crude and adjusted binary logistic regression was performed, and receiver operating characteristic curves were obtained for determining the predictive capacity of those variables. For the new detection method, decision trees were employed using automatic detection by interaction through Chi-square. Results: The prevalence of the MetS was of 43.7%. The final decision trees uses WC and basal glucose (BG), whose cutoff values were: for men, WC ≥ 102.5 cm and BG > 98 mg/dL (sensitivity = 67.1%, specificity = 90.3%, positive predictive value = 85%, validity index = 79.9%); and for women, WC ≥ 92.5 cm and BG ≥ 97 mg/dL (sensitivity = 65.9%, specificity = 92.7%, positive predictive value = 87.1%, validity index = 81.3%). In older women the best predictive value of MetS was a WC of 92.5 cm. Conclusions: It is possible to make a simplified diagnosis of MetS in older people using the WC and basal capillary glucose, with a high diagnostic accuracy and whose use could be recommended in the resource-poor health areas. A new cutting point in older women for the WC should be valued

Nutritional Impact and Eating Pattern Changes in Schizophrenic Spectrum Disorders after Health Education Program on Symbiotic Dietary Modulation Offered by Specialised Psychiatric Nursing–Two-Arm Randomised Clinical Trial

Background: The traditional therapeutic approach has perceived the role of nutrition as a minor intervention in psychiatry. The microbiota–gut–brain axis theory evidences the influence of dietary and nutritional patterns on mental health. Aims: To evidence the impact of dietary advice on increasing symbiotic intake on nutritional status and dietary habits in individuals with schizophrenia spectrum disorders. Methods: Randomised clinical trial (two-arm, double-blind, balanced-block, six-month intervention) in 50 individuals diagnosed with schizophrenia spectrum disorders. The control group received conventional dietary advice on an individual basis. A personal nutritional education programme was established in the intervention group (IG) to increase prebiotic and probiotic intake through dietary advice (dairy and fermented foods, green leafy vegetables, high-fibre fruit, whole grains, etc.). Data on nutritional status and dietary habits were collected (baseline and six months). The degree of dietary adherence to the recommended patterns was recorded weekly. Anthropometric parameters were also analysed monthly. Results: Finally, 44 subjects completed the follow-up. All participants exceeded the dietary reference intakes. The overall and intra-group analysis showed a statistically significant (p < 0.05) reduction in macro and micronutrient intakes with a closer approximation to the recommended dietary intakes, except for polyunsaturated fatty acids, oligosaccharides, polysaccharides and dietary fibre. After six months of intervention, statistical differences (p < 0.001) were found in all variables of the anthropometric profile in the IG, as well as an increase in the consumption of foods with a high symbiotic content (at baseline and six months). Likewise, a reduction in eggs, meat, fish, sugars and ultra-processed foods was evident, leading to significant intra-group differences (p < 0.05). Conclusions: Implementing conventional nutritional education strategies and specific nutritional advice with a symbiotic effect improves the dietary-nutritional profile in patients with schizophrenia spectrum disorders. Furthermore, it highlights the nutritional impact on mental health, stating itself as adjuvant therapy for physical health and lifestyle improvement

Association between the FTO SNP rs9939609 and Metabolic Syndrome in Chilean Children

The increasing prevalence of obesity in children has raised the incidence of Metabolic Syndrome (MetS) in this age group. Given the short- and long-term health impact of MetS, it is essential to prevent its onset by detecting its main triggers. Besides, genetic factors play an essential role in influencing which individuals within a population are most likely to develop obesity in response to a particular environment. In this regard, a common variation in the FTO gene is reproducibly associated with BMI and obesity from childhood and the genetic load has been linked to several cardiovascular risk factors, highlighting the FTO single nucleotide polymorphism (SNP) rs9939609. Therefore, this study aimed to establish the relationship between the FTO SNP rs9939609 and MetS. Methods: A cross-sectional study was carried out on 220 children from the Biobío region (Chile). MetS diagnosis was established through the modified Cook criteria, using prevalence ratios, COR curves, and linear regressions to determine its association with MetS and its components. Results: The prevalence of MetS was significantly increased among carriers of the risk allele (A): TT, 20.2%; TA, 25.4%; AA, 44.7% (p = 0.006). Also, the presence of A was associated with altered MetS-related variables. Conclusions: The FTO SNP rs9939609 was associated with a raised prevalence of MetS among A allele carriers, and was higher in the homozygous genotype (AA)

Accuracy of the Resting Energy Expenditure Estimation Equations for Healthy Women

Background: There exist several prediction equations for the estimation of resting energy expenditure (REE). However, none of these equations have been validated in the Chilean female population yet. The aims of this study are (1) to determine the accuracy of existing equations for prediction of REE and (2) to develop new equations in a sample of healthy Chilean women. Methods: A cross-sectional descriptive study was carried out on 620 Chilean women. The sample showed an age range between 18 and 73 years, a body mass index average of 28.5 ± 5.2 kg/m2, and a prevalence of overweight and obesity of 41% and 33.2%, respectively. REE was measured by indirect calorimetry (REEIC), which was used as the gold standard to determine the accuracy of twelve available REE prediction equations and to calculate alternative formulas for estimation of REE. Paired t-tests and Bland–Altman plots were used to know the accuracy of the estimation equations with REEIC. At the same time, multiple linear regressions were performed to propose possible alternative equations. The analyses were carried out by age groups and according to nutritional status. Results: All the equations showed a tendency to overestimate REE, regardless of age or nutritional status. Overall, the Ireton-Jones equation achieved the highest mean percentage difference from REEIC at 67.1 ± 31%. The alternative new equations, containing variables of body composition, reached a higher percentage of classification within ± 10% of REEIC. Conclusions: The available equations do not adequately estimate REE in this sample of Chilean women. Although they must be validated, the new formulas proposed show better adaptation to this Chilean sample

Equation Córdoba: A Simplified Method for Estimation of Body Fat (ECORE-BF)

Background: Many methods for measuring body fat have been developed, but applications in clinical settings are limited. For this reason, researchers have tried to identify different formulas for its estimation but most of are hard to incorporate into daily work due to the variability in population and difficulty of use. The aim of this study was to develop and validate a new equation for the simplified estimation of body fat using the Clínica Universidad de Navarra – Body Adiposity Estimator (CUN-BAE) as a reference. Methods: This research was conducted in two phases. In the first, the new body fat estimation equation was developed. The developed equation was validated in the second phase. Pearson’s linear correlation, raw and adjusted linear regressions, the intraclass correlation coefficient, and Bland–Altman graphs were used. Results: The variables that best adjusted the body fat percentage were age, sex, and the Napierian logarithm of Body Mass Index (LnBMI), forming the Equation Córdoba for Estimation of Body Fat (ECORE-BF) model. In its validation, the model presented correlation values of 0.994, an intraclass correlation coefficient of 0.960, with the Bland–Altman graph indicating means differences of 1.82 with respect to the estimation with the CUN-BAE. Nevertheless, although the aim was to simplify the CUN-BAE, the main limitation of this study is that a gold standard, such as air displacement plethysmography (ADP) or dual-energy X-ray absorptiometry (DXA), was not used. Conclusions: The proposed equation (ECORE-BF) simplified the CUN-BAE and provided a precise method, respecting the principle of parsimony, for the calculation of body fat

Nutritional state, immunological and biochemical parameters, and mortality in the ICU: an analytical study

Intensive care unit (ICU) hospitalization involves critically ill patients with multiple diseases and possible complications, including malnutrition, which increases hospital stay and mortality. Therefore, identifying the patient’s prior nutritional state, following up during hospitalization, and implementing early intervention positively affect patient’s vital situations at discharge. The objective of this study is to determine the nutritional state of patients admitted to an ICU in Cali (Colombia) in 2019 and its association with immunological and biochemical parameters and mortality observed during hospitalization. This was an observational, analytical, and retrospective study of patients admitted to an ICU in a clinic in Cali (Colombia) from 1 January to 31 March 2019. The association between their nutritional state and outcome variables such as hospital stay, immunological and biochemical function, and mortality was analyzed. Logistic regression was used to predict patients’ vital status at hospital discharge. In terms of the nutritional level, low weight was observed in 17.5% patients, and overweight/obesity was observed in 53.5% of the population. Nutritional state was associated with leukocytosis. The patients with lymphocytosis had longer hospital stays than those with normal lymphocyte ranges. Age, blood leukocytes, and creatinine and potassium levels increased the risk of mortality. Lymphocyte values have been used as predictors of severity and hospitalization time. The scientific literature has also evidenced a higher leukocyte count in people with obesity, and such leukocytosis is associated with the risk of mortality. The results of blood and laboratory tests determining kidney function and blood electrolytes allow for the prediction of mortality risk in critically ill patients