The effect of exercise on cardiovascular risk markers in Mexican school-aged children: comparison between two structured group routines

Objective. To assess the effects of two groups of exercise routines on cardiovascular disease risk markers. Material and Methods. An intervention study was conducted with 319 Mexican school-aged children in which routines were implemented Monday through Friday for 12 weeks. Routine A was the reference group, with 20 min of less intense activity and routine B was the new group with 40 min of aerobic exercises. Body mass index (BMI), waist circumference, fat mass percentage (FM%), systolic and diastolic blood pressure, lipids, lipoproteins, glucose and insulin were measured before and after the intervention. Results. Routine A had an effect on diastolic pressure, while routine B had an effect on BMI, FM%, blood pressure and triglycerides. Routine B had a greater effect on blood pressure than routine A. The prevalence of obesity, high blood pressure and hypertriglyceridemia decreased in both groups. Conclusion. Aerobic exercise is an effective health promotion strategy to reduce some cardiovascular disease risk markers

Nutrition care for chronic kidney disease during pregnancy: an updated review

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AUTOCUIDADO EN DIABETES GESTACIONAL: ASOCIACIÓN CON FACTORES CLÍNICOS Y SOCIOECONÓMICOS

Describir  el autocuidado de un grupo de mujeres con diabetes mellitus gestacional (DMG) que  reciben tratamiento médico y dietoterapia y su relación con  algunos factores demográficos y socioeconómicos. Estudio transversal y descriptivo, realizado en 2009. Se invitó a mujeres asistentes a consulta prenatal del Instituto Nacional de Perinatología, con embarazo entre las semanas 30 a 34 de gestación, con DMG y que tenían por lo menos tres semanas con dieta indicada en el Instituto. El autocuidado fue evaluado a través de la adherencia al tratamiento dietético; automonitoreo capilar y actividad física. Se calcularon medidas de dispersión y tendencia central, ji cuadrada de Pearson  y T de Student. Participaron 30 embarazadas, de ellas, el 87% presentaron sobrepeso u obesidad pregestacional. La adherencia a la dieta fue de 81%, a la actividad física 66% y al automonitoreo 3%. El 83% tenían familiar con antecedentes de diabetes mellitus. Del 23% de mujeres con DMG, 57% de ellas realizó un autocuidado malo. Mujeres sin antecedentes de DMG realizaron más ejercicio físico que las que tenían antecedentes (p=0.053), ellas mismas obtuvieron puntaje más alto en autocuidado. El 60% de participantes que vivía cerca del Instituto llevó  autocuidado malo. Las embarazadas sin antecedentes de DMG obtuvieron en general mejor autocuidado  que las mujeres con antecedentes y mostraron una mayor tendencia a realizar actividad física. Las gestantes que vivían más lejos del Instituto, mostraron mejor autocuidado. Aunque hubo alto porcentaje de adherencia a la dieta, la práctica del automonitoreo de glucosa capilar fue muy poco común. Abstract To describe self-care behaviors of a group of women with gestational diabetes mellitus (GDM) receiving medical treatment and diet therapy and its relationship with demographic and socioeconomic factors. Cross-sectional study conducted in 2009. Women were invited to participate in the outpatient prenatal care at the National Institute of Perinatology, if they were pregnant (30-34 weeks of gestation), were diagnosed with GDM and had at least three weeks with a prescribed diet. Dietary, physical activity, self-monitoring of capillary glucose behaviors and prenatal visits were assessed with a specific questionnaire. .Descriptive statistics, Chi square test, Pearson correlation and Student t-test were used for analysis. A total of 30 pregnant women participated in the study; 87% were overweight or obese before pregnancy. Diet adherence was 81%, physical activity 66% and capillary glucose self monitoring was 3%. Most women (83%) had familiar history of diabetes mellitus and 23% had personal history of GDM. More than half of the women with history of GDM (57%) were classified as having inadequate self-care behaviors. Women without history of GDM reported to do more exercise than those with previous GDM (p=0.053), and obtained the highest score in self-care behaviors. Living near the hospital (60% of women) was related with worse self care behaviors. Women without personal history of GDM showed better self-care behaviors than women with previous GDM, with higher levels of exercise. Even though, diet adherence was acceptable, capillary glucose self-monitoring was not a common behavior in this group of women. Palabras clave: Embarazo, diabetes gestacional, autocuidado, adherenci

FACTORES SOCIOCULTURALES Y DEL ENTORNO QUE INFLUYEN EN LAS PRÁCTICAS ALIMENTARIAS DE GESTANTES CON Y SIN OBESIDAD

Identificar y describir factores socioculturales y del entorno que afectan las prácticas alimentarias de un grupo de gestantes mexicanas con y sin sobrepeso u obesidad. Estudio transversal descriptivo realizado en Instituto Nacional de Perinatología durante el 2009. Se invitó  a embarazadas asistentes a control prenatal y se dividieron en dos grupos: gestantes con peso normal y con sobrepeso u obesidad. A todas se aplicó una encuesta para identificar autopercepción del peso y  alimentación, preferencias de alimentos, creencias y fuentes de información.  Se calcularon medidas de dispersión y tendencia central, X2 de Pearson y T de Student. Participaron 301 gestantes. Las mayores de 30 años con sobrepeso u obesidad tuvieron mayor inconformidad con su peso corporal que las de IMC normal (42 vs 14%, p=0.001). El 34% de las gestantes practicó algún tratamiento para bajar de peso antes del embarazo. Una mayor proporción de participantes con peso normal reportó tener una alimentación buena o excelente comparadas con las de sobrepeso u obesidad (61% vs 39%, p=0.004) independientemente del nivel socioeconómico. La mayoría de las gestantes (95-97%) consideraron el sobrepeso u obesidad como factor de riesgo para presentar alguna co-morbilidad. La información sobre dietas y alimentación en todas las participantes se obtuvo principalmente de la familia (14% p=0.022). El 88% de las gestantes reportaron una influencia positiva de su pareja y/o madre. El 30% de las embarazadas omitieron un tiempo de comida de dos a tres veces por semana, y no consumieron los tres grupos de alimentos en forma constante. La falta de voluntad y de poder adquisitivo para la compra de ciertos alimentos fueron limitantes para una alimentación correcta. La obesidad es un problema prevalente en el embarazo. La falta de orientación resulta en prácticas alimentarias inadecuadas, posiblemente por falta de información o a que la información obtenida no siempre es la correcta. Es indispensable establecer estrategias educativas para brindar información veraz, tomando en cuenta el contexto de las mujeres, así como a sus familias. Abstract Identify and describe sociocultural and environmental factors affecting feeding practices in a group of Mexican pregnant women with and without obesity. Descriptive cross-sectional study conducted at the National Institute of Perinatology during 2009. Pregnant women who attend antenatal care were invited to participate and were divided into two groups: pregnant women with normal weight and overweight or obese. A survey was applied in all women in order to identify the self-perception of their weight and diet, food preferences, beliefs and sources of information. Measures of dispersion and central tendency (Pearson's X2 and T-Student) were calculated. A total of 301 pregnant women participate in this study. Overweight or obese women over 30 years were more dissatisfied with their actual weight than those with normal weight (42 vs 14%, p = 0.001). 34% of pregnant women underwent a loss weight treatment before pregnancy. A greater proportion of women with normal weight reported having a good or excellent diet compared with overweight or obese women (61% vs 39%, p = 0.004) regardless of socioeconomic status. Most pregnant women (95-97%) considered overweight or obesity as a risk factor for presenting comorbidities. The information about diet and nutrition was mainly obtained from the family (14% p = 0.022). A positive influence of their mother/partner was observed in 88% of pregnant women.  One third of the women skipped one meal time two to three times a week, and not always consumed foods from the three main food groups. The lack of will and money to purchase certain foods limited the practice of good eating habits. Obesity is prevalent problem in pregnancy. Lack of nutrition education results in inappropriate feeding practices, possibly because of lack of information or because the information obtained is not always the correct. It is essential to establish educational strategies to provide truthful information, taking into account the context of women and their families.Palabras clave: Embarazo, obesidad, creencias, prácticas alimentaria

Low Glycemic Index Carbohydrates versus All Types of Carbohydrates for Treating Diabetes in Pregnancy: A Randomized Clinical Trial to Evaluate the Effect of Glycemic Control

Background. Due to the higher prevalence of obesity and diabetes mellitus (DM), more pregnant women complicated with diabetes are in need of clinical care. Purpose. Compare the effect of including only low glycemic index (GI) carbohydrates (CHO) against all types of CHO on maternal glycemic control and on the maternal and newborn’s nutritional status of women with type 2 DM and gestational diabetes mellitus (GDM). Methods. Women (n=107, ≤29 weeks of gestation) were randomly assigned to one of two nutrition intervention groups: moderate energy and CHO restriction (Group 1: all types of CHO, Group 2: low GI foods). Results. No baseline differences in clinical data were observed. Capillary glucose concentrations throughout pregnancy were similar between groups. Fewer women in Group 2 exceeded weight gain recommendations. Higher risk of prematurity was observed in women in Group 2. No differences in glycemic control were observed between women with type 2 DM and those with GDM. Conclusions. Inclusion of low GI CHO as part of a comprehensive nutrition intervention is equally effective in improving glycemic control as compared to all types of CHO. This strategy had a positive effect in preventing excessive maternal weight gain but increased the risk of prematurity

Gestational Diabetes Mellitus and Diet: A Systematic Review and Meta-analysis of Randomized Controlled Trials Examining the Impact of Modified Dietary Interventions on Maternal Glucose Control and Neonatal Birth Weight

OBJECTIVE: Medical nutrition therapy is a mainstay of gestational diabetes mellitus (GDM) treatment. However, data are limited regarding the optimal diet for achieving euglycemia and improved perinatal outcomes. This study aims to investigate whether modified dietary interventions are associated with improved glycemia and/or improved birth weight outcomes in women with GDM when compared with control dietary interventions. RESEARCH DESIGN AND METHODS: Data from published randomized controlled trials that reported on dietary components, maternal glycemia, and birth weight were gathered from 12 databases. Data were extracted in duplicate using prespecified forms. RESULTS: From 2,269 records screened, 18 randomized controlled trials involving 1,151 women were included. Pooled analysis demonstrated that for modified dietary interventions when compared with control subjects, there was a larger decrease in fasting and postprandial glucose (−4.07 mg/dL [95% CI −7.58, −0.57]; P = 0.02 and −7.78 mg/dL [95% CI −12.27, −3.29]; P = 0.0007, respectively) and a lower need for medication treatment (relative risk 0.65 [95% CI 0.47, 0.88]; P = 0.006). For neonatal outcomes, analysis of 16 randomized controlled trials including 841 participants showed that modified dietary interventions were associated with lower infant birth weight (−170.62 g [95% CI −333.64, −7.60]; P = 0.04) and less macrosomia (relative risk 0.49 [95% CI 0.27, 0.88]; P = 0.02). The quality of evidence for these outcomes was low to very low. Baseline differences between groups in postprandial glucose may have influenced glucose-related outcomes. As well, relatively small numbers of study participants limit between-diet comparison. CONCLUSIONS: Modified dietary interventions favorably influenced outcomes related to maternal glycemia and birth weight. This indicates that there is room for improvement in usual dietary advice for women with GDM

To treat or not to treat: comparison of different criteria used to determine whether weight loss is to be recommended

Background: Excess body fat is a major risk factor for disease primarily due to its endocrine activity. In recent years several criteria have been introduced to evaluate this factor. Nevertheless, treatment need is currently assessed only on the basis of an individual's Body Mass Index (BMI), calculated as body weight (in kg) divided by height in m2. The aim of our study was to determine whether application of the BMI, compared to adiposity-based criteria, results in underestimation of the number of subjects needing lifestyle intervention. Methods: We compared treatment need based on BMI classification with four adiposity-based criteria: percentage body fat (%BF), considered both alone and in relation to metabolic syndrome risk (MS), waist circumference (WC), as an index of abdominal fat, and Body Fat Mass Index (BFMI, calculated as fat mass in kg divided by height in m2) in 63 volunteers (23 men and 40 women, aged 20 – 65 years). Results: According to the classification based on BMI, 6.3% of subjects were underweight, 52.4% were normal weight, 30.2% were overweight, and 11.1% were obese. Agreement between the BMI categories and the other classification criteria categories varied; the most notable discrepancy emerged in the underweight and overweight categories. BMI compared to almost all of the other adiposity-based criteria, identified a lower percentage of subjects for whom treatment would be recommended. In particular, the proportion of subjects for whom clinicians would strongly recommend weight loss on the basis of their BMI (11.1%) was significantly lower than those identified according to WC (25.4%, p = 0.004), %BF (28.6%, p = 0.003), and MS (33.9%, p = 0.002). Conclusion: The use of the BMI alone, as opposed to an assessment based on body composition, to identify individuals needing lifestyle intervention may lead to unfortunate misclassifications. Population-specific data on the relationships between body composition, morbidity, and mortality are needed to improve the diagnosis and treatment of at-risk individual

Insulin resistance and its association with the components of the metabolic syndrome among obese children and adolescents

<p>Abstract</p> <p>Background</p> <p>Insulin resistance is the primary metabolic disorder associated with obesity; yet little is known about its role as a determinant of the metabolic syndrome in obese children. The aim of this study is to assess the association between the degree of insulin resistance and the different components of the metabolic syndrome among obese children and adolescents.</p> <p>Methods</p> <p>An analytical, cross-sectional and population-based study was performed in forty-four public primary schools in Campeche City, Mexico. A total of 466 obese children and adolescents between 11-13 years of age were recruited. Fasting glucose and insulin concentrations, high density lipoprotein cholesterol, triglycerides, waist circumference, systolic and diastolic blood pressures were measured; insulin resistance and metabolic syndrome were also evaluated.</p> <p>Results</p> <p>Out of the total population studied, 69% presented low values of high density lipoprotein cholesterol, 49% suffered from abdominal obesity, 29% had hypertriglyceridemia, 8% presented high systolic and 13% high diastolic blood pressure, 4% showed impaired fasting glucose, 51% presented insulin resistance and 20% metabolic syndrome. In spite of being obese, 13% of the investigated population did not present any metabolic disorder. For each one of the components of the metabolic syndrome, when insulin resistance increased so did odds ratios as cardiometabolic risk factors.</p> <p>Conclusions</p> <p>Regardless of age and gender an increased degree of insulin resistance is associated with a higher prevalence of disorders in each of the components of the metabolic syndrome and with a heightened risk of suffering metabolic syndrome among obese children and adolescents.</p