This study aimed to identify risk factors for excessive adiposity and overweight in children from a region in Mexico with high obesity prevalence. The study examined 551 children aged 6-12 years. Independent risk factors for overweight/obesity were found to be having a first-degree relative with obesity, a sedentary lifestyle, and being the third child or younger. Having a first-degree relative with obesity underscores the impact of genes and family lifestyle on excessive adiposity. Being later in birth order may indicate different nurturing practices for younger offspring.
Miracle of Herbals and Natural Products in Treatment and Regulation of Obesityijtsrd
The perfect anti obesity sedate would deliver supported weight misfortune with negligible side effects. The instruments that direct vitality adjust have significant built in repetition, overlap considerably with other physiological capacities, and are affected by social, hedonic and psychological components that restrain the viability of pharmacological intercessions. It is therefore unsurprising that anti obesity medicate revelation programs have been littered with untrue starts, failures in clinical improvement, and withdrawals due to unfavorable impacts that were not fully appreciated at the time of dispatch. Drugs that target pathways in metabolic tissues, such as adipocytes, liver and skeletal muscle, have appeared potential in preclinical considers but none has however come to clinical development. Later enhancements within the understanding of peptidergic flagging of starvation and satiety from the gastrointestinal tract intervened by ghrelin, cholecystokinin CCK , peptide YY PYY and glucagon like peptide 1 GLP 1 Himangshu Jyoti Hazarika | Aziz Ahmed | Kaushal K. Chandrul ""Miracle of Herbals and Natural Products in Treatment and Regulation of Obesity"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-4 , June 2019, URL: https://www.ijtsrd.com/papers/ijtsrd23549.pdf
Paper URL: https://www.ijtsrd.com/pharmacy/other/23549/miracle-of-herbals-and-natural-products-in-treatment-and-regulation-of-obesity/himangshu-jyoti-hazarika
Aleitamento materno e adiposidade adultaLaped Ufrn
Aleitamento materno e adiposidade adulta (JPed 2014) - Artigo apresentado em Reunião Científica da Liga Acadêmica de Pediatria da UFRN - LAPED UFRN - Natal - RN - Brasil.
What is the epidemiological evidence linking early life events and cancer risk and what are the potential critical windows for cancer prevention?
By Professor Ricardo Uauy, University of Chile, London School of Hygiene and Tropical Medicine
World Cancer Congress, Saturday 6 December 2014
Background and Aims.Metabolic syndrome (MetS) is a disorder that includes a cluster
of several risk factors for the development of type 2 diabetes and cardiovascular disease.
The R230C variant of theABCA1gene has been associated with low HDL-cholesterol in
several studies, but its association with MetS in children remains to be determined. The
aim of this study was to analyze the association of the R230C variant with MetS and other
metabolic traits in school-aged Mexican children.
Methods.The study was performed in seven urban primary schools in the State of
Mexico. Four hundred thirty-two Mexican school-age children 6e13 years old were
recruited. MetS was identified using the International Diabetes Federation definition.
The R230C variant of theABCA1gene was genotyped to seek associations with MetS
and other metabolic traits.
Results.The prevalence of MetS was 29% in children aged 10e13 years. The R230C
variant was not associated with MetS (OR51.65;p50.139). Furthermore, in the whole
population, the R230C variant was associated with low HDL-cholesterol levels
(bcoefficient53.28,p!0.001). Interestingly, in the total population we found a novel
association of this variant with high triglyceride levels (b coefficient 514.34;
p50.027).
Conclusions.We found a new association of the R230C variant of the ABCA1 gene with
high triglyceride levels. Our findings also replicate the association of this variant with low
HDL-cholesterol levels in Mexican school-age children.
Taking account of research around the relationship between genetics and our new ‘food environment’, Dr Robyn Toomath (endocrinologist and Clinical Director Wellington Hospital) argues that we are in the middle of an obesity epidemic which impacts widely on public health. She advocates for new approaches to obesity based not on blame or impossible personal goals, but on outcomes. She argues it is the responsibility of all to become informed and active (personally and politically), in working for change to present health policies and gives examples of what can be done.
http://dosomething.org.nz
A Study Of Age At Menarche And Body Composition In School Girls Of Metro citiesijcite
Two thousand and seventeen subjects of various schools from two important metro cities in Maharashtra namely Mumbai and Pune in the age group of 10-14 year were studied to examine association between age at menarche and body composition. Data was collected through General Questionnaire & their body composition was assessed using analyzer (Tanita model no. BC 420 PM A). Out of the total sample, 370 students with mean age 12.35 year ±1.009 had attained menarche (AM) in the recent period of their recruitment whereas 1,646 girls had not attained menarche meaning they were perimenarcheal (PM) at the recruitment with mean age 11.42 year ±1.065. A concerning fact established by our study was that 10% of girls
from our population had attained menarche when they were just 11 yrs and 52.18% girls had attained menarche before they were 12 years of age. Results showed that All the body composition parameter except total body water percentage (TBW %) were higher in AM group compared to PM group. It was observed that fat percentage and fat mass was negatively
correlated with age at menarche which was statistically significant at 0.01 levels. Fat free mass, muscle mass, TBW (kg) were weakly negatively correlated whereas TBW (%) was positively correlated with age at menarche which was statistically significant at 0.01 levels.
Gynecological and Nutritional Risk Factors for Female Infertilityijtsrd
Backgrounds Besides aging, there are a number of modifiable lifestyle risk factors, such as smoking, elevated consumption of caffeine and alcohol, stress, chronic exposure to environmental pollutants, hormonal imbalance and other nutritional habits exert a negative impact on a women's fertility. The aim of present work was to study the gynecological and nutritional risk factors implicated in developing female infertility. Methodology This cross sectional study comprised of 109 women with infertility either primary or secondary . Data were collected using a questionnaire and in face to face interviews. The questionnaire include questions about risk factors, food intake history by 24 hours recall and modified FFQ beside data on anthropometric. Data was presented as either mean ± SD or frequencies and percentages according to the natural of data. Chi square test was used at a 0.05. Results Of the total samples 109 women with infertility aged between 17 40 years old shown that the peak age at 18 25 years old. The gynecological risk factors shown no significant differences. However, the obtained biochemical result revealed that abnormal high levels of estrogen, TSH, T4, LH, and testosterone, and abnormal low levels of FSH, and T3. The nutritional risk factors have been determined include low levels of serum vitamin D, and serum ferritin. In addition, women with infertility shown to have heavier body weight, overall BMI was 31.5 kg m2 by which the majorities of women found significant obesity P 0.05 , have high risk of waist circumferences and also WHR P 0.05 . The result of present work found that food intake and food pattern of women have low energy intake and their dietary habits shown lack fruits and fish intake with increased junk food consumption P 0.05 . Conclusion The gynecological risk factors can be modified. The correct balance of energy, vitamin D and iron in the daily diet provides essential benefit for an optimal female reproductive health and reduces the risk of infertility. In this context, the association of certain risk factor to develop of infertility could be ameliorate by increase intake of balance diet or triggers can be eliminated. Souad El-mani | Reima Mansour | Ali Ateia Elmabsout "Gynecological and Nutritional Risk Factors for Female Infertility" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-6 , October 2021, URL: https://www.ijtsrd.com/papers/ijtsrd47507.pdf Paper URL : https://www.ijtsrd.com/medicine/other/47507/gynecological-and-nutritional-risk-factors-for-female-infertility/souad-elmani
Miracle of Herbals and Natural Products in Treatment and Regulation of Obesityijtsrd
The perfect anti obesity sedate would deliver supported weight misfortune with negligible side effects. The instruments that direct vitality adjust have significant built in repetition, overlap considerably with other physiological capacities, and are affected by social, hedonic and psychological components that restrain the viability of pharmacological intercessions. It is therefore unsurprising that anti obesity medicate revelation programs have been littered with untrue starts, failures in clinical improvement, and withdrawals due to unfavorable impacts that were not fully appreciated at the time of dispatch. Drugs that target pathways in metabolic tissues, such as adipocytes, liver and skeletal muscle, have appeared potential in preclinical considers but none has however come to clinical development. Later enhancements within the understanding of peptidergic flagging of starvation and satiety from the gastrointestinal tract intervened by ghrelin, cholecystokinin CCK , peptide YY PYY and glucagon like peptide 1 GLP 1 Himangshu Jyoti Hazarika | Aziz Ahmed | Kaushal K. Chandrul ""Miracle of Herbals and Natural Products in Treatment and Regulation of Obesity"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-4 , June 2019, URL: https://www.ijtsrd.com/papers/ijtsrd23549.pdf
Paper URL: https://www.ijtsrd.com/pharmacy/other/23549/miracle-of-herbals-and-natural-products-in-treatment-and-regulation-of-obesity/himangshu-jyoti-hazarika
Aleitamento materno e adiposidade adultaLaped Ufrn
Aleitamento materno e adiposidade adulta (JPed 2014) - Artigo apresentado em Reunião Científica da Liga Acadêmica de Pediatria da UFRN - LAPED UFRN - Natal - RN - Brasil.
What is the epidemiological evidence linking early life events and cancer risk and what are the potential critical windows for cancer prevention?
By Professor Ricardo Uauy, University of Chile, London School of Hygiene and Tropical Medicine
World Cancer Congress, Saturday 6 December 2014
Background and Aims.Metabolic syndrome (MetS) is a disorder that includes a cluster
of several risk factors for the development of type 2 diabetes and cardiovascular disease.
The R230C variant of theABCA1gene has been associated with low HDL-cholesterol in
several studies, but its association with MetS in children remains to be determined. The
aim of this study was to analyze the association of the R230C variant with MetS and other
metabolic traits in school-aged Mexican children.
Methods.The study was performed in seven urban primary schools in the State of
Mexico. Four hundred thirty-two Mexican school-age children 6e13 years old were
recruited. MetS was identified using the International Diabetes Federation definition.
The R230C variant of theABCA1gene was genotyped to seek associations with MetS
and other metabolic traits.
Results.The prevalence of MetS was 29% in children aged 10e13 years. The R230C
variant was not associated with MetS (OR51.65;p50.139). Furthermore, in the whole
population, the R230C variant was associated with low HDL-cholesterol levels
(bcoefficient53.28,p!0.001). Interestingly, in the total population we found a novel
association of this variant with high triglyceride levels (b coefficient 514.34;
p50.027).
Conclusions.We found a new association of the R230C variant of the ABCA1 gene with
high triglyceride levels. Our findings also replicate the association of this variant with low
HDL-cholesterol levels in Mexican school-age children.
Taking account of research around the relationship between genetics and our new ‘food environment’, Dr Robyn Toomath (endocrinologist and Clinical Director Wellington Hospital) argues that we are in the middle of an obesity epidemic which impacts widely on public health. She advocates for new approaches to obesity based not on blame or impossible personal goals, but on outcomes. She argues it is the responsibility of all to become informed and active (personally and politically), in working for change to present health policies and gives examples of what can be done.
http://dosomething.org.nz
A Study Of Age At Menarche And Body Composition In School Girls Of Metro citiesijcite
Two thousand and seventeen subjects of various schools from two important metro cities in Maharashtra namely Mumbai and Pune in the age group of 10-14 year were studied to examine association between age at menarche and body composition. Data was collected through General Questionnaire & their body composition was assessed using analyzer (Tanita model no. BC 420 PM A). Out of the total sample, 370 students with mean age 12.35 year ±1.009 had attained menarche (AM) in the recent period of their recruitment whereas 1,646 girls had not attained menarche meaning they were perimenarcheal (PM) at the recruitment with mean age 11.42 year ±1.065. A concerning fact established by our study was that 10% of girls
from our population had attained menarche when they were just 11 yrs and 52.18% girls had attained menarche before they were 12 years of age. Results showed that All the body composition parameter except total body water percentage (TBW %) were higher in AM group compared to PM group. It was observed that fat percentage and fat mass was negatively
correlated with age at menarche which was statistically significant at 0.01 levels. Fat free mass, muscle mass, TBW (kg) were weakly negatively correlated whereas TBW (%) was positively correlated with age at menarche which was statistically significant at 0.01 levels.
Gynecological and Nutritional Risk Factors for Female Infertilityijtsrd
Backgrounds Besides aging, there are a number of modifiable lifestyle risk factors, such as smoking, elevated consumption of caffeine and alcohol, stress, chronic exposure to environmental pollutants, hormonal imbalance and other nutritional habits exert a negative impact on a women's fertility. The aim of present work was to study the gynecological and nutritional risk factors implicated in developing female infertility. Methodology This cross sectional study comprised of 109 women with infertility either primary or secondary . Data were collected using a questionnaire and in face to face interviews. The questionnaire include questions about risk factors, food intake history by 24 hours recall and modified FFQ beside data on anthropometric. Data was presented as either mean ± SD or frequencies and percentages according to the natural of data. Chi square test was used at a 0.05. Results Of the total samples 109 women with infertility aged between 17 40 years old shown that the peak age at 18 25 years old. The gynecological risk factors shown no significant differences. However, the obtained biochemical result revealed that abnormal high levels of estrogen, TSH, T4, LH, and testosterone, and abnormal low levels of FSH, and T3. The nutritional risk factors have been determined include low levels of serum vitamin D, and serum ferritin. In addition, women with infertility shown to have heavier body weight, overall BMI was 31.5 kg m2 by which the majorities of women found significant obesity P 0.05 , have high risk of waist circumferences and also WHR P 0.05 . The result of present work found that food intake and food pattern of women have low energy intake and their dietary habits shown lack fruits and fish intake with increased junk food consumption P 0.05 . Conclusion The gynecological risk factors can be modified. The correct balance of energy, vitamin D and iron in the daily diet provides essential benefit for an optimal female reproductive health and reduces the risk of infertility. In this context, the association of certain risk factor to develop of infertility could be ameliorate by increase intake of balance diet or triggers can be eliminated. Souad El-mani | Reima Mansour | Ali Ateia Elmabsout "Gynecological and Nutritional Risk Factors for Female Infertility" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-6 , October 2021, URL: https://www.ijtsrd.com/papers/ijtsrd47507.pdf Paper URL : https://www.ijtsrd.com/medicine/other/47507/gynecological-and-nutritional-risk-factors-for-female-infertility/souad-elmani
Normal Weight Obesity Is Associated with MetabolicSyndrome a.docxhenrymartin15260
Normal Weight Obesity Is Associated with Metabolic
Syndrome and Insulin Resistance in Young Adults from a
Middle-Income Country
Francilene B. Madeira1, Antônio A. Silva2*, Helma F. Veloso2, Marcelo Z. Goldani3, Gilberto Kac4,
Viviane C. Cardoso5, Heloisa Bettiol5, Marco A. Barbieri5
1 Physical Education Undergraduate Course, State University of Piauı́, Teresina, Brazil, 2 Department of Public Health, Federal University of Maranhão, São Luı́s, Brazil,
3 Department of Pediatrics and Puericulture, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil, 4 Department of Social and Applied
Nutrition, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil, 5 Department of Puericulture and Pediatrics, Faculty of Medicine of
Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
Abstract
Objective: This population-based birth cohort study examined whether normal weight obesity is associated with metabolic
disorders in young adults in a middle-income country undergoing rapid nutrition transition.
Design and Methods: The sample involved 1,222 males and females from the 1978/79 Ribeirão Preto birth cohort, Brazil,
aged 23–25 years. NWO was defined as body mass index (BMI) within the normal range (18.5–24.9 kg/m2) and the sum of
subscapular and triceps skinfolds above the sex-specific 90th percentiles of the study sample. It was also defined as normal
BMI and % BF (body fat) .23% in men and .30% in women. Insulin resistance (IR), insulin sensitivity and secretion were
based on the Homeostasis Model Assessment (HOMA) model.
Results: In logistic models, after adjusting for age, sex and skin colour, NWO was significantly associated with Metabolic
Syndrome (MS) according to the Joint Interim Statement (JIS) definition (Odds Ratio OR = 6.83; 95% Confidence Interval CI
2.84–16.47). NWO was also associated with HOMA2-IR (OR = 3.81; 95%CI 1.57–9.28), low insulin sensitivity (OR = 3.89; 95%CI
2.39–6.33), and high insulin secretion (OR = 2.17; 95%CI 1.24–3.80). Significant associations between NWO and some
components of the MS were also detected: high waist circumference (OR = 8.46; 95%CI 5.09–14.04), low High Density
Lipoprotein cholesterol (OR = 1.65; 95%CI 1.11–2.47) and high triglyceride levels (OR = 1.93; 95%CI 1.02–3.64). Most
estimates changed little after further adjustment for early and adult life variables.
Conclusions: NWO was associated with MS and IR, suggesting that clinical assessment of excess body fat in normal-BMI
individuals should begin early in life even in middle-income countries.
Citation: Madeira FB, Silva AA, Veloso HF, Goldani MZ, Kac G, et al. (2013) Normal Weight Obesity Is Associated with Metabolic Syndrome and Insulin Resistance
in Young Adults from a Middle-Income Country. PLoS ONE 8(3): e60673. doi:10.1371/journal.pone.0060673
Editor: Reury F.P Bacurau, University of São Paulo, Brazil
Received November 23, 2012; Accepted March 1, 201.
Epidemiological studies are applicable to communicable and non-com.docxSALU18
Epidemiological studies are applicable to communicable and non-communicable diseases. Childhood obesity is an area that is receiving more attention in public health due to the multiple morbidities that emerge as a result of this condition. Below are links to a cross-sectional study and a case-control study. Imagine that you are interested in conducting a case-control or cross-sectional study proposal of childhood obesity vs. birth weight (prenatal and early life influences). Both articles below address prenatal influences on childhood obesity and birth weight using different approaches.
Article 1 -attached
Article 2-attached
Using the information in the articles, answer the following questions using AMA format.
1. How would you select cases and controls for this study and how would you define exposure and outcome variables for a case-control study design? What other factors would you control for?
2. How would you design a proposal measuring the effect of birthweight on childhood obesity for a cross-sectional study design? What other factors would you control for?
BioMed CentralBMC Public Health
ss
Open AcceStudy protocol
Cross sectional study of childhood obesity and prevalence of risk
factors for cardiovascular disease and diabetes in children aged 11–
13
Anwen Rees*1, Non Thomas1, Sinead Brophy2, Gareth Knox1 and
Rhys Williams2
Address: 1Cardiff School of Sport, University of Wales Institute Cardiff, Wales, UK and 2School of Medicine, Swansea University, Wales, UK
Email: Anwen Rees* - [email protected]; Non Thomas - [email protected]; Sinead Brophy - [email protected];
Gareth Knox - [email protected]; Rhys Williams - [email protected]
* Corresponding author
Abstract
Background: Childhood obesity levels are rising with estimates suggesting that around one in
three children in Western countries are overweight. People from lower socioeconomic status and
ethnic minority backgrounds are at higher risk of obesity and subsequent CVD and diabetes.
Within this study we examine the prevalence of risk factors for CVD and diabetes (obesity,
hypercholesterolemia, hypertension) and examine factors associated with the presence of these
risk factors in school children aged 11–13.
Methods and design: Participants will be recruited from schools across South Wales. Schools
will be selected based on catchment area, recruiting those with high ethnic minority or deprived
catchment areas. Data collection will take place during the PE lessons and on school premises. Data
will include: anthropometrical variables (height, weight, waist, hip and neck circumferences, skinfold
thickness at 4 sites), physiological variables (blood pressure and aerobic fitness (20 metre multi
stage fitness test (20 MSFT)), diet (self-reported seven-day food diary), physical activity (Physical
Activity Questionnire for Adolescents (PAQ-A), accelerometery) and blood tests (fasting glucose,
insulin, lipids, fibrinogen (Fg), adiponectin (high molecular weight), C-react ...
External validation of an electronic phenotyping algorithm to detect attentio...TÀI LIỆU NGÀNH MAY
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tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
Ethnic differences, obesity and cancer,
stages of the obesity epidemic and cancer prevention
Professor TH Lam, JP, BBS
MD, FFPH, FFOM, Hon FHKCCM, FHKAM, FRCP
Sir Robert Kotewall Professor in Public Health, School of Public Health, The University of Hong Kong
UICC World Cancer Congress Melbourne, Australia 3-6 December 2014
1· The precise goal of the study or experiment· The populati.docxeugeniadean34240
1
· The precise goal of the study or experiment
· The population
· Your expected sample size
· How you will go about collecting your sample
· Exactly what statistical computations you expect to perform (hypothesis, null hypothesis, alternative hypothesis, type I and II error, significance level, critical value, P-value, etc.
· How you will present your results to the reader
· Itemized expected cost for your study in terms of time and money
Childhood Obesity among Pittsburgh School Students, Ages 6-12 Years
The hypothesis of if schools served healthier food and gave the children more time to eat as well as having more chances to be active, like recess and physical education, then child hood obesity rates would decrease drastically. This study will investigate effects of teaching obese children better habits of eating and exercise and improved habits and self-esteem. The children for the study will be drawn from the general school population (ages 6 to 12). Students (n = 20) will receive a brief intervention regarding nutrition, activity, and snacking. Students will serve as their own control. Each participant will be pre- and post-tested regarding eating behavior, activity, snacking behavior, and levels of self-esteem. The hypothesis will be tested through the application of quantitative analysis (one-way ANOVA) to the data collected
(Dotsch, Kokocinski, Knerr, Rascher, Rascher & Weigel, 2008).
The goal of this proposal is to study the prevalence of obesity among school children 6-12 years old in Pittsburgh Public Schools, and to identify any variation as per age, gender, place of residence, and type of school. Obesity is usually defined as more than 20 percent above ideal weight for a particular height and age ("Obesity,"). This proposal is addressed to meet the needs of children who have become obese due to environmental factors. If we can alter a few key and relatively simple areas in the lives of individuals, reinforce this within the schools and community, and re-evaluate the messages being sent in our culture, American school children will soon see an end to an excessive weight gain.
The results of this survey are important for the development of evidence-based practice guidelines and the overall process will have an impact on the clinical practice, research and dietetic policy.
School children between 6-12 years old will be sampled using stratified random sampling (SRS) with cumulative population proportionate from each school (cluster) of four districts. A total of 20 clusters will be selected by systematic sampling. The clusters spread out geographically by schools, and then the sample starts at a random cluster and then takes every 10th cluster in the list. First, take a separate SRS in each stratum to allow separate conclusions about each stratum. Then, a stratified sample will have a smaller margin of error than an SRS of the same size. Data will be analyzed using Body Mass Index (BMI- CDC) calculator and/or a .
ABSTRACT- Background: Malnutrition constitutes a major public health concern worldwide and serves as an indicator
of hospitalized patient’s prognosis. Nutritional support is an essential aspect of the clinical management of children
admitted to hospital. Malnutrition has been long associated with poor quality, poor diet and inadequate access to health
care, and it remains a key global health issue that both stems from and contributes to weakness, with 50% of childhood
deaths due to principal under nutrition.
Methods: The present hospital based cross sectional study was conducted in April to Dec 2015 among 300 rural
adolescents of 9-18 years age (146 boys and 154 girls) attending the outpatient department at Patna Medical College and
Hospital, Bihar, India, belonging to the all caste communities. The nutritional status was assessed in terms of under
nutrition (weight-for-age below 3rd percentile), stunting (Height-for-age below 3rd percentile) and thinness (BMI-for-age
below 5th percentile). Diseases were accepted as such as diagnosed by pediatrician, skin specialist and medical officer.
Results: The prevalence of underweight, stunting and thinness were found to be 31%, 22.3% and 30.7% respectively. The
maximum prevalence of malnutrition was observed among early adolescents (23% - 54%) and the most common
morbidities were diarrhoea (16.7%), carbuncle / furuncle (16.7%) and scabies (12%).
Conclusion: Malnutrition among hospitalized under five children and around suffers moderately high rates of
malnutrition. Present nutrition programs attention on education for at risk children and referral to regional hospitals for
malnourished children. Screening tools to classify children at risk of developing malnutrition might be helpful.
Key-words- Malnutrition, Hospitalized children, Morbidities, Prevalence, Stunting
Mortalidad asociada al diagnóstico de síndrome de Guillain-Barré en adultos i...Erwin Chiquete, MD, PhD
Mortality associated with a diagnosis of Guillain-Barré syndrome in adults of Mexican health institutions
Introduction. Guillain-Barré syndrome (GBS) is a neurological emergency representing the main cause of flaccid paralysis
around the world, affecting all age groups. Little is known about the essential epidemiology of GBS in most Latin American
countries.
Aim. To determine the mortality associated with the diagnosis of GBS in hospital discharges during 2010 in hospitals of
the Ministry of Health, Mexico.
Patients and methods. We analyzed the database of hospital discharges of institutions pertaining to the Ministry of
Health. Study cases were identified by the code G61.0 of the International Classification of Diseases, 10th revision (ICD-10).
We excluded records of patients younger than 18 years and patients without complete demographic information.
Results. During the year 2010 there were 2,634,339 discharges from hospitals of the Ministry of Health. We identified a
total of 467 hospitalizations due to GBS in adults (median age: 41 years; 62.1% male) from 121 health institutions of the
32 Republic States. The highest frequency of GBS hospitalizations occurred during summer and fall. The median hospital
stay was 8 days. The hospital mortality rate was 10.5%. The probability of death was directly associated with age, without
a particular trend regarding gender, hospital care or state.
Conclusions. In 2010 GBS hospital mortality in this part of the Mexican health system was higher than that reported in
contemporary studies. A seasonal association was observed regarding the frequency of hospitalizations for GBS.
Key words. Climate. Epidemiology. Guillain-Barré syndrome. Mortality. Mexico.
Rogelio Domínguez-Moreno, Paulina Tolosa-Tort, Anais Patiño-Tamez, Alejandra Quintero-Bauman,
Deisy K. Collado-Frías, María G. Miranda-Rodríguez, Obet J. Canela-Calderón, Pablo Hurtado-Valadez,
Raúl de Gante-Castro, Karoll M. Ortiz-Guillén, Bruno Estañol-Vidal, Horacio Sentíes-Madrid,
Guillermo García-Ramos, Carlos Cantú-Brito, José Luis Ruiz-Sandoval, Erwin Chiquete
Seroepidemiology of Toxoplasma gondii infection in drivers involved in road t...Erwin Chiquete, MD, PhD
Background: The prevalence of toxoplasmosis in the general population of Guadalajara, Mexico, is around 32%.
Toxoplasmosis can cause ocular lesions and slowing of reaction reflexes. Latent toxoplasmosis has been related
with traffic accidents. We aimed to assess the prevalence of anti-Toxoplasma gondii antibodies and visual
impairments related with traffic accidents in drivers from the metropolitan Guadalajara.
Methods: We prospectively evaluated the prevalence of IgG and IgM anti-T. gondii antibodies in 159 individuals
involved in traffic accidents, and in 164 control drivers never involved in accidents. Cases of toxoplasmosis
reactivation or acute infection were detected by PCR in a subset of 71 drivers studied for the presence of T. gondii
DNA in blood samples. Ophthalmologic examinations were performed in drivers with IgG anti-T. gondii antibodies
in search of ocular toxoplasmosis.
Results: Fifty-four (34%) traffic accident drivers and 59 (36%) controls were positive to IgG anti-T. gondii antibodies
(p = 0.70). Among the 113 seropositive participants, mean anti-T. gondii IgG antibodies titers were higher in traffic
accident drivers than in controls (237.9 ± 308.5 IU/ml vs. 122.9 ± 112.7 IU/ml, respectively; p = 0.01 by Student’s t
test, p = 0.037 by Mann–Whitney U test). In multivariate analyses, anti-T. gondii IgG antibody titers were consistently
associated with an increased risk of traffic accidents, whereas age showed an inverse association. The presence of
IgM-anti-T. gondii antibodies was found in three (1.9%) subjects among traffic accident drives, and in two (1.2%)
controls. Three (4.2%) samples were positive for the presence of T. gondii DNA, all among seropositive individuals.
No signs of ocular toxoplasmosis were found in the entire cohort. Moreover, no other ocular conditions were found
to be associated with the risk of traffic accidents in a multivariate analysis.
Conclusions: Anti-T. gondii antibody titers are associated with the risk of traffic accidents. We could not determine
any association of ocular toxoplasmosis with traffic accidents. Our results warrant further analyses in order to clarify
the link between toxoplasmosis and traffic accidents.
Tiempo de llegada hospitalaria y pronóstico funcional después deun infarto ce...Erwin Chiquete, MD, PhD
Introducción: La información sobre el tiempo de llegada hospitalaria después de un infartocerebral (IC) se ha originado en países con unidades especializadas en ictus. Existe poca infor-mación en naciones emergentes. Nos propusimos identificar los factores que influyen en eltiempo de llegada hospitalaria a 1, 3 y 6 h y su relación con el pronóstico funcional después delictus.Métodos: Se analizó la información de pacientes con IC incluidos en el estudio Primer RegistroMexicano de Isquemia Cerebral (PREMIER) que tuvieran tiempo definido desde el inicio de lossíntomas hasta la llegada hospitalaria. El desenlace funcional se evaluó mediante la escalamodificada de Rankin a los 30 días, 3, 6 y 12 meses.Resultados: De 1.096 pacientes con IC, 61 (6%) llegaron en < 1 h, 250 (23%) en < 3 h y 464 (42%)en < 6 h. Favorecieron la llegada temprana en < 1 h: el antecedente familiar de cardiopatíaisquémica y ser migra˜noso; en < 3 h: edad 40-69 a˜nos, antecedente familiar de hipertensión,antecedente personal de dislipidemia y cardiopatía isquémica, así como la atención en hospitalprivado; en < 6 h: antecedente familiar de hipertensión, ser migra˜noso, ictus previo, cardiopatíaisquémica y atención en hospital privado. La llegada hospitalaria tardía se asoció a ictus lacunary alcoholismo. Solo el 2,4% recibió trombólisis. Independientemente de la trombólisis, la llegadaen < 3 h se asoció a menor mortalidad a los 3 y 6 meses, además de menos complicacionesintrahospitalarias.
Comportamiento del barorreflejo en pacientes con síncope vasovagal durante el...Erwin Chiquete, MD, PhD
Caroline Malamud-Kessler, Bruno Estañol-Vidal, Óscar Infante-Vázquez, Miguel Campos-Sánchez,
Erwin Chiquete
Introducción. El síncope mediado neuralmente, también conocido como síncope vasovagal, se define como la pérdida
súbita y transitoria del estado de alerta como consecuencia de un descenso brusco y profundo de la presión arterial.
Objetivo. Conocer las diferencias de los parámetros hemodinámicos que median el barorreflejo durante el ortostatismo
activo en pacientes con diagnóstico clínico de síncope vasovagal y sujetos sanos.
Sujetos y métodos. Estudio transversal, observacional y comparativo. Se incluyeron 20 pacientes con diagnóstico de síncope
neuralmente mediado y 30 controles, a los que se les practicó la prueba de ortostatismo activo y se les registró por
finometría la presión arterial sistólica (PAS) y la frecuencia cardíaca (intervalo entre latidos) de manera continua (latido a
latido) y no invasiva.
Resultados. Los pacientes con síncope presentaron una PAS basal con una media significativamente mayor que la de los
sanos. Las magnitudes medidas desde la PAS basal demostraron una diferencia significativa, que era de menor valor en el
grupo de los controles. No se demostraron diferencias entre grupos en la caída de la PAS desde el primer pico, recuperación
de la PAS desde la sima o en las latencias medidas en la frecuencia cardíaca.
Conclusiones. La PAS basal y la caída de la PAS medida desde la basal en posición supina fue mayor en los pacientes con
síncope mediado neuralmente que en los sujetos sanos. La magnitud de la elevación de la frecuencia cardíaca tuvo una
tendencia a ser mayor en el grupo de pacientes en comparación con el grupo control. Esto sugiere una hiperactividad
simpática en los pacientes con síncope
Delírium en adultos que reciben cuidados paliativos: revisión de laliteratura...Erwin Chiquete, MD, PhD
Delírium en adultos que reciben cuidados paliativos: revisión de laliteratura con un enfoque sistemáticoSofía Sánchez-Romána, Cristina Beltrán Zavalab, Argelia Lara Solaresby ErwinChiquetea,∗
El delírium en pacientes que reciben cuidados paliativos es frecuente y constituyeun importante reto de diagnóstico y tratamiento. Nuestro objetivo fue realizar en 2 fases unanálisis bibliométrico de la evidencia científica reciente (2007 a 2012) sobre diagnóstico y tra-tamiento del delírium en adultos en cuidados paliativos. En la fase 1 (estudios descriptivos yrevisiones narrativas) se identificaron 133 artículos relevantes: 73 trataron el tema del delíriumde forma secundaria y en 60 artículos como tema principal. Sin embargo, solo se identificaron4 estudios observacionales prospectivos en los que el delírium fue central. De 135 artículos iden-tificados en la fase 2 (ensayos clínicos o estudios descriptivos sobre tratamiento del delírium enpacientes paliativos), solo 3 fueron sobre prevención o tratamiento: 2 estudios retrospectivosy un ensayo clínico sobre prevención multicomponente en pacientes con cáncer. Gran parte dela literatura reciente corresponde a revisiones que hablan de estudios realizados hace másde una década en pacientes diferentes a los que reciben cuidados paliativos. En conclusión, laevidencia científica reciente sobre el delírium en cuidados paliativos es escasa y subóptima.Urgen estudios prospectivos que se enfoquen específicamente en esta población altamentevulnerable.
Central Adiposity and Mortality after First-Ever Acute Ischemic StrokeErwin Chiquete, MD, PhD
Erwin Chiquete a José L. Ruiz-Sandoval c Luis Murillo-Bonilla e
Carolina León-Jiménez g Bertha Ruiz-Madrigal d, f Erika Martínez-López d, f
Sonia Román d, f Arturo Panduro d, f Alma Ramos b Carlos Cantú-Brito
Background: The waist-to-height ratio (WHtR) may be a better
adiposity measure than the body mass index (BMI). We
evaluated the prognostic performance of WHtR in patients
with acute ischemic stroke (AIS). Methods: First, we compared
WHtR and BMI as adiposity measures in 712 healthy
adults by tetrapolar bioimpedance analysis. Thereafter,
baseline WHtR was analyzed as predictor of 12-month allcause
mortality in 821 Mexican mestizo adults with first-ever
AIS by a Cox proportional hazards model adjusted for baseline
predictors. Results: In healthy individuals, WHtR correlated
higher than BMI with total fat mass and showed a higher
accuracy in identifying a high percentage of body fat (p <
0.01). In AIS patients a U-shaped relationship was observed
between baseline WHtR and mortality (fatality rate 29.1%).
On multivariate analysis, baseline WHtR ≤ 0.300 or >0.800 independently
predicted 12-month all-cause mortality (h
José L. Ruiz-Sandoval, Guadalupe Ramírez-Guzmán,
Erwin Chiquete and Ángel Vargas-Sánchez
A 45-year-old garbage collector was referred to our department
with a history of tonic-clonic seizures and risky
sexual behavior (anilingus). A neurological examination was
normal. Contrast-enhanced cranial CT showed calcified lesions
and viable parasites compatible with a diagnosis of
massive non-encephalitic neurocysticercosis. Oral metallic
implants impeded performing brain MRI. Hepatitis and HIV
serologies were negative. The patient was discharged with
steroids and an anticonvulsant. Delayed cysticidal therapy
was planned; however, albendazole therapy was immediately
initiated in another hospital, which led to brain edema, uncontrolled
seizures, rostrocaudal deterioration and death.
Cestoda infections are rare in developed countries (1). In
contrast, neurocysticercosis is a leading cause of adult-onset
epilepsy in Latin America. Massive infections are classified
as encephalitic or non-encephalitic (2). In patients with the
encephalitic presentation, cysticidal drugs can cause extensive
parasite lysis and aggravate brain inflammation (2). In
patients with non-encephalitic massive neurocysticercosis,
cysticidal therapy is usually considered; (2) however, rapid
initiation of antiparasitic medications can launch an encephalitic
process.
Cost of care according to disease-modifying therapy in Mexicans with relapsin...Erwin Chiquete, MD, PhD
Miguel A. Macı´as-Islas • Isaac F. Soria-Cedillo • Merced Velazquez-Quintana •
Victor M. Rivera • Vero´nica I. Baca-Muro • Edith A. Lemus-Carmona • Erwin Chiquete
Limited data exist on the costs of care of
patients with multiple sclerosis (MS) in low- to middleincome
nations. The purpose of this study was to describe
the economic burden associated with care of Mexican
patients with relapsing-remitting MS in a representative
sample of the largest institution of the Mexican public
healthcare system. We analysed individual data of 492
patients (67 % women) with relapsing-remitting MS registered
from January 2009 to February 2011 at the Mexican
Social Security Institute. Direct costs were measured about
the use of diagnostic tests, disease-modifying therapies
(DMTs), symptoms control, medical consultations,
relapses, intensive care and rehabilitation. Four groups
were defined according to DMT alternatives: (1) interferon
beta (IFNb)-1a, 6 million units (MU); (2) IFNb-1a, 12MU;
(3) IFNb-1b, 8MU; and (4) glatiramer acetate. All patients
received DMTs for at least 1 year. The most frequently
used DMT was glatiramer acetate (45.5 %), followed by
IFNb-1a 12MU (22.6 %), IFNb-1b 8MU (20.7 %), and
IFNb-1a 6MU (11.2 %). The mean cost of a specialised
medical consultation was €74.90 (US $107.00). A single
relapse had a mean total cost of €2,505.97 (US $3,579.96).
No differences were found in annualised relapse rates and
costs of relapses according to DMT. However, a significant
difference was observed in total annual costs according to
treatment groups (glatiramer acetate being the most
expensive), mainly due to differences in unitary costs of
alternatives. From the public institutional perspective,
when equipotent DMTs are used in patients with comparable
characteristics, the costs of DMTs largely determine
the total expenses associated with care of patients with
relapsing-remitting MS in a middle-income country.
Blood pressure at hospital admission and outcome after primary intracerebral ...Erwin Chiquete, MD, PhD
Introduction: The importance of the admission blood pressure (BP) for intracerebral
hemorrhage (ICH) outcome is not completely clear. Our objective was to
analyze the clinical impact of BP at hospital arrival in patients with primary ICH.
Material and methods: We studied 316 patients (50% women, mean age:
64 years, 75% with hypertension history) with acute primary ICH. The first BP reading
at admission was evaluated for its association with neuroimaging findings
and outcome. A Cox proportional hazards model and Kaplan-Meier analyses
were constructed to evaluate factors associated with in-hospital mortality.
Results: Intraventricular irruption occurred in 52% of cases. A high frequency
of third ventricle extension was observed in patients with BP readings in the
upper quartiles of the distribution (systolic, diastolic, or mean arterial pressure).
Blood pressure readings did not correlate with hematoma volumes. In-hospital
case fatality rate was 46% (63% among those with ventricular irruption). Systolic
BP (SBP) > 190 mm Hg was independently associated with in-hospital mortality
in supratentorial (n = 285) ICH (hazard ratio: 1.19, 95% confidence interval:
1.02-1.38, for the highest vs. the lowest quartile) even after adjustment for
known strong predictors (age, ICH volume, Glasgow coma scale and ventricular
extension). Blood pressure was not significantly associated with ventricular
extension or outcome in patients with infratentorial ICH.
Conclusions: A high BP on admission is associated with an increased risk of
intraventricular extension and early mortality in patients with supratentorial
ICH. However, a significant proportion of patients with high BP readings without
ventricular irruption still have an increased risk of death.
Serum Uric Acid and Outcome after Acute Ischemic Stroke: PREMIER StudyErwin Chiquete, MD, PhD
Background: Current evidence shows that uric acid is a potent
antioxidant whose serum concentration increases rapidly
after acute ischemic stroke (AIS). Nevertheless, the relationship
between serum uric acid (SUA) levels and AIS
outcome remains debatable. We aimed to describe the
prognostic significance of SUA in AIS. Methods: We studied
463 patients (52% men, mean age 68 years, 13% with glomerular
filtration rate <60 />2) at 30 days, or with
any outcome measure at 3, 6 or 12 months poststroke. After
adjustment for age, gender, stroke type and severity (NIHSS
<9),><24 h. Conclusions: A low SUA
concentration is modestly associated with a very good
short-term outcome. Our findings support the hypothesis
that SUA is more a marker of the magnitude of the cerebral
infarction than an independent predictor of stroke outcome.
Hepatitis C virus infection and type 2 diabetes mellitus in Mexican patients. Erwin Chiquete, MD, PhD
34. Chiquete E, Ochoa-Guzmán A, García-Lamas L, Anaya-Gómez F, Gutiérrez-Manjarrez JI, Sánchez-Orozco LV, Godínez-Gutiérrez SA, Maldonado M, Román S, Panduro A. Hepatitis C virus infection and type 2 diabetes mellitus in Mexican patients. Rev Med Inst Mex Seguro Soc. 2012;50(5):481-6. [PMID: 23282259]
Atherothrombotic Disease, Traditional Risk Factors, and 4-Year Mortality in a...Erwin Chiquete, MD, PhD
Erwin Chiquete, MD, PhD
Background: Atherothrombosis is becoming the leading cause of chronic morbidity in developing countries. This
epidemiological transition will represent an unbearable socioeconomic burden in the near future. We investigated
factors associated with 4-year all-cause mortality in a Latin American population at high risk.
Hypothesis: Largely modifiable risk factors as well as polyvascular disease are the main predictors of 4-year all-cause and
cardiovascular mortality in this Latin American cohort.
Methods: We analyzed 1816 Latin American stable outpatients (62.3% men, mean age 67 years) with symptomatic
atherothrombosis (87.1%) or with multiple risk factors only (12.9%), in the Reduction of Atherothrombosis for Continued
Health registry.
Results: Of patients with symptomatic atherothrombosis, 57.3% had coronary artery disease, 32% cerebrovascular disease,
and 11.7% peripheral artery disease at baseline (9.1% polyvascular). The main risk factors were hypertension (76%),
hypercholesterolemia (60%), and smoking (52.3%) in patients with established atherothrombosis; and hypertension
(89.7%), diabetes (80.8%), and hypercholesterolemia (73.9%) in those with risk factors only. Four-year all-cause mortality
steeply increased with none (6.8%), 1 (9.2%), 2 (15.5%), and 3 (29.2%) symptomatic arterial disease locations. In patients
with only 1 location, cardiovascular mortality was significantly higher with peripheral artery disease (11.3%) than with
cerebrovascular disease (6%) or coronary artery disease (5.1%). Significant baseline predictors of 4-year all-cause mortality
were congestive heart failure (hazard ratio [HR]: 3.81), body mass index<20 (HR: 2.32), hypertension (HR: 1.84), polyvascular
disease (HR: 1.69), and age ≥65 years (HR: 1.47), whereas statin use (HR: 0.49) and body mass index ≥30 (HR: 0.58) were
associated with a reduced risk.
Conclusions: Hypertension was the main modifiable risk factor for atherothrombosis and all-cause mortality in this Latin
José L. Ruiz-Sandoval, Erwin Chiquete,
Lucía E. Álvarez-Palazuelos, Miguel
A. Andrade-Ramos & Luis R. Rodríguez-
Rubio
Osmotic demyelination syndrome (ODS) is the
damage over the central nervous system caused by several
electrolytes, metabolic and toxic disorders. We aimed to
describe cases of unusual forms of ODS. In a 9-year period,
25 consecutive patients with ODS (15 men; mean age
42 years) were registered in our referral institution, among
them, four (16 %) with atypical neuroimaging findings
were abstracted for this communication. None of them
presented cardiorespiratory arrest, head trauma, seizures,
neuromyelitis optica spectrum or contact with toxic
chemicals. Case 1 was a 33-year-old alcoholic man without
hypertension or electrolyte imbalance, who presented a
classic central pontine myelinolysis (CPM) and a hemorrhage
within the pons. Case 2 was a 34-year-old alcoholic
man with hypoglycemia and hyponatremia who presented
CPM and diffuse bihemispheric extrapontine myelinolysis
(EPM) after correction of serum sodium. Case 3 was a
52-year-old woman with mild hypokalemia and hyponatremia
(inadequately corrected), who presented a peduncular
and cerebellar EPM. Case 4 was a 67-year-old
woman who had a suicidal attempt with antidepressants
and carbamazepine without impaired consciousness, who
complicated with mild hyponatremia associated with a
classical CPM and a spinal cord EPM. Case 2 died and the
rest remained with variable neurological impairments at
last follow-up visit. With modern neuroimaging, the
so-called atypical forms of ODS may not be as rare as
previously thought; however, they could have a more
adverse outcome than the classical ODS.
Spontaneous intracerebral hemorrhage in Mexico: results from a Multicenter Na...Erwin Chiquete, MD, PhD
Introduction. Scarce information exists on intracerebral hemorrhage (ICH) in Latin America, and the existent is derived
from single-center registries with non-generalizable conclusions. The aim of this study is to describe the frequency, etiology,
management and outcome of ICH in Mexico.
Patients and methods. We studied consecutive patients with ICH pertaining to the National Multicenter Registry on Cerebrovascular
Disease (RENAMEVASC), conducted in 25 centers from 14 states of Mexico. The Intracerebral Hemorrhage Grading
Scale (ICH-GS) at admission was used to assess prognosis at 30 days follow-up.
Results. Of 2,000 patients with acute cerebrovascular disease registered in RENAMEVASC, 564 (28%) had primary ICH
(53% women; median age: 63 years; interquartile range: 50-75 years). Hypertension (70%), vascular malformations (7%)
and amyloid angiopathy (4%) were the main etiologies. In 10% of cases etiology could not be determined. Main ICH
locations were basal ganglia (50%), lobar (35%) and cerebellum (5%). Irruption into the ventricular system occurred in
43%. Median score of ICH-GS was 8 points: 49% had 5-7 points, 37% had 8-10 points and 15% had 11-13 points. The 30-day
case fatality rate was 30%, and 31% presented severe disability. The 30-day survival was 92% for patients with ICH-GS 5-7
points, whereas it decreased to 27% in patients with ICH-GS 11-13 points.
Conclusions. In Mexico, ICH represents about a third of the forms of acute cerebrovascular disease, and the majority of
patients present severe disability or death at 30 days of follow-up. Hypertension is the main cause; hence, control of this
important cardiovascular risk factor should reduce the health burden of ICH.
An Expandable Prosthesis with Dual Cage-and-Plate Function in a Single Device...Erwin Chiquete, MD, PhD
Juan J. Ramı´rez, Erwin Chiquete, Juan J. Ramı´rez, Jr., Ernesto Go´mez-Limo´n, and Juan M. Ramı´rez
An expandable vertebral body prosthesis with dual cage-and-plate function in a single
device (JR prosthesis) was designed to test the hypothesis that this modular system can
provide the biomechanical requirements for immediate and durable spine stabilization
after corpectomy. Cadaver assays were performed with a stainless steal device to test fixation
and adequacy to the human spine anatomy. Then, 14 patients with vertebral tumors
(eight metastatic) underwent corpectomy and vertebral body replacement with a titaniummade
JR prosthesis. All patients had neurological deficit, severe pain and spine instability
prior to surgery. Mean pain score before surgery on a visual analog scale decreased from
7.6e3.0 points after operation ( p 5 0.002). All patients achieved at least one grade of
improvement in the Frankel score ( p 5 0.003), excepting the three patients with Frankel
grade A before surgery. Two patients with renal cell carcinoma died during the following
4 days after surgery. The remaining patients attained a painless and stable spine immediately,
which was maintained for long periods (mean follow-up: 25.4 months). No significant
infections or implant failures were registered. A nonfatal case of inferior vena cava
surgical injury was observed (repaired during surgery without further complications). In
conclusion, the JR prosthesis stabilizes the spine immediately after surgery and for the
rest of the patients’ life. To our knowledge, this is the first report on the clinical experience
of any expandable vertebral body prosthesis with dual cage-and-plate function in
a single device.
Expression profile of BRCA1 and BRCA2 genes in premenopausal Mexican women wi...Erwin Chiquete, MD, PhD
Gloria Loredo-Pozos, Erwin Chiquete,
Antonio Oceguera-Villanueva, Arturo Panduro,
Fernando Siller-Lo´pez, Martha E. Ramos-Márquez
Low BRCA1 gene expression is associated with
increased invasiveness and influences the response of
breast carcinoma (BC) to chemotherapeutics. However,
expression of BRCA1 and BRCA2 genes has not been
completely characterized in premenopausal BC. We analyzed
the clinical and immunohistochemical correlates of
BRCA1 and BRCA2 expression in young BC women. We
studied 62 women (mean age 38.8 years) who developed
BC before the age of 45 years. BRCA1 and BRCA2 mRNA
expression was assessed by reverse transcriptase-polymerase
chain reaction (RT-PCR) and that of HER-2 and
p53 proteins by immunohistochemistry. Body mass index
(BMI) C27 (52%) and a declared family history of BC
(26%) were the main risk factors. Ductal infiltrative adenocarcinoma
was found in 86% of the cases (tumor size
[5 cm in 48%). Disease stages I–IV occurred in 2, 40, 55,
and 3%, respectively (73% implicating lymph nodes).
Women aged B35 years (24%) had more family history of
cervical cancer, stage III/IV disease, HER-2 positivity, and
lower BRCA1 expression than older women (P-.05).
BRCA1 and BRCA2 expression correlated in healthy, but
not in tumor tissues (TT). Neither BRCA1 nor BRCA2
expression was associated with tumor histology, differentiation,
nodal metastasis or p53 and HER-2 expression.
After multivariate analysis, only disease stage explained
BRCA1 mRNA levels in the lowest quartile. Premenopausal
BC has aggressive clinical and molecular
characteristics. Low BRCA1 mRNA expression is associated
mainly with younger ages and advanced clinical stage
of premenopausal BC. BRCA2 expression is not associated
with disease severity in young BC women.
En conclusión, la neurotoxicidad por exposición
crónica a PDCB es rara y ha sido poco descrita
en la bibliografía. Las propiedades lipofílicas de
este compuesto producen desmielinización central,
y dan lugar a leucoencefalopatía difusa,
supra e infratentorial. Las manifestaciones más
frecuentemente descritas son agudas, y son de
interés particular, en nuestro paciente, las manifestaciones
cognitivas de tipo demenciales en
un seguimiento a largo plazo. Las recomendaciones
domésticas deben dirigirse a evitar el
contacto por parte de los menores de edad con
este compuesto, así como a su eventual sustitución
por productos menos tóxicos.
Spontaneous intracerebral hemorrhage in Mexico: results from a Multicenter Na...Erwin Chiquete, MD, PhD
José L. Ruiz-Sandoval, Erwin Chiquete, Alejandra Gárate-Carrillo, Ana Ochoa-Guzmán, Antonio Arauz,
Carolina León-Jiménez, Karina Carrillo-Loza, Luis M. Murillo-Bonilla, Jorge Villarreal-Careaga,
Fernando Barinagarrementería, Carlos Cantú-Brito, and the RENAMEVASC investigators
Introduction. Scarce information exists on intracerebral hemorrhage (ICH) in Latin America, and the existent is derived
from single-center registries with non-generalizable conclusions. The aim of this study is to describe the frequency, etiology,
management and outcome of ICH in Mexico.
Patients and methods. We studied consecutive patients with ICH pertaining to the National Multicenter Registry on Cerebrovascular
Disease (RENAMEVASC), conducted in 25 centers from 14 states of Mexico. The Intracerebral Hemorrhage Grading
Scale (ICH-GS) at admission was used to assess prognosis at 30 days follow-up.
Results. Of 2,000 patients with acute cerebrovascular disease registered in RENAMEVASC, 564 (28%) had primary ICH
(53% women; median age: 63 years; interquartile range: 50-75 years). Hypertension (70%), vascular malformations (7%)
and amyloid angiopathy (4%) were the main etiologies. In 10% of cases etiology could not be determined. Main ICH
locations were basal ganglia (50%), lobar (35%) and cerebellum (5%). Irruption into the ventricular system occurred in
43%. Median score of ICH-GS was 8 points: 49% had 5-7 points, 37% had 8-10 points and 15% had 11-13 points. The 30-day
case fatality rate was 30%, and 31% presented severe disability. The 30-day survival was 92% for patients with ICH-GS 5-7
points, whereas it decreased to 27% in patients with ICH-GS 11-13 points.
Conclusions. In Mexico, ICH represents about a third of the forms of acute cerebrovascular disease, and the majority of
patients present severe disability or death at 30 days of follow-up. Hypertension is the main cause; hence, control of this important cardiovascular risk factor should reduce the health burden of ICH.
Hemorragia intracerebral espontánea en México: resultados del Registro Hospit...Erwin Chiquete, MD, PhD
José L. Ruiz-Sandoval, Erwin Chiquete, Alejandra Gárate-Carrillo, Ana Ochoa-Guzmán, Antonio Arauz,
Carolina León-Jiménez, Karina Carrillo-Loza, Luis M. Murillo-Bonilla, Jorge Villarreal-Careaga,
Fernando Barinagarrementería, Carlos Cantú-Brito, investigadores RENAMEVASC
Introducción. Existe poca información respecto a la hemorragia intracerebral (HIC) en América Latina, y la existente ha
sido derivada de registros hospitalarios de un solo centro con conclusiones no generalizables. El objetivo de este estudio
es describir la frecuencia, etiología, manejo y desenlace clínico de la HIC en México.
Pacientes y métodos. Se estudiaron pacientes consecutivos con HIC incluidos en el Registro Nacional Mexicano de Enfermedad
Vascular Cerebral (RENAMEVASC), conducido en 25 centros de 14 estados de la República Mexicana. Se usó la
Intracerebral Hemorrhage Grading Scale (ICH-GS) para estimar el pronóstico a 30 días.
Resultados. De 2.000 pacientes con ictus agudo en el RENAMEVASC, 564 (28%) presentaron HIC espontánea (53% mujeres;
edad media: 63 años; rango intercuartílico: 50-75 años). La hipertensión arterial (70%), las malformaciones vasculares
(7%) y la angiopatía amiloidea (4%) fueron las causas más frecuentes. No se determinó la etiología en el 10% de
los casos. Las localizaciones más frecuentes fueron ganglionar (50%), lobar (35%) y cerebelosa (5%). La irrupción hacia
el sistema ventricular ocurrió en el 43%. La mediana en la escala ICH-GS al ingreso hospitalario fue de 8 puntos: el 49%
presentó 5-7 puntos; el 37%, 8-10 puntos, y el 15%, 11-13 puntos. La tasa de mortalidad a 30 días fue del 30%, y el 31%
mostró discapacidad grave. La sobrevida a 30 días fue del 92% en pacientes con 5-7 puntos en la escala ICH-GS, mientras
que se redujo al 27% en aquellos con 11-13 puntos.
Conclusiones. En México, la HIC representa casi un tercio de las formas de enfermedad vascular cerebral aguda, y la mayoría de los pacientes que la padecen presentan discapacidad funcional grave o muerte a 30 días. La hipertensión es la principal causa, por lo que el control de este importante factor de riesgo debería reducir la carga sanitaria de la HIC.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. ever, in recent years it has been demonstrated that most ational physical activities), for at least 3 days per week. For an-
of the biological conditions that mediate the harmful thropometrics, children were measured in light sportwear after
they had emptied their bladders. Height was measured without
consequences of the excessive amount of adipose tissue shoes to the nearest 0.5 cm using a wall-mounted metric rule.
also occur early in life [7–11]. Childhood overweight pre- Waist and hip circumferences (cm) were measured with an an-
dicts obesity in the following decades [12, 13] and implies thropometric tape. Waist was measured at the minimum cir-
a high risk of cardiovascular disease and early mortality cumference between the iliac crest and the rib cage, below the
in adulthood [11]. Therefore, prevention and effective sternum. The hip measurement was taken at the maximum pos-
terior protrusion of the buttocks, around the greater trochanter.
treatment of overweight in children is essential to pro- Weight and body fat content were assessed by bioimpedance
mote a longer and healthier lifespan. analysis (BIA) with a four-pole impedance meter at 800 mAmp
There are several reports that have described deter- and 50 kHz (BIA 310 Bioimpedance Analyzer, Biodynamics, Se-
minants of childhood overweight, mainly lifestyle hab- attle, Wash., USA), at least 2 h after food ingestion. This instru-
its [14–16]. Nevertheless, little is known on whether ment has a maximum possible difference between any two mea-
surements for the same subject of 0.68 kg [95% confidence inter-
common early factors, other than caloric intake and en- val (CI) 0.58–0.84 kg] for estimation of body fat content in
ergy expenditure can predict adiposity in children per- children [21]. Children were asked to stand barefoot and without
taining to a population with a high prevalence of over- metals on an insulating sole, and electrodes were placed in the
weight. Therefore, we sought to identify independent four limbs, as corresponded. Gender and height details were en-
predictors of adiposity in childhood and of the high risk tered manually into the electronic system via a keyboard. Body
weight and total as well as percentage body fat (PBF) were esti-
of obesity in adulthood, in a cohort of schoolchildren mated using the standard built-in prediction algorithms for
from a region in the North of Mexico with one of the children. The printed report provided readings of fat mass, lean
highest prevalences of overweight in children and adults mass, bone mineral content, total body mass (sum of fat mass,
[17–19]. lean mass and bone mineral content), body mass index (BMI)
and PBF. The whole body scan time was 2–3 min. Overweight
was estimated by comparing BMI standardized for age and sex,
relative to reference data of the International Obesity Task Force
Materials and Methods (IOTF, standardized BMI cut-off points that predict overweight
and obesity at age 18 years) [13].
Study Population
This cross-sectional study was performed between February Statistical Analysis
and July 2004, in the urban population of Magdalena de Kino, The main dependent variables were PBF and the composite
State of Sonora. This city in the North of Mexico has a total pop- overweight/obesity, defined as the current BMI that predicts a fu-
ulation of about 24,447 inhabitants and is located at 80 km (49.6 ture BMI 625 when adult, according to IOTF reference tables
miles) from the frontier with the USA. The city of Magdalena de [13]. BMI and PBF were divided in percentiles, taking the highest
Kino has 33.5% of people aged !15 years [20], and pertain to a quartiles (percentile 75th or more) as dependent variables. Pear-
state of the Mexican Republic with an estimated prevalence of son 2 and Fisher exact tests were used to assess nominal variables
overweight and obesity combined of near 35%, in persons aged in bivariate and homogeneity analyses. To compare quantitative
3–17 years [18]. The internal Committee of Ethics of our institu- variables between two groups, Student’s t test and Mann-Whitney
tion approved the present study. Informed consent was obtained U test were performed in distributions of parametric and non-
from the children’s parents or legal proxy. parametric variables, respectively. Pearson correlation was used
in continuous variables (e.g. BMI, body fat content, height, weight,
Design and other somatometric variables). To find independent predic-
Parents and teachers of children from 2 public institutions of tors of adiposity, BMI in the highest quartile of the sample and of
the 16 elementary schools (either public or private) of the city were overweight/obesity, multivariate models were constructed by
asked for their alumni to participate in the analysis (669 children stepwise logistic regression. Input variables were those that re-
aged 6–13 years). Parents of 551 (82.3%) children responded to our sulted significantly associated with adiposity in bivariate analy-
request. A standardized, structured questionnaire was used to ses, but demographic variables and known risk factors for over-
collect data directly from the parents regarding demography, rel- weight (other than caloric intake) were also included in logistic
evant antecedents and current alimentary and exercise habits. regression analyses for adjustment, as potential confounders. Ad-
The questionnaire was administered as an interview by trained justed odds ratios with the respective 95% CIs are provided. The
personnel. Informed consent was obtained from the parents or fitness of the models was evaluated by using the Hosmer-Leme-
legal proxies. show goodness-of-fit test, which was considered as reliable if p 1
0.2. All p values are two-sided and considered significant when
Anthropometry and Assessment of Body Fat Content p ! 0.05. SPSS Version 13.0 for Windows (SPSS Inc., Chicago, Ill.,
A sedentary lifestyle was defined as 13 h per day spent sitting USA) was used for all statistical calculations.
down during leisure time (i.e., television watching, computer
use, and similar activities) in a child who is not engaged in a sys-
tematic exercise practice (i.e., sports, dance, and other recre-
228 Ann Nutr Metab 2008;52:227–232 Basaldúa/Chiquete
3. Table 1. Main characteristics of the 551 children analyzed
Variable Total Girls (n = 278) Boys (n = 273) p valuea
Age, median (range), years 9 (6–12) 9 (6–12) 9 (6–12) 0.58
Age, years 8.981.8 8.981.8 8.981.8 0.59
Child number 3 or more in offspring, n (%) 124 (28.9) 59 (26.6) 65 (31.4) 0.27
First-degree relative with obesity, n (%) 307 (71.7) 157 (69.8) 150 (73.9) 0.34
First-degree relative with diabetes, n (%) 225 (52.6) 120 (53.3) 105 (51.7) 0.74
Sedentary lifestyle, n (%)b 187 (43.7) 122 (54.2) 65 (32) <0.001
Height, m 1.3580.12 1.3580.13 1.3480.12 0.14
Weight, kg 35.1812.1 35.4812.2 34.9812.1 0.65
Waist circumference, cm 66.7810.5 66.2810.4 66.4810.6 0.51
BMI, kg/m2 18.784.0 18.683.9 18.984.1 0.51
BMI in the highest quartile, n (%) 138 (25) 69 (24.8) 69 (25.3) 0.90
PBF 17.487.3 20.486.4 14.487.0 <0.001
PBF in the highest quartile, n (%) 124 (24.7) 95 (37.5) 29 (11.6) <0.001
Overweight/obesity, n (%)c 207 (37.6) 106 (38.1) 101 (37) 0.78
Obesity, n (%)c 73 (13) 31 (11.2) 42 (15.4) 0.14
b
BMI = Body mass index; PBF = percentage of body fat. >3 h per day spent sitting down during leisure time (i.e., oth-
a p value for differences between boys and girls; Pearson 2 , er than school hours) and absence of systematic exercise practice
Student t test (for means) or Mann-Whitney U test (for medians), (i.e., sports, dance, and similar activities).
as corresponded. c
Current BMI that predicts overweight or obesity in adult-
hood, according to the International Obesity Task Force reference
tables.
Results
60
A total of 551 children aged 6–12 years were included Homogeneity, p = 0.02 *
in the final analysis (table 1). All the children were of Lat-
50
*
Frequency (%)
40
in-American ethnicity and their family had an annual * *
income of USD !15,000. 30 *
Age, ethnicity, social class, relevant antecedents, 20
height, weight, BMI, waist circumferences, the relative 10
frequency of obesity and the composite overweight/obe- 0
sity did not differ according to gender. However, seden- 6 7 8 9 10 11 12
Age (years)
tary lifestyle and a high body fat content were more fre-
quent in girls than in boys (table 1). Although the natural
increment of BMI with every year of age was identified,
Fig. 1. Distribution of the percentage of body fat in the highest
the relative frequency of overweight/obesity was homo- quartile across the age groups in girls (g), boys (k) and both
geneous across the age groups. PBF standardized as in- genders combined (i). * p ! 0.05.
crements of 1 year remained higher in girls than in boys
in age 6, and from 8 to 11 years (in all, p ! 0.01), but not
in age 7 and 12 years (fig. 1).
As expected, PBF positively correlated with height,
weight, BMI and waist circumference (fig. 2). Age also relative with obesity, sedentary lifestyle, and being the
moderately correlated with PBF (r = 0.174, r2 = 0.030, p ! third child or more in offspring. Independent predictors
0.001) and total body fat content (r = 0.426, r2 = 0.181, of PBF in the highest quartile were female gender, having
p ! 0.001). a first-degree relative with obesity and being the third
After multivariate analyses (table 2), independent pre- child or more in offspring. BMI in the highest quartile
dictors of overweight/obesity were having a first-degree was predicted only by the antecedent of a first-degree rel-
Predicting Excessive Adiposity in Ann Nutr Metab 2008;52:227–232 229
Children
4. 50 50
r = 0.224, r2 = 0.059, p < 0.001 r = 0.639, r2 = 0.408, p < 0.001
40 40
Body fat (%)
Body fat (%)
30 30
20 20
10 10
0 0
1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 10 20 30 40 50 60 70 80 90
a Height (m) b Weight (kg)
50 50
r = 0.791, r2 = 0.625, p < 0.001 r = 0.637, r2 = 0.406, p < 0.001
40 40
Body fat (%)
Body fat (%)
30 30
20 20
10 10
0 0
Fig. 2. Correlations between percentage 10 15 20 25 30 35 40 20 40 60 80 100 120
of body fat with height (a), weight (b), BMI c BMI (kg/m2) d Waist circumference (cm)
(c) and waist circumference (d). S = Girls,
U = boys.
Table 2. Determinants of excessive adiposity and overweight: three binary logistic regression models
Variables Multivariate odds ratios (95% CI)
overweight/obesitya PBF in the highest quartileb BMI in the highest quartilec
Female gender NS 5.60 (3.22–9.77) NS
First-degree relative with obesity 2.26 (1.40–3.64) 2.59 (1.41–4.74) 2.50 (1.40–4.44)
Sedentary lifestyle 1.58 (1.05–2.37) NS 1.95 (1.24–3.05)
Third child or more in offspring 1.59 (1.02–2.47) 2.07 (1.22–3.51) NS
b
BMI = Body mass index; PBF = percentage of body fat; NS = Hosmer-Lemeshow test for goodness-of-fit in the final step
non-significant variable, hence, not appearing as predictor after of the regression model: 2 = 5.67, 6 d.f., p = 0.46. Only significant
multivariate analysis, but included in prediction models as a con- predictors are shown. Adjusted for age, birth weight, duration of
founder. breastfeeding, maternal age, sedentary lifestyle and family his-
a
Hosmer-Lemeshow test for goodness-of-fit in the final step tory of diabetes mellitus.
of the regression model: 2 = 1.14, 6 d.f., p = 0.98. Only significant c
Hosmer-Lemeshow test for goodness-of-fit in the final step
predictors are shown. Adjusted for age, gender, birth weight, du- of the regression model: 2 = 0.03, 2 d.f., p = 0.99. Only significant
ration of breastfeeding, maternal age and family history of diabe- predictors are shown. Adjusted for age, gender, birth weight, du-
tes mellitus. ration of breastfeeding, maternal age, being the third child or
more in offspring and family history of diabetes mellitus.
230 Ann Nutr Metab 2008;52:227–232 Basaldúa/Chiquete
5. ative with obesity and a sedentary lifestyle. Therefore, the tions in weight [26]. However, with the methodology used
antecedent of obesity in family members was the con- in this study we could not account for other non-system-
stant predictor for the three measures of overweight. atic physical activities like playing outside or bicycle rid-
ing, as these activities were very inconstant in nature and
duration in the sample studied, but that can indeed affect
Discussion energy expenditure [26].
The constant predictor of the three measures of exces-
We found a high relative frequency of overweight/obe- sive adiposity was having a first-degree relative with obe-
sity. Over the past years, the prevalence of pediatric over- sity. This risk factor has been identified iteratively [11, 12,
weight has risen dramatically, so that 115% of the chil- 27] and underscores the impact of genes and a shared life-
dren are now considered overweight [22]. Our findings style on the accumulation of adipose tissue. The exact
are in agreement with previous reports about the preva- meaning of being the third child or younger in offspring
lence of overweight in Mexican children [17, 18]. Compa- and its relationship with overweight could not be deter-
rable dietary patterns are shared between persons living mined with the original methodology of our study. A
in the North of Mexico with those of southern USA [15, plausible explanation to this finding may be that with a
17], but, as is shown in the present report, with a higher large offspring the breastfeeding practice becomes more
frequency of overweight in the Mexican people, as com- difficult, leaving without this protective factor for child-
pared with US inhabitants [22]. It has been demonstrated hood overweight [28] to the younger offspring. This find-
that similar dietary habits in persons living in the same ing, however, deserves more exploration, since we did not
region, but with distinct backgrounds (i.e., race), are as- assess breastfeeding practices on patient’s siblings. An-
sociated with a higher frequency of overweight [23]. In a other deficiency that can be accounted on our study is the
previous study on 1,350 children from the North of Mex- method used to assess body fat content (i.e., bioimped-
ico, a 39% prevalence of overweight was found and a risk ance), which, although simple, inexpensive and accept-
factor related to this condition was the regular ‘crossing’ ably reliable when analyzing large cohorts [21], it is not
from Mexico to USA [17]. Different genes concurring in the most accurate method to estimate adiposity.
a similar environment imply different interactions and In summary, common variables included in a regular
consequences on health [24]. history-taking can predict childhood adiposity and the
In the present report, except for a more sedentary life- high risk of obesity in adulthood. In a population with
style and a higher body fat content in the female gender, high prevalence of obesity, the constant predictor of over-
there were no relevant differences between genders. Sed- weight in childhood is the family history of this condi-
entarism is a risk factor that is more common in girls than tion, which might underscore the importance of heritage
in boys [25] and together with the hormonal changes that or more likely the shared dietary and exercise habits.
characterize puberty, it may contribute to the higher body Identification of children at risk before they develop ex-
fat content observed in girls. We found that independent cessive adiposity is necessary to prevent unhealthy prac-
predictors of overweight/obesity were having a first-de- tices that led to a positive energy balance.
gree relative with obesity, a sedentary lifestyle, and being
the third child or younger in offspring. Factors associated
with PBF differed in that sedentarism was replaced by the Acknowledgments
female gender, as a predictor. On the other hand, BMI in
The authors are indebted to Dr. Sandra M. De la Herrán and
the highest quartile was associated with a sedentary life-
Dr. Martín A. Grijalva for their invaluable efforts and assistance
style and the family history of obesity. A concern may in anthropometry, interviews and important suggestions to this
arise on whether a sedentary lifestyle may be the conse- work. Also, the authors gratefully acknowledge the interest for
quence of excess weight rather than a cause. Indeed, with this study of the school authorities, directors and personnel of the
the cross-sectional design of this study we can only con- local health system in Magdalena de Kino, Sonora; as well as the
children’s parents.
clude that a lower physical activity is present in over-
weight children, but cannot assess whether the sedentary
lifestyle has preceded the weight gain. Recently it has
been demonstrated that variations in posture and simple
movements that are associated with the routines of daily
life could be biologically determined and precede varia-
Predicting Excessive Adiposity in Ann Nutr Metab 2008;52:227–232 231
Children
6. References
1 Ebbeling CB, Pawlak DB, Ludwig DS: Child- 10 Ovesen L: Adolescence: a critical period for 18 Hurtado-Valenzuela JG, Sotelo-Cruz N,
hood obesity: public-health crisis, common long-term tracking of risk for coronary heart Avilés-Rodríguez M, Peñuelas-Beltrán CI:
sense cure. Lancet 2002;360:473–482. disease? Ann Nutr Metab 2006;50:317–324. Aumento de la prevalencia de obesidad en
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