Factores perinatales para riesgo de sobrepeso y obesidad en niños de 4 a 5 años en Colombia 2010.

Introducción: La OMS revela que en 2010 alrededor de 43 millones de niños menores de 5 años presentan sobrepeso. En Colombia según la Encuesta Nacional de Situación Nutricional en Colombia en su versión 2005, mostraba una prevalencia general de sobrepeso de 3.1% niños de 0 a 4 años. Es una condición de salud de origen multifactorial en la que interviene factores genéticos, ambientales, maternos y perinatales. Objetivo: Establecer la asociación de riesgo entre el bajo peso al nacer y el desarrollo de sobrepeso y obesidad en niños de 4 a 5 años. Metodología: Se realizó un estudio observacional descriptivo retrospectivo de corte transversal con los datos nutricionales, maternos y perinatales de la Encuesta Nacional de Demografía en Salud del año 2010 en Colombia. Se analizó la asociación entre la variable independiente bajo peso al nacer con el desenlace sobrepeso y obesidad en menores de 4 a 5 años, usando como medida el IMC según la edad. Se realizaron análisis univariados, bivariados y de regresión logística con un modelo de riesgo según las variables que inciden en el desenlace y la variable independiente. Resultados: La muestra obtenida para el estudio fue de 2166 niños de 4 a 5 años de edad quienes cumplían los criterios de inclusión. La prevalencia de sobrepeso u obesidad en la primera infancia fue de 21.8% (472) y el bajo peso al nacer. Los resultados sugieren la asociación de bajo peso y sobrepeso u obesidad es de ORajustado= 0.560 (0.356 – 0.881). Conclusiones: Los resultados sugieren que existe una asociación como factor protector entre el bajo peso y el sobrepeso u obesidad en la primera infancia. Sin embargo, debido al comportamiento de las variables consideradas en la muestra no hay suficiente información para rechazar completamente la hipótesis nula.

Banco de Leite Humano : Visão Global e Procedimento de Trabalho : Hospital Universitário Virgen de las Nieves, Granada

Várias evidências científicas têm mostrado consistentemente que o leite materno é o melhor alimento para os bebés sendo altamente benéfico para sua saúde a curto, médio e longo prazo. É recomendado às mulheres que amamentem o seu bebé exclusivamente por 6 meses e continuem a amamentar após os 6 meses, como parte de uma dieta equilibrada. Em casos em que, por qualquer motivo, a mãe não produz quantidade suficiente de leite, o bebé seja prematuro ou tenha alguma patologia, o leite materno doado pode ser a alternativa mais benéfica. Este trabalho tem por objetivo analisar a realidade dos bancos de leite doado em Portugal e no resto do mundo, bem como descrever o seu funcionamento desde a chegada do leite ao banco até à dispensa. Assim, para além do trabalho diário no banco de leite do Hospital Universitario Virgen de las Nieves em Granada, estudou-se o funcionamento de outros bancos de leite no mundo, incluindo Portugal, com o objetivo de comparar técnicas, procedimentos, e propor melhoramentos no processamento do leite materno doado. Com este estudo, foi possível concluir sobre a relevância nutricional e imunológica do Leite Humano Doado (LHD). Verificando-se que em casos de impossibilidade de a mãe amamentar, esta será a melhor opção de alimentação para bebés prematuros e/ou com muito baixo peso ao nascer. Quanto ao procedimento nos Bancos de Leite Humano (BLH), conclui-se que são necessários mais estudos e mais formação dos profissionais de saúde de forma a melhorar a qualidade do LHD bem como reduzir os riscos de infeção.

Probiotics and prebiotics in infant nutrition

The human colonic microflora has a central role in health and disease, being unique ill its complexity and range of functions. As such, dietary modulation is important for improved gut health, especially during the highly-sensitive stage of infancy. Diet call affect the composition of the gut microflora through the availability of different substrates for bacterial fermentation. Differences in gut microflora composition and incidence of infection exist between breast-fed and formula-fed infants, with the former thought to have improved protection. Historically, this improvement has been believed to be a result of the higher presence of reportedly-beneficial genera such as the bifidobacteria. As such, functional food ingredients such as prebiotics and probiotics could effect a beneficial modification in the composition and activities of gut microflora of infants by increasing positive flora components. The prebiotic approach aims to increase resident bacteria that are considered to be beneficial for human health, e.g. bifidobacteria and lactobacilli, while probiotics advocates the use of the live micro-organisms themselves in the diet. Both approaches have found their way into infant formula feeds and aim to more closely simulate the gut microbiota composition seen during breast-feeding.

Self-exclusion from health care in women at high risk for postpartum depression

Background A significant proportion of women who are vulnerable to postnatal depression refuse to engage in treatment programmes. Little is known about them, other than some general demographic characteristics. In particular, their access to health care and their own and their infants' health outcomes are uncharted. Methods We conducted a nested cohort case-control study, using data from computerized health systems, and general practitioner (GP) and maternity records, to identify the characteristics, health service contacts, and maternal and infant health outcomes for primiparous antenatal clinic attenders at high risk for postnatal depression who either refused (self-exclusion group) or else agreed (take-up group) to receive additional Health Visiting support in pregnancy and the first 2 months postpartum. Results Women excluding themselves from Health Visitor support were younger and less highly educated than women willing to take up the support. They were less likely to attend midwifery, GP and routine Health Visitor appointments, but were more likely to book in late and to attend accident and emergency department (A&E). Their infants had poorer outcome in terms of gestation, birthweight and breastfeeding. Differences between the groups still obtained when age and education were taken into account for midwifery contacts, A&E attendance and gestation;the difference in the initiation of breast feeding was attenuated, but not wholly explained, by age and education. Conclusion A subgroup of psychologically vulnerable childbearing women are at particular risk for poor access to health care and adverse infant outcome. Barriers to take-up of services need to be understood in order better to deliver care.

Dietary practices and nutritional status of 0-24-month-old children from Brazilian Amazonia

Objective: To assess the nutritional status and dietary practices of 0-24-month-old children living in Brazilian Amazonia. Design: Cross-sectional study. Information oil children`s dietary intakes was obtained from diet history data. Weight and length Were measured for anthropometric evaluation. Fe status Was assessed Using fasting venous blood samples; Hb, serum ferritin and soluble tranferrin receptor concentrations were measured. Setting: The towns of Assis Brasil and Acrelandia in the state of Acre, north-west Brazil. Subjects: A total of sixty-nine randomly selected 0-24-month-old children. Results: Of these children, 40.3 % were anaemic, 63.1% were Fe-deficient, 28.1% had Fe-deficiency anaemia and 11.6% were stunted. Breast-feeding was initiated by 97.1% of mother followed by early feeding with complementary foods. The dietary pattern reflected a high intake of carbohydrate-rich foods and cow`s milk, with irregular intakes Of fruit, Vegetables and meat. All infants and 92.3% of toddlers were at risk Of inadequate Fe intakes. Fe from animal foods contributed Oil average 0.5% and 14.3% to total dietary Fe intake among infants and toddlers, respectively. Conclusions: Poor nutritional status and inadequate feeding practices in this study population reinforce the importance of exclusive breast-feeding during the first 6 months of life. Greater emphasis is required to improve the bioavailability of dietary Fe during complementary feeding practices.

Pregnancy and lactation have no long-term deleterious effect on measures of bone mineral in healthy women: a twin study

BACKGROUND: The long-term effects of pregnancy and lactation on measures of bone mineral in women remain unclear.

OBJECTIVE: We studied whether pregnancy or lactation has deleterious long-term effects on bone mineral in healthy women.

DESIGN: We measured bone mineral density (BMD; g/cm(2)) in women aged > or = 18 y. Analyses were performed on 3 data sets: study 1, 83 female twin pairs (21 monozygous and 62 dizygous) aged (x +/- SD) 42.2 +/- 15.5 y who were discordant for ever having been pregnant beyond 20 wk; study 2, 498 twin pairs aged 42.3 +/- 15.0 y; and study 3, 1354 individual twins, their siblings, and family members.

RESULTS: In study 1, there were no significant within-pair differences in unadjusted BMD or BMD adjusted for age, height, and fat mass at the lumbar spine or total-hip or in total-body bone mineral content (BMC; kg) (paired t tests). In study 2, there was no significant within-pair difference in measures of bone mineral or body composition related to the within-pair difference in number of pregnancies. In study 3, subjects with 1 or 2 (n = 455) and > or = 3 pregnancies (n = 473) had higher adjusted lumbar spine BMD (2.9% and 3.8%, respectively; P = 0.001) and total-body BMC (2.2% and 3.1%; P < 0.001) than did nulliparous women (n = 426). Parous women who breast-fed had higher adjusted total-body BMC (2.6%; P = 0.005), total-hip BMD (3.2%; P = 0.04), and lower fat mass (10.9%; P = 0.01) than did parous non-breast-feeders.

CONCLUSION: We found no long-term detrimental effect of pregnancy or breast-feeding on bone mineral measures.

Atopic disease and breastfeeding - cause or consequence?

Background

A number of studies have observed an association between breast-feeding and increased risk of development of asthma and eczema. It has been proposed that these results might be due to early signs of atopic disease in the infant causing mothers to prolong breast-feeding.

Objective

We sought to determine whether early symptoms of atopic disease (eczema, food reaction, or asthma) or positive skin prick test responses reduce the likelihood of ceasing breast-feeding.

Methods

A prospective birth cohort of 620 infants from Melbourne, Australia, was used. Telephone interviews every 4 weeks were conducted until 64 weeks and then again at 78 and 104 weeks to determine duration of breast-feeding (both exclusive and total) and evidence of atopic disease. Because of the varying time of onset of atopic symptoms, they were modeled as time-varying covariates in Cox models.
Results

Only 52 (8.4%) infants did not establish breast-feeding, whereas an additional 103 (25.0%) did not establish exclusive breast-feeding. Early signs of atopic disease or sensitization were independently associated with an approximately 28% reduction in risk of ceasing exclusive breast-feeding (adjusted hazard ratio, 0.72; 95% CI, 0.53-0.97); P = .029), but there was no evidence for a relationship with risk of ceasing breast-feeding completely (adjusted hazard ratio, 1.12; 95% CI, 0.92-1.37; P = .262).
Conclusion

Early signs of atopic disease might prolong the duration of exclusive breast-feeding. This could mask a protective effect of breast-feeding or even result in breast-feeding appearing to be a risk factor for the development of atopic diseases. Future investigation of the relationship between breast-feeding and atopic diseases should consider this possibility.

A population-based study of preschoolers' food neophobia and its associations with food preferences

Objective: This cross-sectional study was designed to investigate the relationships between food preferences, food neophobia, and children’s characteristics among a population-based sample of preschoolers.

Design: A parent-report questionnaire.

Setting: Child-care centers, kindergartens, playgroups, day nurseries, and swimming centers.

Subjects: 371 two- to five-year-old Australian children.

Outcome Measures: Associations between food neophobia and the food preferences and characteristics.

Analysis: Analysis of variance, analysis of covariance, Pearson product-moment correlations, and Fisher z test were used to estimate and compare the associations between these variables.

Results: Food neophobia was associated with reduced preferences for all food groups, but especially for vegetables (r = −0.60; P < .001). It was also associated with liking fewer food types (r = −0.55; P < .001), disliking more food types (r = 0.42; P < .001), the number of untried food types (r = 0.25; P < .001), a less varied range of food preferences (r = −0.59; P < .001), and less healthful food preferences overall (r = −0.55; P < .001). No significant relationships (P < .01) were observed between food neophobia and a child’s age, sex, or history of breast-feeding.

Conclusions: The study confirms and extends results obtained in experimental research and population-based intake studies of food neophobia to children’s everyday food preferences. The findings suggest that preschool children’s everyday food preferences are strongly associated with food neophobia but not with children’s age, sex, or history of breast-feeding. When aiming to influence children’s food preferences, the effects of food neophobia and strategies to reduce it should be considered.

Cambodian migrant women's postpartum experiences in Victoria, Australia

Objective: to explore the postpartum experiences of Cambodian born migrant women who gave birth for the first time in Victoria, Australia between 2000 and 2010. Design: an ethnographic study with 35 women using semi-structured and unstructured interviews and participant observation; this paper draws on interviews with 20 women who fit the criteria of first time mothers who gave birth in an Australian public hospital. Setting: the City of Greater Dandenong, Victoria Australia. Participants: twenty Cambodian born migrant women aged 23-30 years who gave birth for the first time in a public hospital in Victoria, Australia. Findings: after one or two home visits by midwives in the first 10 day postpartum women did not see a health professional until 4-6 weeks postpartum when they presented to the MCH centre. Women were home alone, experienced loneliness and anxiety and struggled with breast feeding and infant care while they attempted to follow traditional Khmer postpartum practices. Implications for practice: results of this study indicate that Cambodian migrant women who are first time mothers in a new country with no female kin support in the postpartum period experience significant emotional stress, loneliness and social isolation and are at risk of developing postnatal depression. These women would benefit from the introduction of a midwife-led model of care, from antenatal through to postpartum, where midwives provide high-intensity home visits, supported by interpreters, and when required refer women to professionals and community services such as Healthy Mothers Healthy Babies (Victoria Department of Health, 2011) for up to 6 weeks postpartum

Therapeutic approaches to disease modifying therapy for multiple sclerosis in adults: an Australian and New Zealand perspective: part 3 treatment practicalities and recommendations

In this third and final part of our review of multiple sclerosis (MS) treatment we look at the practical day-to-day management issues that are likely to influence individual treatment decisions. Whilst efficacy is clearly of considerable importance, tolerability and the potential for adverse effects often play a significant role in informing individual patient decisions. Here we review the issues surrounding switching between therapies, and the evidence to assist guiding the choice of therapy to change to and when to change. We review the current level of evidence with regards to the management of women in their child-bearing years with regards to recommendations about treatment during pregnancy and whilst breast feeding. We provide a summary of recommended pre- and post-treatment monitoring for the available therapies and review the evidence with regards to the value of testing for antibodies which are known to be neutralising for some therapies. We review the occurrence of adverse events, both the more common and troublesome effects and those that are less common but have potentially much more serious outcomes. Ways of mitigating these risks and managing the more troublesome adverse effects are also reviewed. Finally, we make specific recommendations with regards to the treatment of MS. It is an exciting time in the world of MS neurology and the prospects for further advances in coming years are high.

Observable essential fatty acid deficiency markers and autism spectrum disorder

Autism Spectrum Disorder (ASD) has been associated with essential fatty acid (EFA) deficiencies, with some researchers theorising that dysregulation of phospholipid metabolism may form part of the biological basis for ASD. This pilot study compared observable signs of fatty acid status of 19 children with an ASD diagnosis to 23 of their typically developing siblings. A pregnancy, birth and breastfeeding history was also obtained from their parents, which included a measure of infant intake of fatty acid rich colostrum immediately post-partum. When considered within their family group, those infants not breastfed (with colostrum) within the first hour of life and who had a history of fatty acid deficiency symptoms were more likely to have an ASD diagnosis. Other variables such as formula use, duration of breastfeeding, gestational age and Apgar scores were not associated with group membership. The results of this study are consistent with previous research showing a relationship between fatty acid metabolism, breastfeeding and ASD such that early infant feeding practices and the influence this has on the fatty acid metabolism of the child may be a risk factor for ASD.

Randomised controlled trials in child health in developing countries: trends and lessons over 11 years.

Using a uniform systematic approach annually, we reviewed 1553 publications from randomised controlled trials in child health in developing countries published between July 2002 and June 2013. There were annual increases in such publications, from 38 in the 12 months to July 2003 to over 200 in each of 2012 and 2013. These trials involved children in 76 developing countries. Studies of nutrition (366 publications, 23.6%) and malaria (336 publications, 21%) predominated. 79% of nutrition trials have been of micronutrients (288 publications), with comparatively few publications related to macronutrient interventions or complimentary feeding (48 publications) or measures to improve breast feeding (20 publications). Trials of malaria have involved a comprehensive range of treatment and preventive strategies and have heralded the implementation of new interventions as routine health strategies, and reductions in malaria in each affected country in the world in the last decade. There have been a relatively small number of trials of interventions for treatment or prevention of acute respiratory infection (98 publications, 6.3%), neonatal health (64 publications, 4.1%) and tuberculosis in children (26 publications, 1.7%). In the last 5 years there has been increasing focus on non-communicable diseases such as asthma and allergy, obesity, diabetes and cardiac disease, and behavioural-developmental disorders. Mental health conditions have received little attention (21 publications, 1.4% of publications). There is increasing research activity and capacity in child health in developing countries. Some areas have been the subject of a large amount of research, and have led to the design and implementation of effective public health interventions and reduced disease burdens, while in other areas comprehensive approaches and the systematic application of research findings have been lacking.

O discurso da amamentação

O presente trabalho pretende ser o primeiro no campo da psicologia da mulher, a enfocar o tema amamentação numa perspectiva sócio-cultural. Trata-se de uma pesquisa de campo não experimental realizada entre mulheres que amamentaram seus filhos. O método utilizado para coleta de dados foi a história de vida. A população estudada consta de trinta nutrizes, a saber: dez de classe média, dez de classe baixa e dez avós. Foi feita uma análise comparativa da experiência de amamentação das mulheres dos três grupos estudados. Com base nesses dados pode-se concluir, que a amamentação longe de ser apenas um fato biológico singular, é uma construção social, instrumento ideológico de opressão da mulher.

The effectiveness of community-based interventions to improve maternal and infant health in the Northeast of Brazil

EMOND, Alan et al. The effectiveness of community-based interventions to improve maternal and infant health in the Northeast of Brazil. Revista Panamericana de Salud Pública/ Pan American Journal of Public Health , v.12, n.2, p.101-110, 2002