RESUMO

OBJECTIVE: To evaluate the associations of pre-gestational body mass index (BMI) and gestational weight gain (GWG) with the risks of overweight, obesity, and adiposity in the first seven years of life in the offspring of a cohort of pregnant women. METHODS: Analysis of 751 mothers and their children participating in the PROGRESS cohort. These women were recruited in Mexico City between 2007 and 2010. Pre-gestational BMI was classified as normal, overweight, and obesity according to the WHO. GWG was calculated as the difference between the last reported pre-pregnancy weight and the pre-gestational weight and categorized as inadequate, adequate, or excessive, according to US IOM recommendations. Children's anthropometry was evaluated at 4-5 and 6-7 years of age. Adiposity was classified into three groups: normal (BMI z-score and waist circumference), overweight (BMI z-score>1), and overweight plus abdominal obesity (OW+AO). A generalized structural equation model (GSEM) was constructed to account for the temporal relationship between variables and to assess direct and indirect effects. RESULTS: A total of 49.3% of the women had excessive (13.8 ± 4.2 kg) and 19.8% inadequate (3.15 ± 3.4 kg) GWG. Women with pre-gestational overweight or obesity were more likely to have excessive GWG (OR 1.9 [95% CI: 1.32, 2.74] and 3.50 [95% CI: 1.83, 6.69], respectively). In the GSEM, excessive GWG was directly associated with OW+AO at 4-5 years. At 6-7 years, pre-gestational obesity was associated with OW+AO. CONCLUSION: Pre-gestational obesity and excessive GWG were independent predictors of childhood obesity.

Assuntos

RESUMO

OBJETIVO: Analizar la asociación entre fuentes de exposición al plomo (FEPb) y la concentración en sangre capilar (PbS) en menores de 1 a 4 años de edad a nivel nacional y regional, así como cuantificar la contribución relativa de las distintas FEPb. Material y métodos. Se utilizaron datos de la Encuesta Nacional de Salud y Nutrición (Ensanut 2022). Las FEPb consideradas fueron uso de loza de barro vidriada con plomo (LBVPb), residencia cercana a sitios contaminados y exposición paraocupacional. Se estimaron prevalencias de intoxicación (PbS ≥ 5.0 mg/dL) y medias geométricas de PbS. Se utilizaron modelos de regresión para PbS (escala logarítmica) y la descomposición Shapley-Owen de R2 para evaluar la contribución relativa de cada FEPb. RESULTADOS: Las FEPb estudiadas explican el 6% de la variabilidad de PbS a nivel nacional; de este, el 87.3% lo explica el uso de LBVPb, el 4.2% otras FEPb ambiental y 1.3% FEPb paraocupacionales. La contribución relativa del uso de LBVPb varía entre regiones, desde 38.1 a 76.8%. Algunas regiones destacan la FEPb ambiental, pero no paraocupacional. CONCLUSIONES: Los resultados confirman que el uso de LBVPb es la principal fuente de exposición reportada y sugieren que la población no identifica las principales FEPb documentadas hasta ahora.

RESUMO

OBJETIVO: Describir y actualizar al año 2022 la prevalencia de intoxicación por plomo (Pb) en la población infantil de 1-4 años en México y describir fuentes de exposición ambiental, paraocupacional y uso de barro vidriado (BV). Material y métodos. Estudio en una muestra de menores que participaron en la Encuesta Nacional de Salud y Nutrición 2022 (Ensanut 2022). Se midió la concentración de plomo en sangre (PbS) capilar. Se aplicó un cuestionario para indagar sobre fuentes de exposición a Pb. RESULTADOS: Se midió PbS en 1 158 menores de 1-4 años. La prevalencia nacional de intoxicación por Pb (≥5.0 µg/dL) fue 16.8% (IC95%:13.6,20.5). La proporción de hogares que reportó exposición a una fuente exclusiva fue de 21.2, 17.7 y 7.4% para BV, exposición ambiental y paraocupacional, respectivamente. La prevalencia de intoxicación de los expuestos a una sola fuente fue 21.5%, y esta cifra aumenta a 24.2% entre quienes reportaron exposición combinada tres tipos de fuentes. Conclusión. La prevalencia nacional de intoxicación por plomo permaneció estable con respecto a lo reportado en la Ensanut 2018-19. El uso de BV es una fuente de exposición relevante, pero no es la única. Se identificó una contribución importante por exposición ambiental y, en menor medida, de exposición paraocupacional.

RESUMO

The prevalence of childhood obesity has increased rapidly in Mexico, with significant consequences for the population's health in the future. Little is known about the prevalence of obesity in children under two years of age, even though this life stage is fundamental to prevent this condition. This study aims to determine the magnitude, distribution, and trends of overweight and obesity in children under 24 months of age using the Mexican National Health and Nutrition Surveys (ENSANUT) conducted in the last 10 years. The data presented here are derived from four ENSANUTs, carried out in Mexico in 2012, 2016, 2018, and 2020. They include 6,719 infants under 24 months with complete anthropometric data (weight/height) by age, gender, Indigeneity, area of residence, and socioeconomic status. The risk of overweight levels and overweight + obesity rates were calculated according to World Health Organization guidelines. We identified that infants < 12 months currently have a higher prevalence of overweight + obesity (10.3%) and that those aged 12 to 23 months are generally at a higher risk of overweight (26.1%). The most relevant findings of this study, linking weight trends to sex, region, socioeconomic status, and indigeneity, show that overweight and obesity prevalences vary across the Mexican population, without presenting a specific behavior. There is a high prevalence of overweight and obesity among Mexican infants and a slight trend toward increased obesity in infants < 12 months. Weight monitoring and obesity prevention interventions focused on the first 1,000 days of life are essential.

Assuntos

RESUMO

Abstract: The prevalence of childhood obesity has increased rapidly in Mexico, with significant consequences for the population's health in the future. Little is known about the prevalence of obesity in children under two years of age, even though this life stage is fundamental to prevent this condition. This study aims to determine the magnitude, distribution, and trends of overweight and obesity in children under 24 months of age using the Mexican National Health and Nutrition Surveys (ENSANUT) conducted in the last 10 years. The data presented here are derived from four ENSANUTs, carried out in Mexico in 2012, 2016, 2018, and 2020. They include 6,719 infants under 24 months with complete anthropometric data (weight/height) by age, gender, Indigeneity, area of residence, and socioeconomic status. The risk of overweight levels and overweight + obesity rates were calculated according to World Health Organization guidelines. We identified that infants < 12 months currently have a higher prevalence of overweight + obesity (10.3%) and that those aged 12 to 23 months are generally at a higher risk of overweight (26.1%). The most relevant findings of this study, linking weight trends to sex, region, socioeconomic status, and indigeneity, show that overweight and obesity prevalences vary across the Mexican population, without presenting a specific behavior. There is a high prevalence of overweight and obesity among Mexican infants and a slight trend toward increased obesity in infants < 12 months. Weight monitoring and obesity prevention interventions focused on the first 1,000 days of life are essential.

Resumen: La prevalencia de la obesidad infantil ha aumentado rápidamente en México, y tiene consecuencias para la salud de la población en el futuro. Poco se sabe sobre la prevalencia de obesidad en niños que tienen menos de dos años, etapa fundamental para la prevención de esta condición. El objetivo fue determinar la magnitud, la distribución y las tendencias de sobrepeso y obesidad en niños menores de 24 meses de edad utilizando las Encuestas Nacionales de Salud y Nutrición (ENSANUT) en México en los últimos 10 años. Los datos presentados se derivan de cuatro ENSANUTs en México: 2012, 2016, 2018 y 2020. Los datos incluyen 6.719 menores de 24 meses de edad con datos antropométricos completos (peso/altura) por edad, sexo, etnicidad, lugar de residencia y nivel socioeconómico. Se calculó el riesgo de sobrepeso y sobrepeso + obesidad siguiendo las directrices de la Organización Mundial de la Salud. Se identificó que los menores de 12 meses tienen una prevalencia más alta de sobrepeso + obesidad (10,3%), y los que tienen entre 12 y 23 meses tienen riesgo de sobrepeso más alto (26,1%). Los hallazgos más relevantes por sexo, región, nivel socioeconómico y etnicidad de este estudio que las prevalencias de sobrepeso y obesidad varían en la población mexicana, sin presentar un comportamiento específico. Hay una alta prevalencia de sobrepeso y obesidad en niños mexicanos, y una ligera tendencia de aumento de obesidad en menores de 12 meses. El monitoreo del peso y las intervenciones de prevención de obesidad centradas en los primeros 1.000 días de vida son esenciales.

Resumo: A prevalência da obesidade infantil tem aumentado rapidamente no México, com consequências para a saúde da população no futuro. Pouco se sabe sobre a prevalência de obesidade em crianças menores de dois anos de idade, etapa fundamental para a prevenção desta condição. Nosso objetivo foi determinar a magnitude, distribuição e tendências de sobrepeso e obesidade em crianças menores de 24 meses de idade usando as Pesquisas Nacionais de Saúde e Nutrição (ENSANUT) no México nos últimos 10 anos. Os dados apresentados são derivados de quatro ENSANUTs no México: 2012, 2016, 2018 e 2020. Os dados incluem 6.719 crianças menores de 24 meses e seus dados antropométricos completos (peso/altura) por idade, sexo, etnicidade, área de residência e nível socioeconômico. O risco de sobrepeso e sobrepeso + obesidade foram calculados seguindo as diretrizes da Organização Mundial da Saúde. Foi identificado que crianças menores de 12 meses atualmente têm uma prevalência maior de sobrepeso + obesidade (10,3%), e aqueles com idade de 12 a 23 meses têm mais risco de sobrepeso (26,1%). Os achados mais relevantes por sexo, região, nível socioeconômico e etnicidade deste estudo mostram um México heterogêneo em relação a sobrepeso e obesidade sem apresentar um comportamento específico. Há uma alta prevalência de sobrepeso e obesidade em bebês mexicanos, e uma leve tendência de aumento da obesidade em crianças menores de 12 meses. O monitoramento do peso e as intervenções de prevenção de obesidade focadas nos primeiros 1.000 dias de vida são essenciais.

RESUMO

BACKGROUND: Woman's weight changes during pregnancy and postpartum contribute to obesity and health outcomes later in life. This study aimed to identify and characterize weight change trajectories from pregnancy to one year postpartum among adult women. METHODS: We used data from an ongoing cohort of healthy adult women (n = 819) with singleton pregnancies from 2007 - 2011. Sociodemographic data, pre-pregnancy body weight, and sedentary and breastfeeding practices were collected using questionaries applied by trained professionals. We applied a group-based trajectory modeling to distinguish weight change measured in the second and third trimesters of pregnancy and at one month, six, and 12 months postpartum. Multinomial regression models were run to characterize each trajectory. RESULTS: We identified six weight change trajectories with the main difference in the patterns followed after one month of delivery. One in three women (36.7%) was classified in some of the three postpartum weight gain trajectories and regained weight from the second trimester of the first year postpartum. Women who followed some of these trajectories were more likely to have higher age, obesity before pregnancy, < 10 years of schooling, and partner, compared with women (10.7%, n = 87) in a postpartum sustained-fast-lost-weight trajectory (p < 0.05). CONCLUSIONS: Women with obesity before pregnancy have higher odds of regaining gestational weight after delivery without reaching their pre-pregnancy weight. The first six months postpartum are crucial to establishing obesity prevention strategies. Further research is needed to evaluate the effect of the interventions that prevent substantial weight gain through reproductive years in high-risk women.

Assuntos

RESUMO

BACKGROUND AND AIM: An association between lead (Pb) exposure and antisocial behaviors has been documented, but findings have been inconclusive. We aimed to estimate the association between prenatal, early childhood, and preadolescent/adolescent (periadolescent) Pb exposure and aggression and conduct problems in periadolescent residents of Mexico City. METHODS: Using information from the ELEMENT cohort study, we assessed prenatal Pb exposure through maternal patella Pb (MPPb) measurement during the puerperium, early childhood (birth to 5 years of age) exposure through a cumulative blood lead index (CBLI), and periadolescent exposure through a blood Pb (BPb) measurement concurrent with the evaluation of the outcomes. Outcomes were assessed during periadolescence using the parent-reported scales of aggression and conduct problems of the Behavioral Assessment System for Children-2nd version (BASC-2). We modeled the association between Pb exposure at each stage and each outcome (defined as a T-score ≥60 in the corresponding behavioral scale) using logistic regression, adjusting for sex, maternal age at delivery, maternal education, and household socioeconomic status (SES). The differential effect by sex was assessed with an interaction term in the models. RESULTS: 743, 704, and 595 participants were respectively eligible for inclusion in final models of prenatal, early childhood, and periadolescent Pb exposure. Median Pb exposure at each stage was 9.9 µg/g for MPPb (prenatal), 5.19 µg/dl for CBLI (early childhood), and 2.62 µg/dl for concurrent BPb (periadolescence). 12 % of participants met the criterion for aggression, and 15 % for conduct problems. In adjusted models, a one interquartile range increase in MPPb increased the odds of conduct problems (OR:1.31; 95 % CI: 1.01, 1.70) and aggression (OR=1.24; 95 % CI: 0.93, 1.65) during periadolescence. Pb exposure during early childhood or periadolescence was not associated with either outcome. We found no evidence of interactions by sex. CONCLUSIONS: Exposure to Pb during the prenatal stage was associated with aggression and conduct problems during periadolescence.

Assuntos

RESUMO

Background: Although clinical trials showed that vaccines have high efficacy and safety, differences in study designs and populations do not allow for comparison between vaccines and age groups. The objective of this study was to evaluate the effectiveness of vaccines against COVID-19 in real-world conditions in adults aged 60 years and older in Colombia. Methods: In this retrospective, population-based, matched cohort study, we evaluated the effectiveness of vaccines against COVID-19-related hospitalisation and death in people aged 60 years and older. The full cohort consisted of every person who was eligible to receive a COVID-19 vaccine in Colombia (the ESPERANZA cohort). The exposed cohort consisted of older adults who were fully vaccinated with Ad26.COV2-S, BNT162b2, ChAdOx1 nCoV-19, or CoronaVac, and who did not have a history of confirmed SARS-CoV-2 infection. The unexposed cohort were people aged 60 years and older who had not received any dose of a COVID-19 vaccine during the study period. Participant follow-up was done between March 11, 2021, and Oct 26, 2021. Vaccine effectiveness was estimated as 1- hazard ratio from cause-specific proportional hazards models in the presence of competing risks. We estimated the overall effectiveness of being fully vaccinated, as well as effectiveness for each vaccine, adjusting by main potential confounders. The effectiveness of each vaccine was also assessed by age groups (ages 60-69 years, 70-79 years, and ≥80 years). Findings: 2 828 294 participants were assessed between March 11 and Oct 26, 2021. For all ages, the overall effectiveness across all assessed COVID-19 vaccines at preventing hospitalisation without subsequent death was 61·6% (95% CI 58·0-65·0, p<0·0001), 79·8% (78·5-81·1, p<0·0001) for preventing death after hospitalisation with COVID-19, and 72·8% (70·1-75·3, p<0·0001) for preventing death without previous COVID-19 hospitalisation. The effectiveness of all vaccines analysed at preventing death after hospitalisation for COVID-19 was 22·6% lower in adults who were aged 80 and older (68·4% [65·7-70·9], p<0·0001) compared with adults aged between 60 and 69 years (91·0% [89·0-92·6], p<0·0001). Interpretation: All vaccines analysed in this study were effective at preventing hospitalisation and death from COVID-19 in fully vaccinated older adults, which is a promising result for the national vaccination programme against COVID-19 in Colombia and in countries where these biologics have been applied. Efforts should be improved to increase coverage among older adults. In addition, given that we observed that the effectiveness of vaccines declined with increasing age, a booster dose is also justified, which should be prioritised for older adults. Funding: Colombian Ministry of Health and Social Protection.

Assuntos

RESUMO

The aim of this study was to identify serum ferritin (SF) cut-off points (COPs) in a cohort of healthy full-term normal birth weight infants who had repeated measurements of SF and haemoglobin every 3 months during the first year of life. The study included 746 full-term infants with birth weight ≥2,500 g, having uncomplicated gestations and births. Participants received prophylactic iron supplementation (1 mg/day of iron element) from the first to the 12th month of life and did not develop anaemia during the first year of life. Two statistical methods were considered to identify COPs for low iron stores at 3, 6, 9 and 12 months of age: deviation from mean and cluster analysis. According to the K-means cluster analysis results by age and sex, COPs at 3 and 6 months for girls were 39 and 21 µg/L and for boys 23 and 11 µg/L, respectively. A single COP of 10 µg/L was identified, for girls and boys, at both 9 and 12 months. Given the physiological changes in SF concentration during the first year of life, our study identified dynamic COPs, which differed by sex in the first semester. Adequate SF COPs are necessary to identify low iron stores at an early stage of iron deficiency, which represents one of the most widespread public health problems around the world, particularly in low- and middle-income countries.

Assuntos

RESUMO

OBJECTIVE: To evaluate the associations of pregestational BMI, gestational weight gain (GWG) and breast-feeding at 1 month postpartum with four patterns of weight change during the first year after delivery: postpartum weight retention (PPWR), postpartum weight gain (PPWG), postpartum weight retention + gain (PPWR + WG) and return to pregestational weight. DESIGN: In this secondary analysis of a prospective study, we categorised postpartum weight change into four patterns using pregestational weight and weights at 1, 6 and 12 months postpartum. We evaluated their associations with pregestational BMI, GWG and breast-feeding using multinomial logistic regression. Results are presented as relative risk ratios (RRR) and 95 % CI. SETTING: Mexico City. PARTICIPANTS: Women participating in the Programming Research in Obesity, Growth, Environment and Social Stressors pregnancy cohort. RESULTS: Five hundred women were included (53 % of the cohort). Most women returned to their pregestational weight by 1 year postpartum (57 %); 8 % experienced PPWR, 14 % PPWG and 21 % PPWR + WG. Compared with normal weight, pregestational overweight (RRR 2·5, 95 % CI 1·3, 4·8) and obesity (RRR 2·2, 95 % CI 1·0, 4·7) were associated with a higher risk of PPWG. Exclusive breast-feeding, compared with no breast-feeding, was associated with a lower risk of PPWR (RRR 0·3, 95 % CI 0·1, 0·9). Excessive GWG, compared with adequate, was associated with a higher risk of PPWR (RRR 3·3, 95 % CI 1·6, 6·9) and PPWR + WG (RRR 2·4, 95 % CI 1·4, 4·2). CONCLUSIONS: Targeting women with pregestational overweight or obesity and excessive GWG, as well as promoting breast-feeding, may impact the pattern of weight change after delivery and long-term women's health.

Assuntos