La Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (CCINSHAE) eligió como una de las mejores tesis del año pasado el trabajo de la Dra. Claudia Ivonne Ramírez Silva, alumna de la Escuela de Salud Pública de México (ESPM) del Instituto Nacional de Salud Pública (INSP).
En el marco del XX Encuentro Nacional de Investigadores de la Secretaría de Salud, llevado a cabo en Puebla en octubre de 2015, Ramírez Silva fue elegida como ganadora de la convocatoria de mejores tesis de doctorado realizadas en 2014, junto con alumnos del Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", del Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz" y del Hospital General "Manuel Gea González".
Para la realización de la tesis titulada Alimentación y crecimiento en los primeros 4 años de vida en una cohorte de niños mexicanos: efectos en adiposidad, perfil de lípidos y tensión arterial, la Dra. Ivonne Ramírez contó con la dirección del Dr. Juan Rivera Dommarco, director del Centro de Investigación en Nutrición y Salud (CINyS) del INSP.
Por otra parte, esta tesis dio origen a dos artículos publicados en The Journal of the Federation of American Societies for the Experimental Biology y en The Journal of Nutrition en 2014 y 2015, respectivamente.
El primero se titula "Breastfeeding status at age 3 months is associated with adiposity and cardiometabolic markers at age 4 years in Mexican children", cuyo resumen se muestra a continuación:
“Background: The role of breastfeeding on cardiometabolic risk factors is not well characterized. Objective. The objective was to assess the association of breastfeeding status at 3 mo and duration with adiposity and cardiometabolic markers at 4y. Methods. We studied 727 children with prospectively-collected breastfeeding information and anthropometric measurements at 4y, of whom 524 provided a non-fasting blood sample. Breastfeeding (BF) status at 3 months was classified as exclusive or predominant (EBF-PreBF), partial (PaBF), or non-breastfeeding (NBF). Total duration of any breastfeeding (TDBF) was classified as <3 mo, 3 to 6 mo, >6 to 12 mo and >12 mo. We modeled associations of BF with Body Mass Index (BMI), serum total (TCH) and LDL cholesterol (LDL-C), tryglicerides (TG) and Insulin (In) at 4 y. Results. Children who were NBF or PaBF at 3 mo had higher BMI [0.46 kg/m2 (95%CI: 0.16, 0.76), and 0.31 kg/m2 ( 95%CI: 0.07, 0.54)], respectively, than the EBF-PreBF group (P <0.01). NBF children had higher TCH [8.02 mg/dL (95% CI: 1.39, 14.64); P =0.02] than children who were EBF-PreBF. LDL-C [5.04 mg/dL (95% CI: -0.72, 10.81)] and TG [12% change (95% CI: -0.01, 0.24)] showed similar patterns. An inverse association between EBF-PreBF and insulin, mediated through abdominal circumference was documented (P <0.05). Children breastfed <3 mo had higher BMI [0.44 kg/m2 (95% CI: 0.11, 0.77] at 4 y than those breastfed for >12 mo. Conclusion. EBF and PreBF at 3 mo were associated with lower adiposity and serum total cholesterol in children at 4y. Additionally, breastfeeding >12 mo was associated with lower adiposity. These data confirm the importance of exclusive breastfeeding and prolonged breastfeeding for later cardiometabolic health”.
El segundo artículo es "Rapid weight gain through age 4 y is associated with increased adiposity, higher blood pressure and insulin alterations at 4-5 y" y su resumen es el siguiente:
Background. In developed countries rapid weight gain (RWG) before 2y of age is associated with higher risk of obesity and cardiometabolic alterations later in life, while in low and middle income countries these associations are only observed after 2 years of life. In Mexico, a middle-income country in an advance stage of a nutrition transition, these associations have not been studied. Objective. To evaluate the relationship between rapid weight gain (RWG) in selected periods between 1-48 mo with adiposity, blood pressure and insulin levels at 4-5 y of age. Methods. We studied 449 offspring of Mexican women who participated in a randomized trial in which women were supplemented with 400 mg/d DHA or placebo from mid-pregnancy to parturition. Insulin from non-fasting blood was obtained at 4 y, and anthropometry and blood pressure were obtained at 5 y. RWG was defined as an increase of >+1.0 Z-score weight-for-height within the age periods 0-6, 6-12, 12-24 and 24-48 mo. We used multivariate multiple linear models, with adjustment for DHA treatment and confounding variables (socioeconomic level, BMI of the mother during pregnancy, maternal schooling, breastfeeding at 3mo, hours of fasting, sex and height of the child). Results. Relative to children without RWG, those with RWG at each period had higher BMI (differences ranged from 0.42 to 0.89Kg/m2; all p <0.01), sum-of-skinfold (range 1.1 to 3.6mm; all p<0.01) and abdominal circumference (range 1.2 to 3.8 cm; all p<0.01) at 5 y; RWG in any period from 6-48 mo was associated with higher systolic and diastolic blood pressure (ranges 1.2 to 1.8 mmHg and 0.9 to 1.2 mmHg; all p<0.05, respectively) at 5 y. RWG in any period from 12-48 mo was associated with 13% higher insulin levels (p<0.05) at 4 y. RWG at older age intervals (24–48 mo) was associated with greater levels of adiposity and BP compared to younger age periods RWG from 12-24 mo only was associated with 14% higher insulin levels (p <0.05) at 4 y. Conclusion. Children with RWG during the first 4 y had higher risk of adiposity and cardiometabolic alterations at 4-5 y.