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Abstract Objective. To characterize the current consumption of fruits and vegetables based on the international recommendations, as well as its relationship to certain variables of interest in Mexican children aged 6 to 12 years. Materials and methods. Adherence to the international recommendations for the consumption of fruits and vegetables was estimated based on data from the National Health and Nutrition Survey Ensanut Logistic regression models were developed.
Souza y R. Aller, R. Conde, O. Izaola, B. Primo y M. Aller, O.
Izaola, M. Conde y M. Betanzos-Cabrera, D. Estrada-Luna, H. Belefant-Miller y J. Vilches-Larrea, T. Zamora Elson, C. Lander Azcona, M. Marquina Lacueva, J.
Martinuzzi, E. Ferraresi, M. Orsatti, A. Palaoro, J. Chaparro, S. Amin, C. Feller, M. Di Leo, A. Guillot y V. Ribas y L. Vidal Casariego y M. Mercadal-Orfila, J. Lluch-Taltavull, C. Campillo-Artero y M. Valenza, L. Aguilar Cordero, M.
Castro, E. Jara, M. Leal, D. Bunout, S. Hirsch, G. Barrera, L. Leiva y M. Leiva-Badosa, J. Figueras-Suriol, A. Quirante-Cremades, M. Oya, C. Rodrigues Coy, R. Franco Leal, M. Setsuko Ayrizono, V. Sgarbieri, M. Soriano del Castillo y J. Garin, J. Cardona, R. Martin-Venegas, I. Gich, J. Cardenete y M. Tous Romero, I. Parejo Campos, R. Serrano Aguayo, J. Hisnard Cadet Dussort, J. Pereira Cunill, S. Morales Conde y P. Martins Gonzaga do Nascimento, A.
Max Moreira Reis, J. Yeznach Wick y A. Malpeli, S. Ramos Gordillo, F. Cabrera Franquiz, Y. Cabrera Oliva, M. Yedra y A. Silva de Assis, L. Nascimento Cruz, P. Zuchinali, L. Rohde y E. Cuadrado, S. Alves de Carvalho, P. Coelho Cabral, I. Kruze Grande de Arruda, M. Barros Pernambuco y P. Costa Liboredo, H. Soares Lima, E. Wanden-Berghe, A. Lobo Tamer, A. Zugasti Murillo, A.
Apezetxea Celaya, A. Torres Corts, J. Moreno Villares, D. Penacho, L. Laborda, R. Burgos, J. Irles, C. Cuerda Compes, M. Virgili Casas, M. Chu, S. Ethics Consent by the children who participated in the study and informed consent by their parents or guardians were obtained.
Variables Consumption of fruits and vegetables. This exclusion was due the change in nutritional composition of such items, especially when sugar was added, or to the loss of nutrients during processing. Cut-off points were determined according to Ramirez and colleagues,6 i.
Gender was dichotomized as male and female. Age was analyzed continuously years. Regions in the country were divided according to their geographical location into North, Central, Mexico City and South. Socioeconomic tertile SET. A socioeconomic index was constructed using principal components analysis with variables of housing and availability of goods and services. The first component, which, accumulated, represents The index was classified into three categories using tertiles of the distribution as cut-off points.
This variable was categorized into two groups: those who attended school and those who did not attend school at the time of the survey. Health insurance or affiliation. This was classified according to two categories: 1 those with insurance coverage public or private or affiliation with government agencies and 2 those without any type of insurance or who were not affiliated with any institution.
Characteristics of the head of the family Kinship of the head of the family to the child. Gender and age of the head of the family. Both the gender and the age of the head of the family were taken into consideration. Education of the head of the family.
The highest level of schooling reported by the head of the family was taken into consideration, according to four categories: 1 elementary school or lower, 2 secondary level, 3 high school or equivalent and 4 bachelor's degree or higher. Nutrition Energy obtained from other sources.
Energy from all foods included in the FFQ was estimated including fruits and vegetables using the food composition tables compiled by the INSP as a reference. Health status BMI. Data analysis From a sample of 3 children and adolescents aged years, we included only 1 children, aged years.
Energy adequacy was calculated using as a reference the information from the U. Demographic variables in regard to nutritional, socioeconomic and health status were stratified according to the categories of adherence and nonadherence to the international recommendations for consumption of fruits and vegetables. Differences between these categories were analyzed using statistical tests such as chi-squared independence test or linear regressions, according to the variable scale.
Also, a bivariate logistic model regression was carried out to explore the relationship of each variable with adherence. All variables were included in a multivariate logistic regression model where interactions among the variables were tested i. The same criteria were applied to the interactions, which were tested by the logistic regression analysis.
All analyses were adjusted in accordance with the design of the survey using the SVY module of the Stata v. Results Data were analyzed from a total of 1 participants representing just over Thirty four percent The bivariate logistic regression analysis table II showed that children aged years had 2. The children of the Central region and of Mexico City had approximately 2. The associations observed in relation to the child's age and region of residence persisted after adjusting for potential confounders in a multivariate logistic regression model table III.
A statistically significant interaction was observed between the educational level of the head of the family and his or her kinship to the child and the odds of adhering to the recommendations. Figure 2 shows graphically that the adjusted adherence rate is significantly lower in the children from Northern Mexico than in those of other regions of the country.
Discussion This study was based on the most recent national health and nutrition data in Mexico and has shown that currently only 3 out of every 10 children aged years This apparent increase may be related to the implementation of the ANSA and the PACE, which is derived from the Agreement on Guidelines for the Sale of Food and Beverages within the elementary schools, which became mandatory early in For this reason, the authors assume that these Guidelines were effective in promoting access to fruits and vegetables among elementary school children in Mexico.
Also, certain population subgroups, such as children of the northern region of the country, have shown a low adherence to respect to the other regions. These aspects need further investigation. Age proved to be an important factor in adherence to the recommendations, noting that as age increases, the consumption of fruits and vegetables decreases. This phenomenon was also observed in the Ensanut6 in Canadian children22 and in adolescents,23 as well as in American children. The widespread availability and marketing of cheap, energydense, micronutrient-poor foods, could work against the consumption of fruit and vegetables26 if these foods continue to be prevalent at home.
This relationship differentiated by kinship had not been previously documented, and in this study the number of cases in which this happens is very small, a fact that is reflected in confidence intervals associated to interaction table III.
However, it is possible to propose some hypothesis based on the existing literature. Some studies have reported better nutritional conditions in young children who live in "extended" families because this allows for a greater interaction among its members, facilitating child care and provision of all the necessities of life, regardless of their income. On the other hand, it is possible that this relationship may be due to factors not considered in the analysis, for example, the health status and nutrition of the head of the household.
A better educational level has been associated with greater adherence to health recommendations and guidelines.
Thus, a higher consumption of fruits and vegetables is promoted among the rest of the family. These hypotheses are only proposals that should be interpreted with caution and researched further. The results of this study should be interpreted taking its limitations into account. Because it is cross-sectional, causality or temporality cannot be established. However, it has the advantage of providing information that is representative of the Mexican population and of being comparable to the Ensanut.
Use of the FFQ is subject to various errors in its application and reporting; therefore, staff were trained and standardized to apply it equally to all subjects. As for the reporting, it has been documented that fruits and vegetables are foods that tend to be overreported because they are considered to be healthy.
This is more common in overweight persons or mothers of overweight children. The present study documented that there is currently greater adherence to international recommendations of fruit and vegetable consumption. However, two-thirds of the children aged years still do not adhere to the recommendations.
Therefore, it is urgent to promote a solid public policy with adequate legislation, financing and regulation, in order to facilitate fruit and vegetable consumption among Mexican children. Acknowledgments We appreciate the collaboration of Dr.
Teresa Shamah, Dr. Juan Rivera, and Dr. References 1.
Fomento del consumo mundial de frutas y verduras. Carlton B. Dietary intake of fruit and vegetables and management of body weight.
Geneva: WHO, Eur J Clin Nutr ; 66 10 Diet, nutrition and the prevention of hypertension and cardiovascular diseases. Public Health Nutr ;7 1A