Publications by authors named "Hortensia Moreno-Macias"

55 Publications

Reply: To PMID 24766873.

J Allergy Clin Immunol 2014 Sep 25;134(3):763-4. Epub 2014 Jul 25.

International Agency for Research on Cancer, Lyon, France.

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http://dx.doi.org/10.1016/j.jaci.2014.06.012DOI Listing
September 2014

Association of a low-frequency variant in HNF1A with type 2 diabetes in a Latino population.

JAMA 2014 Jun;311(22):2305-14

Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Sección XVI, Tlalpan, Mexico City, Mexico.

Importance: Latino populations have one of the highest prevalences of type 2 diabetes worldwide.

Objectives: To investigate the association between rare protein-coding genetic variants and prevalence of type 2 diabetes in a large Latino population and to explore potential molecular and physiological mechanisms for the observed relationships.

Design, Setting, And Participants: Whole-exome sequencing was performed on DNA samples from 3756 Mexican and US Latino individuals (1794 with type 2 diabetes and 1962 without diabetes) recruited from 1993 to 2013. One variant was further tested for allele frequency and association with type 2 diabetes in large multiethnic data sets of 14,276 participants and characterized in experimental assays.

Main Outcome And Measures: Prevalence of type 2 diabetes. Secondary outcomes included age of onset, body mass index, and effect on protein function.

Results: A single rare missense variant (c.1522G>A [p.E508K]) was associated with type 2 diabetes prevalence (odds ratio [OR], 5.48; 95% CI, 2.83-10.61; P = 4.4 × 10(-7)) in hepatocyte nuclear factor 1-α (HNF1A), the gene responsible for maturity onset diabetes of the young type 3 (MODY3). This variant was observed in 0.36% of participants without type 2 diabetes and 2.1% of participants with it. In multiethnic replication data sets, the p.E508K variant was seen only in Latino patients (n = 1443 with type 2 diabetes and 1673 without it) and was associated with type 2 diabetes (OR, 4.16; 95% CI, 1.75-9.92; P = .0013). In experimental assays, HNF-1A protein encoding the p.E508K mutant demonstrated reduced transactivation activity of its target promoter compared with a wild-type protein. In our data, carriers and noncarriers of the p.E508K mutation with type 2 diabetes had no significant differences in compared clinical characteristics, including age at onset. The mean (SD) age for carriers was 45.3 years (11.2) vs 47.5 years (11.5) for noncarriers (P = .49) and the mean (SD) BMI for carriers was 28.2 (5.5) vs 29.3 (5.3) for noncarriers (P = .19).

Conclusions And Relevance: Using whole-exome sequencing, we identified a single low-frequency variant in the MODY3-causing gene HNF1A that is associated with type 2 diabetes in Latino populations and may affect protein function. This finding may have implications for screening and therapeutic modification in this population, but additional studies are required.
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http://dx.doi.org/10.1001/jama.2014.6511DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4425850PMC
June 2014

Effects of antioxidant supplements and nutrients on patients with asthma and allergies.

J Allergy Clin Immunol 2014 May;133(5):1237-44; quiz 1245

International Agency for Research on Cancer, Lyon, France.

Asthma and allergic diseases have become a worldwide public health concern because of their increased prevalence. Despite decades of research on risk factors, the causes of these disorders are poorly understood. They are thought to develop through complex interactions between genetic and environmental factors. Because pulmonary and systemic oxidative stress increase inflammatory responses relevant to asthma and allergy, dietary or vitamin supplementation with antioxidants (a broad and varied category) has been proposed as an approach to reducing asthma incidence or morbidity. Meta-analyses of observational epidemiologic studies of variable methodological quality suggest associations of relatively low dietary intake of antioxidants and higher asthma and allergy prevalence. However, there have been few longitudinal studies of maternal or child dietary or vitamin/supplement antioxidant intake and asthma/allergy development. Moreover, there are no clinical trial data to support the use of dietary antioxidants or supplements to prevent asthma or allergy. A few small clinical trials suggest that specific antioxidants from diet or vitamin supplements might improve asthma control or lung function in asthmatic children or adults. Studies suggest that responses to antioxidants might be modified by life stage, genetic susceptibility, and environmental sources of oxidative stress. Large trials of antioxidant vitamin supplementation to prevent cancer suggest an increase in overall mortality with antioxidant vitamin supplementation, at least in populations with sufficient dietary antioxidant intake. This cautionary experience suggests that future trials to assess whether antioxidants reduce asthma incidence or improve asthma control should focus on supplementation of dietary sources of antioxidants. The potential benefits and risks of trials of vitamin supplements might be considered in special situations in which vulnerable populations have marked deficiency in dietary antioxidants, poor access to dietary antioxidants, and high exposure to environmental sources of oxidants.
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http://dx.doi.org/10.1016/j.jaci.2014.03.020DOI Listing
May 2014

Sequence variants in SLC16A11 are a common risk factor for type 2 diabetes in Mexico.

Nature 2014 Feb 25;506(7486):97-101. Epub 2013 Dec 25.

Performing genetic studies in multiple human populations can identify disease risk alleles that are common in one population but rare in others, with the potential to illuminate pathophysiology, health disparities, and the population genetic origins of disease alleles. Here we analysed 9.2 million single nucleotide polymorphisms (SNPs) in each of 8,214 Mexicans and other Latin Americans: 3,848 with type 2 diabetes and 4,366 non-diabetic controls. In addition to replicating previous findings, we identified a novel locus associated with type 2 diabetes at genome-wide significance spanning the solute carriers SLC16A11 and SLC16A13 (P = 3.9 × 10(-13); odds ratio (OR) = 1.29). The association was stronger in younger, leaner people with type 2 diabetes, and replicated in independent samples (P = 1.1 × 10(-4); OR = 1.20). The risk haplotype carries four amino acid substitutions, all in SLC16A11; it is present at ~50% frequency in Native American samples and ~10% in east Asian, but is rare in European and African samples. Analysis of an archaic genome sequence indicated that the risk haplotype introgressed into modern humans via admixture with Neanderthals. The SLC16A11 messenger RNA is expressed in liver, and V5-tagged SLC16A11 protein localizes to the endoplasmic reticulum. Expression of SLC16A11 in heterologous cells alters lipid metabolism, most notably causing an increase in intracellular triacylglycerol levels. Despite type 2 diabetes having been well studied by genome-wide association studies in other populations, analysis in Mexican and Latin American individuals identified SLC16A11 as a novel candidate gene for type 2 diabetes with a possible role in triacylglycerol metabolism.
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http://dx.doi.org/10.1038/nature12828DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4127086PMC
February 2014

Association between rs2981582 polymorphism in the FGFR2 gene and the risk of breast cancer in Mexican women.

Arch Med Res 2013 Aug 18;44(6):459-66. Epub 2013 Sep 18.

Departamento de Epidemiología, Hospital No. 4, IMSS, Tecomán, Colima, Mexico.

Background And Aims: The rs2981582 single nucleotide polymorphism in the fibroblast growth factor receptor 2 gene has been consistently associated with an increased risk of breast cancer. We evaluated the effect of rs2981582 polymorphism in the FGFR2 gene on the risk of breast cancer and its interaction with non-genetic risk factors.

Methods: A population-based case-control study was conducted in Mexico. Data from 687 cases and 907 controls were analyzed.

Results: The T allele of the rs2981582 polymorphism was associated with an increased risk of breast cancer (ORper allele = 1.24, 95% CI 1.06-1.46). There was also an interaction between this polymorphism and alcohol consumption (p = 0.043). The effect of alcohol consumption on the risk of breast cancer varied according to the allelic variants of the rs2981582 polymorphism in the FGFR2 gene: OR = 3.97 (95% CI 2.10-7.49), OR = 2.01 (95% CI 1.23-3.29) and OR = 1.21 (95% CI 0.48-3.05) for genotypes CC, CT and TT, respectively.

Conclusions: This is the first study exploring the association between rs2981582 polymorphism in the FGFR2 gene and breast cancer risk in Mexican women. The interaction found may be of great public health interest because alcohol consumption is a modifiable breast cancer risk factor. Therefore, replication of this finding is of foremost importance.
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http://dx.doi.org/10.1016/j.arcmed.2013.08.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049087PMC
August 2013

Ozone exposure, vitamin C intake, and genetic susceptibility of asthmatic children in Mexico City: a cohort study.

Respir Res 2013 Feb 4;14:14. Epub 2013 Feb 4.

Universidad Autónoma Metropolitana, Unidad Iztapalapa, Avenida San Rafael Atlixco 186, edificio H-001, Col. Vicentina, 09430, D F, México City, Mexico.

Background: We previously reported that asthmatic children with GSTM1 null genotype may be more susceptible to the acute effect of ozone on the small airways and might benefit from antioxidant supplementation. This study aims to assess the acute effect of ozone on lung function (FEF(25-75)) in asthmatic children according to dietary intake of vitamin C and the number of putative risk alleles in three antioxidant genes: GSTM1, GSTP1 (rs1695), and NQO1 (rs1800566).

Methods: 257 asthmatic children from two cohort studies conducted in Mexico City were included. Stratified linear mixed models with random intercepts and random slopes on ozone were used. Potential confounding by ethnicity was assessed. Analyses were conducted under single gene and genotype score approaches.

Results: The change in FEF(25-75) per interquartile range (60 ppb) of ozone in persistent asthmatic children with low vitamin C intake and GSTM1 null was -91.2 ml/s (p = 0.06). Persistent asthmatic children with 4 to 6 risk alleles and low vitamin C intake showed an average decrement in FEF(25-75) of 97.2 ml/s per 60 ppb of ozone (p = 0.03). In contrast in children with 1 to 3 risk alleles, acute effects of ozone on FEF25-75 did not differ by vitamin C intake.

Conclusions: Our results provide further evidence that asthmatic children predicted to have compromised antioxidant defense by virtue of genetic susceptibility combined with deficient antioxidant intake may be at increased risk of adverse effects of ozone on pulmonary function.
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http://dx.doi.org/10.1186/1465-9921-14-14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3579760PMC
February 2013

Contribution of common genetic variation to the risk of type 2 diabetes in the Mexican Mestizo population.

Diabetes 2012 Dec 24;61(12):3314-21. Epub 2012 Aug 24.

Unidad de Biología Molecular y Medicina Genómica, Instituto de Investigaciones Biomédicas de la Universidad Nacional Autónoma de México e Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.

Several studies have identified nearly 40 different type 2 diabetes susceptibility loci, mainly in European populations, but few of them have been evaluated in the Mexican population. The aim of this study was to examine the extent to which 24 common genetic variants previously associated with type 2 diabetes are associated in Mexican Mestizos. Twenty-four single nucleotide polymorphisms (SNPs) in or near genes (KCNJ11, PPARG, TCF7L2, SLC30A8, HHEX, CDKN2A/2B, CDKAL1, IGF2BP2, ARHGEF11, JAZF1, CDC123/CAMK1D, FTO, TSPAN8/LGR5, KCNQ1, THADA, ADAMTS9, NOTCH2, NXPH1, RORA, UBQLNL, and RALGPS2) were genotyped in Mexican Mestizos. A case-control association study comprising 1,027 type 2 diabetic individuals and 990 control individuals was conducted. To account for population stratification, a panel of 104 ancestry-informative markers was analyzed. Association to type 2 diabetes was found for rs13266634 (SLC30A8), rs7923837 (HHEX), rs10811661 (CDKN2A/2B), rs4402960 (IGF2BP2), rs12779790 (CDC123/CAMK1D), and rs2237892 (KCNQ1). In addition, rs7754840 (CDKAL1) was associated in the nonobese type 2 diabetic subgroup, and for rs7903146 (TCF7L2), association was observed for early-onset type 2 diabetes. Lack of association for the rest of the variants may have resulted from insufficient power to detect smaller allele effects.
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http://dx.doi.org/10.2337/db11-0550DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3501881PMC
December 2012

Gene-environment interaction tests for family studies with quantitative phenotypes: A review and extension to longitudinal measures.

Hum Genomics 2010 Jun;4(5):302-26

Department of Environmental Health, Harvard School of Public Health, Boston, MA 02115, USA.

Longitudinal studies are an important tool for analysing traits that change over time, depending on individual characteristics and environmental exposures. Complex quantitative traits, such as lung function, may change over time and appear to depend on genetic and environmental factors, as well as on potential gene-environment interactions. There is a growing interest in modelling both marginal genetic effects and gene-environment interactions. In an admixed population, the use of traditional statistical models may fail to adjust for confounding by ethnicity, leading to bias in the genetic effect estimates. A variety of methods have been developed to account for the genetic substructure of human populations. Family-based designs provide an important resource for avoiding confounding due to admixture. To date, however, most genetic analyses have been applied to cross-sectional designs. In this paper, we propose a methodology which aims to improve the assessment of main genetic effect and gene-environment interaction effects by combining the advantages of both longitudinal studies for continuous phenotypes, and the family-based designs. This approach is based on an extension of ordinary linear mixed models for quantitative phenotypes, which incorporates information from a case-parent design. Our results indicate that use of this method allows both main genetic and gene-environment interaction effects to be estimated without bias, even in the presence of population substructure.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2952941PMC
http://dx.doi.org/10.1186/1479-7364-4-5-302DOI Listing
June 2010

Gene by environment interaction and ambient air pollution.

Proc Am Thorac Soc 2010 May;7(2):116-22

M.P.H., Sc.D., National Institute of Public Health, Av. Universidad # 655, Col. Santa Maria Ahuacatitlán, C. P. 62100, Cuernavaca, Morelos, México.

Epidemiologic studies have clearly shown that air pollution is associated with a range of respiratory effects. Recent research has identified oxidative stress as a major biologic pathway underlying the toxic effect of air pollutants. Genetic susceptibility is likely to play a role in response to air pollution. Genes involved in oxidative stress and inflammatory pathways are logical candidates for the study of the interaction with air pollutants. In this article we use the example of asthma, a genetically complex disease, to address the issue of gene by environment interaction with air pollution. The majority of studies have focused on the genes GSTM1, GSTP1, NQO1, and TNF, but the inconsistency of the results prevents the drawing of firm conclusions. The limited sample size of most studies to date make them underpowered for the study of gene by gene interactions. Large consortia of studies with repeated measurements of environmental exposures and clear phenotypic assessments may help determine special environmental triggers and the window of susceptibility in the development of atopy and asthma. The role of gene by gene interactions and epigenetic mechanisms needs to be considered along with gene by environment interactions.
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http://dx.doi.org/10.1513/pats.200909-097RMDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266017PMC
May 2010

[Food consumption and asthma in school children in Cuernavaca, Morelos, Mexico].

Salud Publica Mex 2009 May-Jun;51(3):202-11

Instituto Nacional de Salud Pública, 62508 Cuernavaca, Morelos, México.

Objective: To evaluate the relation between diet and the development of asthma and allergic rhinitis in schoolchildren from Cuernavaca, Morelos, Mexico.

Material And Methods: We apply the ISAAC's questionnaire in 5460 schoolchildren from 6 to 8 and 11-14-year-old of elementary level selected in random form. Six groups of food were formed using a hierarchic clusters analysis and the association was evaluated using logistic regression models.

Results: The consumption of fast food had an adverse effect for current wheezing (OR=1.82; CI95%=1.16-2.87) and the consumption of tidbits for more than three episodes of wheezing (OR=2.26; CI95%=1.04-4.95) and nasal symptoms without cold, OR=1.35 (IC95%;1.06-1.71).

Conclusions: This study provides evidence that the diet plays a very important role since the high consumption of fast food and tidbits increased the risk of asthma and rhinitis symptoms.
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http://dx.doi.org/10.1590/s0036-36342009000300010DOI Listing
April 2010

[The effects of a rural environment on the prevalence of allergic rhinitis among schoolchildren in Mexicali, Baja California, Mexico].

Rev Panam Salud Publica 2009 May;25(5):431-7

Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico.

Objectives: To assess the prevalence of allergic rhinitis symptoms among schoolchildren in Mexicali, Baja California, Mexico, and determine what impact a rural environment might have on this condition.

Methods: A population-based, cross-sectional study using a standardized questionnaire administered to a random sample of 2087 schoolchildren 6-7 years of age (1078 girls and 1009 boys) living in the city of Mexicali, Baja California, Mexico. The study analyzed associations between exposure variables and personal and family health history, and two dependent variables-nasal symptoms and nasal and ocular symptoms, in the absence of a cold or flu-using odd ratios (OR) and 95% Confidence Intervals (95%CI). The study took place in February-July 2004 and followed the methodology of the International Study of Asthma and Allergies in Childhood (ISAAC).

Results: The general prevalence of nasal symptoms and nasal and ocular symptoms was 25.0% and 10.5%, respectively. The boys and girls who had ever lived on a farm or in a rural area had a lower probability, adjusted for confounding variables, of presenting nasal symptoms (OR=0.43; 95%CI: 0.24-0.77), or nasal and ocular symptoms (OR=0.39; 95%CI: 0.16-0.93).

Conclusions: In the study population, exposure to a rural environment in early childhood decreased the risk of developing allergic rhinitis, regardless of a family history of asthma.
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http://dx.doi.org/10.1590/s1020-49892009000500008DOI Listing
May 2009

Traffic-related air pollution and respiratory symptoms among asthmatic children, resident in Mexico City: the EVA cohort study.

Respir Res 2008 Nov 16;9:74. Epub 2008 Nov 16.

Instituto Nacional de Salud Pública, Mexico.

Background: Taffic-related air pollution has been related to adverse respiratory outcomes; however, there is still uncertainty concerning the type of vehicle emission causing most deleterious effects.

Methods: A panel study was conducted among 147 asthmatic and 50 healthy children, who were followed up for an average of 22 weeks. Incidence density of coughing, wheezing and breathing difficulty was assessed by referring to daily records of symptoms and child's medication. The association between exposure to pollutants and occurrence of symptoms was evaluated using mixed-effect models with binary response and poisson regression.

Results: Wheezing was found to relate significantly to air pollutants: an increase of 17.4 microg/m3 (IQR) of PM2.5 (24-h average) was associated with an 8.8% increase (95% CI: 2.4% to 15.5%); an increase of 34 ppb (IQR) of NO2 (1-h maximum) was associated with an 9.1% increase (95% CI: 2.3% to 16.4%) and an increase of 48 ppb (IQR) in O3 levels (1 hr maximum) to an increase of 10% (95% CI: 3.2% to 17.3%). Diesel-fueled motor vehicles were significantly associated with wheezing and bronchodilator use (IRR = 1.29; 95% CI: 1.03 to 1.62, and IRR = 1.32; 95% CI: 0.99 to 1.77, respectively, for an increase of 130 vehicles hourly, above the 24-hour average).

Conclusion: Respiratory symptoms in asthmatic children were significantly associated with exposure to traffic exhaust, especially from natural gas and diesel-fueled vehicles.
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http://dx.doi.org/10.1186/1465-9921-9-74DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2613139PMC
November 2008

Spatiotemporal associations between GOES aerosol optical depth retrievals and ground-level PM2.5.

Environ Sci Technol 2008 Aug;42(15):5800-6

Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts 02115, USA.

We analyze the strength of association between aerosol optical depth (AOD) retrievals from the GOES aerosol/smoke product (GASP) and ground-level fine particulate matter (PM2.5) to assess AOD as a proxy for PM2.5 in the United States. GASP AOD is retrieved from a geostationary platform, giving half-hourly observations every day, in contrast to once per day snapshots from polar-orbiting satellites. However, GASP AOD is based on a less-sophisticated instrument and retrieval algorithm. We find that daily correlations between GASP AOD and PM2.5 over time at fixed locations are reasonably high, except in the winter and in the western U.S. Correlations over space at fixed times are lower. Simple averaging to the month and year actually reduces correlations over space, but statistical calibration allows averaging over time that produces moderately strong correlations. These results and the data density of GASP AOD highlight its potential to help improve exposure estimates for epidemiological analyses. On average 39% of days in a month have a GASP AOD retrieval compared to 11% for MODIS and 5% for MISR. Furthermore, GASP AOD has been retrieved since November 1994, providing a long-term record that predates the availability of most PM2.5 monitoring data and other satellite instruments.
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http://dx.doi.org/10.1021/es703181jDOI Listing
August 2008

Assessment of personal exposure to ozone in asthmatic children residing in Mexico City.

Salud Publica Mex 2008 Jan-Feb;50(1):67-75

Instituto Nacional de Salud Pública, Universidad 655, Cuernavaca, Mexico.

Objective: A study was conducted to evaluate personal ozone exposure (O3p) among asthmatic children residing in Mexico City.

Material And Methods: A total of 158 children were recruited from December 1998 to April 2000. On average, three O3p measurements were obtained per child using passive badges. Time-activity patterns were recorded in a diary. Daily ambient ozone measurements (O3a) were obtained from the fixed station, according to children's residence. Levels of O3a and ozone, weighted by time spent in different micro-environments (O3w), were used as independent variables in order to model O3p concentrations using a mixed-effects model.

Results: Mean O3p was 7.8 ppb. The main variables in the model were: time spent indoors, distance between residence and fixed station, follow-up group, and two interaction terms (overall R(2)=0.50, p<0.05).

Conclusions: The O3w concentrations can be used as a proxy for O3p, taking into account time-activity patterns and the place of residence of asthmatic Mexican children.
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http://dx.doi.org/10.1590/s0036-36342008000100013DOI Listing
July 2008

[Diabetes mellitus within low socioeconomic strata in Mexico City: a relevant problem].

Rev Invest Clin 2007 Jul-Aug;59(4):246-55

Dirección de Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.

Objective: To evaluate the feeding and nutrition conditions and its relation with diabetes mellitus (DM-2) in adult population (> 30 years) a sample belonging to the low socioeconomic stratum of the Mexico City metropolitan area was studied. They were participants in the Second Feeding and Nutrition Survey in the Mexico City metropolitan area. (ENURBAL-2002).

Material And Methods: Information collected by the ENURBAL 2002 was used in order to evaluate the relationship between some risk factors and diabetes mellitus in adult population of low economical level. Logistical regression analysis was applied.

Results: A complete set of 1279 individuals with ages over 30 years was studied. The 9.9% (IC 95% 7.9, 12.4) had been previously diagnosed as diabetics and 3.9% (IC 95% 2.9, 5.4) were not been diagnosed but their glycemia reached diabetic levels. Total diabetes prevalence observed in this study was 13.8% (IC 95% 11.7, 16.3). People with good score on its knowledge about nutrition, as well as high total fat intake, are significant and positively associated with DM-2 (RM = 2.41, IC 95% 1.09, 5.35 and RM = 2.14 IC 95% 1.24, 3.69, respectively).

Conclusions: Diabetes mellitus was highly prevalent among adult (> 30 years population) mainly on the lower socioeconomic stratum of Mexico City. This result is important to promote changes in life style that allow to prevent its appearance by modifying the obesigenic environment and changes in the feeding patterns.
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January 2008

Trends in the prevalence of asthma and other allergic diseases in schoolchildren from Cuernavaca, Mexico.

Allergy Asthma Proc 2007 May-Jun;28(3):368-74

Instituto Nacional de Salud Publica de Mexico, Cuernavaca, Morelos, Mexico.

Several studies suggest that the prevalence of allergic diseases have increased worldwide in recent years. However, in Mexico, those diseases have not been assessed throughout time. The aim of this study was to determine whether there has been a change in the prevalence of childhood asthma, eczema, and atopic rhinitis in Mexican schoolchildren. Following the methodology recommended by the International Study of Asthma and Allergy in Childhood, we performed two cross-sectional assessments (1995/2002) using a standardized questionnaire-based survey answered by the parents of schoolchildren aged 6-8 years and 11-14 years randomly selected from schools in Cuernavaca, Mexico. The prevalence of asthma diagnosed by a doctor was 5.8% (95% CI, 5.2, 6.4) for 1995 versus 9.1% (95% CI, 8.3, 10.0) for 2002, with a greater prevalence in children aged 6-8 years in 2002 (5.7% versus 9.0%). No significant differences were found over time for wheezing in the last 12 months: 7.7% (95% CI, 7.1, 8.4) in 1995 and 8.0% (95% CI, 7.3, 8.8) in 2002. The prevalence of nasal and eye symptoms without colds was slightly higher in 1995 than it was in 2002: 9.9% (95% CI, 9.1, 10.7) versus 8.2% (95% CI, 7.4, 9.0), respectively. The results suggest an increase in the prevalence of asthma diagnosed by a doctor. However, no difference was observed in the prevalence of wheezing in the last 12 months, which may indicate a possible absence of "epidemic asthma" in the city of Cuernavaca among schoolchildren.
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http://dx.doi.org/10.2500/aap.2007.28.2998DOI Listing
August 2007

[Validity of peak flow record in asthmatic children residing in Mexico City].

Salud Publica Mex 2007 May-Jun;49(3):182-9

Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.

Objective: To determine the concordance between maximum peak expiratory flow records (PEFr) reported by the parents of asthmatic children and the electronic values stored by the AirWatch device (PEFe).

Material And Methods: Records of PEF measurements between October 1998 and 1999 were obtained from 42 asthmatic children 5 to 15 years of age recruited at the Hospital Infantil de Mexico Federico Gomez, in Mexico City. Parents recorded the maximum value in the health diary. Spearman correlation was calculated between PEFe and PEFr and a mixed-effects logistic model was used.

Results: The correlation between PEFe and PEFr was r=0.96 (p<0.05) among children with a diagnosis of moderate or severe asthma and r=0.40 (p<0.05) among children diagnosed with mild asthma. Follow-up time, asthma severity, gender and age of the child and their interactions were predictors of the differences between PEFe and PEFr.

Conclusions: Parents of children with moderate or severe asthma from 6 to 8 years of age report PEF values with greater accuracy during follow-up than others.
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http://dx.doi.org/10.1590/s0036-36342007000300003DOI Listing
August 2007

Impact of traffic flow on the asthma prevalence among school children in Lima, Peru.

J Asthma 2007 Apr;44(3):197-202

Departamento de Estadística, Demografía, Humanidades y Ciencias Sociales, Universidad Peruana Cayetano Heredia, Lima, Perú.

Objective: To estimate the impact of traffic flow on the prevalence of asthma among school children of 6 to 7 and 13 to 14-years of age.

Methods: A cross-sectional study consisting of 5,917 children selected in schools of the Cone Norte of Lima, Peru.

Results: For the 6- to 7-year age group the prevalence of medical diagnosis of asthma according to the traffic flow index was 8.6% (CI: 6.8-10.8), 10.3% (CI: 8.4-12.4), and 15.3% (CI:13.3-17.5) at low, medium and high, respectively, and for the 13- to 14-year age group, 11.9% (CI: 9.4-14.6), 13.3% (CI: 11.6-15.2), and 17.1% (CI: 14.7-19.6).

Conclusions: For both groups, the prevalence of asthma was significantly related to traffic flow density.
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http://dx.doi.org/10.1080/02770900701209756DOI Listing
April 2007

Lung function growth in children with long-term exposure to air pollutants in Mexico City.

Am J Respir Crit Care Med 2007 Aug 19;176(4):377-84. Epub 2007 Apr 19.

Instituto Nacional de Salud Publica, 655 Avenida Universidad, Col. Santa Maria Ahuacatitlán, Cuernavaca, Morelos 62508, México.

Rationale: Although short-term exposure to air pollution has been associated with acute, reversible lung function decrements, the impact of long-term exposure has not been well established.

Objectives: To evaluate the association between long-term exposure to ozone (O(3)), particulate matter less than 10 mum in diameter (PM(10)), and nitrogen dioxide (NO(2)) and lung function growth in Mexico City schoolchildren.

Methods: A dynamic cohort of 3,170 children aged 8 years at baseline was followed from April 23, 1996, through May 19, 1999. The children attended 39 randomly selected elementary schools located near 10 air quality monitoring stations and were visited every 6 months. Statistical analyses were performed using general linear mixed models.

Measurements And Main Results: After adjusting for acute exposure and other potential confounding factors, deficits in FVC and FEV(1) growth over the 3-year follow-up period were significantly associated with exposure to O(3), PM(10), and NO(2). In multipollutant models, an interquartile range (IQR) increase in mean O(3) concentration (IQR, 11.3 ppb) was associated with an annual deficit in FEV(1) of 12 ml in girls and 4 ml in boys, an IQR range (IQR, 36.4 microg/m(3)) increase in PM(10) with an annual deficit in FEV(1) of 11 ml in girls and 15 ml in boys, and an IQR range (IQR, 12.0 ppb) increase in NO(2) with an annual deficit in FEV(1) of 30 ml in girls and 25 ml in boys.

Conclusions: We conclude that long-term exposure to O(3), PM(10), and NO(2) is associated with a deficit in FVC and FEV(1) growth among schoolchildren living in Mexico City.
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http://dx.doi.org/10.1164/rccm.200510-1678OCDOI Listing
August 2007

Maternal dietary omega fatty acid intake and auditory brainstem-evoked potentials in Mexican infants born at term: cluster analysis.

Early Hum Dev 2008 Jan 16;84(1):51-7. Epub 2007 Apr 16.

National Institute of Public Health, Cuernavaca, Mexico.

Objective: To identify biological and socioeconomic factors associated with the neurological development of Mexican infants born at term, as measured by brainstem auditory-evoked potentials (BAEPs).

Subjects And Methods: We conducted a cohort study among 76 women with low risk pregnancies recruited in their third trimester of pregnancy and followed their infants until 12 months of age. BAEP tests were conducted on the infants before 3 months of age during physiologic sleep, using 100 msec bipolar clicks. Maternal dietary intake was evaluated by food frequency questionnaire. Two BAEP groups (short latency, long latency) were identified by cluster analysis. The association between BAEP group and maternal PUFAs was estimated using logistic regression models adjusted for socioeconomic and biological factors.

Results: Short latency BAEPs were associated with a maternal diet rich in arachidonic acid (OR=3.63, 95% CI 1.23-10.67) after adjusting for age (in days) sex, head circumference and gestational age but was not significantly associated to a maternal diet rich in docosahexaenoic acid (DHA).

Conclusions: Our results suggest the importance of arachidonic acid intake during pregnancy for short latency BAEPs and adequate fetal myelination.
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http://dx.doi.org/10.1016/j.earlhumdev.2007.03.005DOI Listing
January 2008

Relationship between indoor, outdoor, and personal fine particle concentrations for individuals with COPD and predictors of indoor-outdoor ratio in Mexico city.

J Expo Sci Environ Epidemiol 2008 Jan 4;18(1):109-15. Epub 2007 Apr 4.

Instituto Nacional de Salud Pública, Centro de Investigaciones en Salud poblacional, Cuernavaca Mor., México.

Personal exposure and indoor and outdoor exposure to PM(10) and PM(2.5) of 38 individuals with chronic obstructive pulmonary disease (COPD) was characterized from February through November 2000. All participants lived in Mexico City and were selected based on their area of residence southeast (n=15), downtown (n=15), and southwest (n=8). Participants were monitored at home using personal PM(2.5) monitoring devices. Indoor and outdoor levels of PM(10) and PM(2.5) were measured using MiniVol samplers. Concurrent individual exposure measurements, indoor and outdoor levels of PM(2.5), which averaged 38.4 (SD 21.4), 30.6 (SD 15.8), and 30.5 mug/m(3) (SD 19.4), respectively. Indoor PM(2.5) concentrations explained 40% of the variability of personal exposure. In addition, the factors that most affected personal exposure were regular indoor contact with animals, mold, cooking activities, and aerosol use, indicating that internal sources may largely affect individual exposure.
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http://dx.doi.org/10.1038/sj.jes.7500557DOI Listing
January 2008

Poor compliance with appropriate feeding practices in children under 2 y in Mexico.

J Nutr 2006 Nov;136(11):2928-33

Research Center on Nutrition and Health, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico.

We evaluated breast-feeding and complementary feeding practices in Mexico, using data from a national probabilistic survey carried out in 17,716 households, with regional and urban-rural representation. Mothers of children <2 y old (n = 3,191) reported duration of breast-feeding and the ages of usual introduction of 7 food groups. The Kaplan-Meier method was used to estimate the median time of feeding events. Practices were analyzed by categories of ethnicity, housing condition, and place of residence (geographic region and degree of urbanization). We found that 86% of infants at 1 mo and 39% at 11 mo were breast-fed, whereas 60% at 1 mo and 8% at 6 mo were exclusively breast-fed. Early introduction (<6 mo) of water, nonhuman milk, nonnutritive liquids, and fruits and vegetables was reported for all categories studied. Also, early introduction of nutritive liquids, cereals and legumes, and animal foods other than milk occurred in all categories except rural areas and the indigenous population. Late introduction of solid foods was documented in large proportions of infants in rural areas and in poor families. Poorer, unemployed, and indigenous women, and those bearing males, had a significantly higher probability of feeding their infants as recommended by the WHO. Feeding practices were unrelated to attained growth when the influence of economic and social factors was considered. Results indicate the need to implement actions for the promotion of exclusive breast-feeding during the first 6 mo and of timely introduction of complementary foods thereafter.
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http://dx.doi.org/10.1093/jn/136.11.2928DOI Listing
November 2006

Infant mortality and air pollution: modifying effect by social class.

J Occup Environ Med 2004 Dec;46(12):1210-6

Instituto Nacional de Salud Pública, Av Universidad 655, Col. Santa. Ma., Ahuacatitlan, Cuernavaca Morelos 65708, Mexico.

Unlabelled: Studies link air pollution with increased mortality; however, information on infants is scarce and inconclusive.

Objective: We studied short-term PM10 exposure, relating to increased respiratory-related infant mortality, and estimated for poor living conditions.

Methods: A case-crossover approach modeled the relationship between infant mortality (1 month-1 year of age), and ambient PM10 levels on days before death in Ciudad Juarez, Mexico (1997-2001). Socioeconomic level (SES) of the deceased was defined by residence location.

Results: Overall air pollutants did not affect infant mortality (odds ratio [OR] = 1.02, 95% confidence interval [CI] = 0.94-1.11 for PM10, lag1) but low SES increased risk. Each 20 microg/m3 in PM10 (24-hour average, lag1, cumulative over 2 previous days) increased respiratory-related mortality (OR = 1.61, 95% CI = 0.97-2.66; OR = 2.56; 95% CI = 1.06-6.17, respectively). Ozone levels did not affect infant mortality for any SES.

Conclusions: Worse living conditions among lower SES concurred with increased mortality.
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December 2004

Breast-feeding practices in Mexico: results from the Second National Nutrition Survey 1999.

Salud Publica Mex 2003 ;45 Suppl 4:S477-89

Instituto Nacional de Salud Pública, Centro de Investigaciones en Nutrición y Salud, Cuernavaca, Morelos, México.

Objective: To assess breast-feeding (BF) practices and determinants of exclusive BF (EBF) < 4 and < 6 months (mo) among women and infants < 23 mo in the NNS-1999.

Material And Methods: BF practices from the day and night before the interview were ascertained, and median duration estimated. Determinants of EBF < 4 and < 6 mo were analysed by logistic regression models for complex surveys.

Results: Prevalence of EBF < 4 mo was 25.7%, and of < 6 mo 20.3%. The overall rate of continued BF (second year) was 30.9%, median duration of BF 9 mo, and the national proportion of children ever breast-fed 92.3%. The probability (p) of EBF < 4 mo was determined by infant age and sex, by maternal socio-economic level (SEL) and ethnicity, and by the interaction between infant sex and SEL. The pEBF < 6 mo was determined by infant age and length, by maternal ethnicity, and employment.

Conclusions: EBF rates and duration are low in Mexico and have improved only slightly in the last 20 y. Infant and maternal characteristics determine the pEBF. If improvements in infant health are a national priority, aggressive interventions to promote and protect BF are urgently needed in Mexico, as well as formal evaluation of current initiatives. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.
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http://dx.doi.org/10.1590/s0036-36342003001000004DOI Listing
March 2004

Antioxidant supplementation and lung functions among children with asthma exposed to high levels of air pollutants.

Am J Respir Crit Care Med 2002 Sep;166(5):703-9

Instituto Nacional de Salud Publica, Cuernavaca, Morelos, Mexico.

To evaluate whether acute effects of ozone, nitrogen dioxide, and particulates with mass median diameter less than 10 micro m could be attenuated by antioxidant vitamin supplementation, we conducted a randomized trial using a double-blinded design. Children with asthma (n = 158) who were residents of Mexico City were randomly given a daily supplement of vitamins (50 mg/day of vitamin E and 250 mg/day of vitamin C) or a placebo and were followed from October 1998 to April 2000. Pulmonary function tests were carried out twice a week in the morning. During the follow-up observation period, the mean 1-hour maximum ozone level was 102 ppb (SD = 47), and the mean 24-hour average PM(10) level was 56.7 micro g/m(3) (SD = 27.4). In children with moderate and severe asthma, ozone levels 1 day before spirometry were inversely associated significantly with forced expiratory flow (FEF(25-75)) (-13.32 ml/second/10 ppb; p = 0.000), FEV(1) (-4.59 ml/10 ppb; p = 0.036), and peak expiratory flow (PEF) (-15.01 ml/second/10 ppb; p = 0.04) in the placebo group after adjusting for potential confounding factors. No association between ozone and lung functions was observed in the supplement group. We observed significant differences in lung function decrements between groups for FEF(25-75) and PEF. Our results suggest that supplementation with antioxidants might modulate the impact of ozone exposure on the small airways of children with moderate to severe asthma.
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http://dx.doi.org/10.1164/rccm.2112074DOI Listing
September 2002
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