Nutritional evaluation of children with phenylketonuria

CONTEXT: Dietary phenylalanine (PA) restriction is the most effective form for reducing its excess in the blood and is the only efficient method for treating phenylketonuria. The diet is complex and should be adapted to combine the patients' eating habits, growth and development. It depends basically on the use of industrialized products as substitutes free of PA for proteins that are not fully supplied. OBJECTIVE: To evaluate the nutritional status of children with phenylketonuria (PKU) by anthropometric measurements and food intake. DESIGN: Cross-sectional study. SETTING: Children with PKU attending the Association of Parents and Friends of Handicapped Children (Associação de Pais e Amigos dos Excepcionais - APAE) and normal children attending at municipal day care centers in São Paulo. PARTICIPANTS: 42 children with PKU and 31 normal children aged 1 to 12 of both sexes were assessed in two groups, under and over 7 years of age. MAIN MEASUREMENTS: Weight and height measurements. RESULTS: Children with PKU ingested calories, calcium, iron, zinc, and copper below the recommended values, whereas the protein intake was within the normal range. Food intake in the group of normal children was within normality rates. The height/weight Z-score means for children with PKU were 0.47 for those under 7 years and 1.86 for 7 year-olds and over; in normal children the means were 0.97 <7 years and 1.54 ³7 years, with no statistically significant difference. The height/age Z-score means were significantly lower in the PKU children <7 years (-1.23) than in the normal controls (0.91). CONCLUSIONS: The data presented demonstrate the importance of nutritional surveillance in patients with PKU so as to support adequacy of nutrient intake and to guarantee growth within the relevant standards.CONTEXTO: A restrição dietética da fenilalanina (FAL) é a forma mais efetiva para reduzir o seu excesso no sangue e o único método efetivo de tratar a fenilcetonúria. A dieta é complexa e deve ser adaptada para combinar hábitos alimentares, crescimento e desenvolvimento dos pacientes. Depende basicamente do uso de produtos industrializados como substitutos protéicos isentos de FAL, não totalmente suplementados. OBJETIVO: Avaliar o estado nutricional das crianças fenilcetonúricas por medidas antropométricas e o consumo alimentar. TIPO DE ESTUDO: Estudo transversal LOCAL: Associação de Pais e Amigos dos Excepcionais (APAE) de São Paulo, Creche e Centro de Juventude da Prefeitura de São Paulo. PARTICIPANTES: 42 crianças fenilcetonúricas e 31 normais, na faixa etária de 1 a 12 anos, divididas em dois grupos abaixo e acima de 7 anos, de ambos os sexos. RESULTADOS: As fenilcetonúricas apresentaram porcentagem de adequação da ingestão de calorias, cálcio, ferro, zinco e cobre abaixo do recomendado. A ingestão protéica estava dentro da normalidade. O consumo alimentar no grupo de crianças normais apresentou-se dentro da faixa da normalidade. As médias de peso para estatura em escore z das fenilcetonúricas foram 0.47 < 7 anos e 1.86 ³ 7 anos; nas normais 0.97 < 7 anos e 1.54 ³ 7 anos, sem diferença estatisticamente significante. As médias de E/I apresentaram diferença estatisticamente significante entre fenilcetonúricas < 7 anos (- 1.23) e crianças normais de mesma faixa etária (0,91). CONCLUSÃO: Concluiu-se que a vigilância nutricional em crianças fenilcetonúricas é importante para manutenção dos padrões de crescimento e o adequado consumo de nutrientes.University of São PauloFederal University of São PauloUNIFESPSciEL

Bone mineral density in juvenile systemic lupus erythematosus

We evaluated spine bone mineral density (BMD) in Brazilian children with juvenile systemic lupus erythematosus (JSLE) in order to detect potential predictors of reduction in bone mass. A cross-sectional study of BMD at the lumbar spine level (L2-L4) was conducted on 16 female JSLE patients aged 6-17 years. Thirty-two age-matched healthy girls were used as control. BMD at the lumbar spine was measured by dual-energy X-ray absorptiometry. Weight, height and pubertal Tanner stage were determined in patients and controls. Disease duration, mean daily steroid doses, mean cumulative steroid doses and JSLE activity measured by the systemic lupus erythematosus disease activity index (SLEDAI) were determined for all JSLE patients based on their medical charts. All parameters were used as potential determinant factors for bone loss. Lumbar BMD tended to be lower in the JSLE patients, however, this difference was not statistically significant (P = 0.10). No significant correlation was observed in JSLE girls between BMD and age, height, Tanner stage, disease duration, corticosteroid use or disease activity. We found a weak correlation between BMD and weight (r = 0.672). In the JSLE group we found no significant parameters to correlate with reduced bone mass. Disease activity and mean cumulative steroid doses were not related to BMD values. We did not observe reduced bone mass in female JSLE.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PediatriaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUNIFESP, EPM, Depto. de PediatriaUNIFESP, EPM, Depto. de MedicinaSciEL

Tetanus and diphtheria immunity in adolescents from São Paulo, Brazil

Tetanus and diphtheria vaccines are of special concern in adolescents because boosters are necessary for adequate maintenance of protection and are often omitted. We assessed serum levels of tetanus and diphtheria antibodies in adolescents and their association with vaccination status. From May to October 2001, we evaluated the vaccination records of 208 adolescents aged 10 to 20 years in São Paulo, Brazil. Antibodies to tetanus and diphtheria were detected using double-antigen ELISA and vaccination records were analyzed according to the guidelines of the Brazilian National Immunization Program. All adolescents had received complete primary vaccinations against tetanus and diphtheria, but 23.1% of them had not received a booster dose in the last 10 years. All adolescents were immune to tetanus and 88.9% were fully protected (antibodies ³0.1 IU/mL). One individual (0.5%) was non-immune to diphtheria and 86% were fully protected against the disease. Adolescents with up-to-date vaccination records had higher antibody levels than those with not up-to-date records for tetanus (0.763 vs 0.239 IU/mL, t-test: P < 0.0001) and diphtheria (0.366 vs 0.233 IU/mL, t-test: P = 0.014). Full immunity against tetanus (antibodies ³0.1 IU/mL) was higher among individuals with up-to-date vaccination (93.1%) when compared to those with not up-to-date records (75%, Fisher's exact test: P = 0.001). All adolescents had received basic immunization in childhood and were protected against tetanus and diphtheria. However, these data indicate that more emphasis should be placed on the tetanus-diphtheria booster in order to avoid a decay in antibody levels

Total and added sugar intake: Assessment in eight Latin American countries

Non-communicable diseases are growing at an alarming rate in Latin America. We assessed total and added sugar intake in Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela, to verify the adequacy of the World Health Organization’s recommendations, considering gender, socioeconomic level (SEL) and age. A total of 9218 non-institutionalized individuals living in urban areas (age range 15-65 years) were assessed in the Latin American Study of Nutrition and Health (ELANS), a multicenter household population-based cross-sectional survey. Socio-demographic data were collected. Total and added sugar intakes were measured using two non-consecutive 24-h dietary recalls. The prevalence of excessive sugar intake was estimated. A large proportion of individuals showed high consumption of total and added sugar intake, which reflected in the high prevalence of excessive sugar intake. With minimal differences across countries, in general, women, individuals with high SEL, and younger people had higher percentages of total energy intake from total and added sugar intake, and of contribution of carbohydrates from total and added sugars. Thus, there is high consumption of total and added sugar intake in the Latin American countries with some peculiarities considering socio-demographic variables, which should be considered in each country’s health intervention proposals

Co‐occurrence and clustering of sedentary behaviors, diet, sugar‐sweetened beverages, and alcohol intake among adolescents and adults: The latin american nutrition and health study (elans)

Poor diet, sedentary behaviors, sugar‐sweetened beverages (SSB) and alcohol intake seem to co‐exist in complex ways that are not well understood. The aim of this study was to provide an understanding of the extent to which unhealthy behaviors cluster in eight Latin America countries. A secondary aim was to identify socio‐demographic characteristics associated with these behaviors by country. Data from adolescents and adults from the “Latin American Health and Nutrition Study” was used and the prevalence of screen‐time, occupational and transportation–sedentary time, socializing with friends, poor diet, SSB and alcohol intake, alone and in combination, were identified. The eight Latin America (LA) countries added to analyses were: Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela. Logistic regression was used to estimate associations between ≥2 behaviors clustering, socio‐demographics and weight status. Among 9218 individuals, the most prevalent behaviors were transportation and occupation–sedentary time, SSB and alcohol intake. Younger, female, married/living with a partner, low and middle‐income and obese individuals had higher chances for these clustering behaviors. These results provide a multi-country level of understanding of the extent to which behaviors co‐occur in the LA population.University of San FranciscoRevisión por pare

Evolution Of Body Mass Index In Two Historical Series Of Adolescents

Objective: To verify the evolution of body mass index (BMI) between two studies of adolescent populations. Methods: Data on the BMI of 8,020 adolescents aged 10 to 15 years living in the city of São Paulo, Brazil, and enrolled on the 2005 study entitled "The nutritional profile of adolescents at public and private schools in São Paulo" were compared with data from the 1989 National Nutrition and Health Census (PNSN - Pesquisa Nacional sobre Saúde e Nutrição). Binomial testing was used to compare proportions once both data sets had been transformed into percentiles. Results: Comparing the two surveys, significant increases were identified in 85th and 95th percentile BMI values for male adolescents aged 10 to 15 years and for female adolescents aged 10 to 14 years. Analysis of the difference between the 5th and 95th BMI percentiles of the São Paulo and PNSN samples indicates that there was probably an increase in the number of adolescents in the higher BMI ranges in São Paulo in relation to the PNSN survey. Conclusions: These results demonstrate a tendency for the adolescents' observed mean BMI values to increase during the period between the two surveys, indicating a need for increased monitoring of this measurement as a form of preventing overweight in this population. Copyright © 2007 by Sociedade Brasileira de Pediatria.832157162Stettler, N., Comment: The global epidemic of childhood obesity: is there a role for the paediatrician? (2004) Obes Rev, 5 (SUPPL. 1), pp. 1-3Obesity: Preventing and managing the global epidemic (1998) Report of the WHO Consultation on Obesity, , World Health Organization, Geneva: WHO;Tomkis, A., Measuring obesity in children: What standards to use? (2006) J Pediatr (Rio J), 82, pp. 246-248Monteiro, C.A., Mondini, L., Medeiros, S.A.L., Popkin, B.M., The nutrition transition in Brasil (1995) Eur J Clin Nutr, 49, pp. 105-113Lobstein, T., Baur, L., Uauy, R., IASO International Obesity TaskForce. Obesity in children and young people: A crisis in public health (2004) Obes Rev, 5 (SUPPL. 1), pp. 4-104Balaban, G., Silva, G.A.P., Prevalência de sobrepeso e obesidade em crianças e adolescentes de uma escola da rede privada de Recife (2001) J Pediatr (Rio J), 77, pp. 96-100Souza Leão, S.C., Araújo, L.M.B., Moraes, L.T.L.P., Assis, A.M., Prevalência de obesidade em escolares de Salvador, Bahia. Arq Bras Edocrinol (2003) Metab, 47, pp. 151-157Costa, R.F., Cintra, I.P., Fisberg, M., Prevalência de sobrepeso e obesidade em escolares da cidade de Santos, SP (2006) Arq Bras Endocrinol Metab, 50, pp. 60-67Costa, R.F., Fisberg, M., Soderberg, T.R., Maxta, J.B., Cunha, J.S.N., Soderberg, A.R.F., Prevalência do sobrepeso e obesidade em crianças de 7 a 10 anos de escolas públicas e particulares da cidade de Santos-SP (2003) Arq Bras Endocrinol Metab, 47, pp. S371Pereira, C.V.R., Silva, C.S., Anjos, L.A., Tendência na disponibilidade de energia e macronutrientes para a população brasileira nos últimos 40 anos (2002) Anais do 12° Seminário de Iniciação Científica, , Niterói: Universidade Federal Fluminense;Burlandy, L., Anjos, L.A., Acesso a vale-refeição e estado nutricional de adultos beneficiários do Programa de Alimentaç ão do Trabalhador no Nordeste e Sudeste do Brasil, 1997 (2001) Cad Saude Publica, 17, pp. 1457-1464Bellizzi, M.C., Dietz, W.H., Workshop on childhood obesity: Summary of the discussion (1999) Am J Clin Nutr, 70, pp. 173S-175SWang, Y., Wang, J.Q., A comparison of international references for the assessment of child and adolescent overweight and obesity in different populations (2002) Eur J Clin Nutr, 56, pp. 973-982Wang, Y., Monteiro, C.A., Popkin, B.M., Trends of obesity and underweight in older children and adolescents in the United States, Brasil, China, and Rússia (2002) Am J Clin Nutr, 75, pp. 971-977Fundo das Nações Unidas para a Infância (IBGE/UNICEF) (1992) Perfil estatístico de crianças e mães, , Instituto Brasileiro de Geografia e Estatística, Brasil. Rio de Janeiro: IBGE;Anjos, L.A., Veiga, G.V., Castro, I.R.R., Distribuição dos valores do índice de massa corporal da população brasileira até 25 anos (1998) Rev Panam Salud Publica, 3, pp. 164-173Jellife DB. Evaluación del estado de nutrición de la comunidad. Ginebra: OMS1968(1995) Expert Committee on Physical Status: The use and interpretation of anthropometry, 854. , World Health Organization WHO, Geneva: WHO;Cole, T.J., Bellizzi, M.C., Flegal, K.M., Dietz, W.H., Establishing a standard definition for child overweight and obesity worldwide: International survey (2000) BMJ, 320, pp. 1240-1243Organización Mundial de La Salud (OMS). La salude de los jovens: desafio para la sociedad. Informe de un grupo de estúdios de la OMS acerca de los jovens y la salud para todos en el año 2000. Ginebra: OMS1999Veiga, G.V., Vieira, A.C.R., Alvarez, M.M., Pereira, R.C., Body mass index in assessment of overweight and obesity in children and adolescents: Agreement and disagreement. Nutrire Rev Soc Bras Aliment (2004) Nutr, 28, pp. 109-124Veiga, G.V., Cunha, A.S., Sichieri, R., Trends in overweight among adolescents living in the poorest and richest regions of Brazil (2004) Am J Public Health, 94, pp. 1544-1548McCarthy, H.D., Ellis, S.M., Cole, T.J., Central overweight and obesity in British youth ages 11-16 years: Cross sectional surveys of waist circumference (2003) BMJ, 326, p. 624Conde, W.L., Monteiro, C.A., Body mass index cutoff points for evaluation of nutritional status in Brazilian children and adolescents (2006) J Pediatr (Rio J), 82, pp. 266-272Passos, M.A.Z., (2005) Percentis, por idade e sexo, do índice de massa corporal e das circunferências do braço, da cintura, do quadril e da relação cintura/quadril, de adolescentes de 10 a 15 anos da cidade de São Paulo [tese], , São Paulo: Universidade Federal de São Paulo;Must, A., Dallal, G.E., Dietz, W.H., Reference data for obesity: 85th and 95th percentiles of body mass index (wt/ht2) and triceps skinfold thickness (1991) Am J Clin Nut, 53, pp. 839-846Growth charts for the United States: Methods and development (2000) Series report, 11 (246 .201). , CDC, Atlanta: CDC;Mendonça, C.P., Anjos, L.A., Aspectos das práticas alimentares e da atividade física como determinantes do crescimento do sobrepeso/obesidade no Brasil (2004) Cad Saude Publica, 20, pp. 698-709(2004) Pesquisa de orçamentos familiares: Medidas antropométricas de crianças e adolescentes 2002-2003, , Instituto Brasileiro de Geografia e Estatística, Rio de Janeiro: IBGE;Katzmarzyk, P.T., Janssen, I., Ross, R., Church, T.S., Blair, S.N., The importance of waist circumference in the definition of metabolic syndrome: Prospective analyses of mortality in men (2006) Diabetes Care, 29, pp. 404-40

Nurturing Children's Healthy Eating: Position statement

The relationship between eating a healthy diet and positive health outcomes is well known; nurturing healthy eating among children therefore has the potential to improve public health. A healthy diet occurs when one''s usual eating patterns include adequate nutrient intake and sufficient, but not excessive, energy intake to meet the energy needs of the individual. However, many parents struggle to establish healthy eating patterns in their children due to the pressures of modern life. Moreover, healthcare providers often do not have the time or the guidance they need to empower parents to establish healthy eating practices in their children. Based on existing evidence from epidemiologic and intervention research, the Nurturing Children''s Healthy Eating collaboration, established by Danone Institute International, has identified four key themes that encourage and support healthy eating practices among children in the modern Western world. The first — positive parental feeding — explores how parenting practices and styles, such as avoiding food restriction, allowing children to make their own food choices, and encouraging children to self-limit their portion sizes, can influence children''s dietary intake. The second — eating together — highlights the link between eating socialization through regular family meals and healthful diet among children. The third — a healthy home food environment — explores the impact on eating practices of family resources, food availability/accessibility, parental modeling, and cues for eating. The fourth — the pleasure of eating — associates children''s healthy eating with pleasure through repeated exposure to healthful foods, enjoyable social meals, and enhancement of the cognitive qualities (e.g. thoughts or ideas) of healthful foods. This paper reviews the evidence leading to the characterization of these nurturing themes, and ways in which recommendations might be implemented in the home

Body Mass Index Percentiles In Adolescents Of The City Of São Paulo, Brazil, And Their Comparison With International Parameters [ppercentis Do índice De Massa Corporal De Adolescentes Na Cidade De São Paulo, Brasil, E Sua Comparação Com Parâmetros Internacionais]

Objective: To describe the percentile distribution of body mass index (BMI) in school adolescents, by gender and age, comparing them with international parameters. Subjects and methods: The study included 8,020 adolescents aged 10-15 years from 43 schools in the city of São Paulo, southeastern Brazil. BMI values of the study sample were distributed in percentiles and compared to international parameters (CDC, Must and cols. and Cole and cols.). Results: Both male and female adolescents aged 10 to 14 years showed BMI cut-offs over the international parameters, especially in the P50-P85 percentile range. At the age of 15, the observed values were very similar to reference data; however, BMI values in the 95th percentile were much higher than international parameters. Conclusions: The study results show how important it is to use adequate BMI values for Brazilian adolescents aged 10-15 since international parameters may not reflect the actual nutritional status of this group.543295302Bini, V., Celi, F., Berioli, M.G., Bacosi, M.L., Stella, P., Giglio, P., Body mass index in children and adolescents according to age and pubertal stage (2000) Eur J Clin Nutr, 54 (3), pp. 214-218Pietrobelli, A., Faith, M.S., Allison, D.B., Gallagher, D., Chiumello, G., Heymsfield, S.B., Body mass index as a measure of adiposity among children and adolescents: A validation Study (1998) J Pediatr, 132 (2), pp. 204-210Mei, Z., Grummer, S.L.M., Pietrobelli, A., Goulding, A., Goran, M.I., Dietz, W.H., Validity of body mass index compared with other body-com-position screening indexes for the assessment of body fatness in children and adolescents (2002) Am J Clin Nutr, 75 (6), pp. 978-985Cardiovascular Diseases, , WHO Expert Committee on Hypertension Control., Geneva1994/2001Belizzi, M.C., Dietz, W.H., Workshop on childhood obesity: Summary of the discussion (1999) Am J Clin Nutr, 70 (1), pp. 173S-5SEbbeling, C.B., Pawlak, D.B., Ludwig, D.S., Childhood obesity: Publichealth crisis, common sense cure (2002) Lancet, 360 (9331), pp. 473-482Wang, Y., Wang, J.Q., A comparison of international references for the assessment of child and adolescent overweight and obesity in different populations (2002) Eur J Clin Nutr, 56 (10), pp. 973-982Jelliffe, D.B., The assessment of the nutritional status of the community (1966) WHO Monograph, 53. , Geneva(1971) CDC Growth Charts: United States, , www.cdc.gov/growthcharts, CDC - Center for disease control and prevention. 2000, [online] Hyaltsville: 2002. Accessed on: Jan 15 2003. Available from, 10. Conover WJ. Practical nonparametric statistics. New York: John Wiley & Sons;Siegel, S., (1975) Estatística Não-paramétrica Para As Ciências Do Comportamento, , São Paulo: MC Graw-HillMiliken, G.A., Johnson, D.E., (1984) Analysis of Messy Data. Designed Experiments, 1. , New York: Van Nostrand Reinhold CompanyMontgomery, D.C., (1991) Design and Analysis of Experiments, , 3th ed. New York: John Wiley SonsCole, T.J., Bellizzi, M.C., Flegal, K.M., Dietz, W.H., Establishing a standard definition for child overweight and obesity worldwide: International Survey (2000) BMJ, 320, pp. 1240-1243Must, A., Dallal, G.E., Dietz, W.H., Reference data for obesity: 85th and 95th percentiles of body mass index (WT/Th2) and triceps skinfold thickness (1991) Am J Clin Nutr, 53 (4), pp. 839-846Baker, J.L., Olsen, L.W., Sørensen, T.I.A., Childhood body mass index and the risk of coronary heart disease in adulthood (2007) N Engl J Med, 357, pp. 2329-2337Thompson, D.R., Obarzanek, E., Franko, D.L., Barton, B.A., Morison, J., Biro, F.M., Childhood overweight and cardiovascular disease risk factors: The National Heart, Lung, and Blood Institute Growth and Health Study (2007) J Pediatr, 150 (1), pp. 18-25Rosa, M.L., Mesquita, E.T., Rocha, E.R., Fonseca, V.M., Body mass index and waist circumference as markers of arterial hipertension in adolescents (2007) Arq Bras Cardiol, 88 (5), pp. 573-578Morrison, J.A., Friedman, L.A., Graymcguire, C., Metaboblic syndrome in childhood predicts adult cardiovascular disease 25 years later: The princeton lipid research clinics follow-up study (2007) Pediatrics, 120 (2), pp. 340-345Mohan, V., Deepa, M., Farooq, S., Narayan, K.M.V., Datta, M., Deepa, R., Anthropometric cut points for identification of cardiometabolic risk factors in an urban Asian Indian population (2007) Metabolism, 56, pp. 961-968Morrison, J.A., Friedman, L.A., Wang, P., Glueck, C.J., Metabolic syndrome in childhood predicts adult metabolic syndrome and type 2 diabetes mellitus 25 to 30 years later (2008) J Pediatr, 152, pp. 201-206Bray, G.A., Jablonski, K.A., Fujimoto, W.Y., Cannor, E.B., Haffner, S., Hanson, R.L., Relation of central adiposity and body mass index to the development of diabetes in the Diabetes Prevention Program (2008) Am J Clin Nutr, 87 (5), pp. 1212-1218Denney, W.E., Hardy, L.L., Dobbins, T., Okely, A.D., Baur, L.A., Body mass index, waist circumference and chronic disease risk factors in Australian adolescents (2008) Arch Pediatr Adolesc Med, 162 (6), pp. 566-573Santos, L.C., Cintra, I.P., Fisberg, M., Martini, L.A., Body trunk fat and insulin resistance in post pubertal obese adolescents (2008) Med J, 126 (2), pp. 82-86Messiah, S.E., Arheart, K.L., Lpshultz, S.E., Miller, T.L., Body Mass Index, waist circumference, and cardiovascular risk factors in adolescents (2008) J Pediatr, 153 (6), pp. 845-850Lawlor, D.A., Hart, C.L., Hole, D.J., Davey, S.G., Reverse causality and confounding and the associations of overweight and obesity with mortality (2006) Obesity, 14, pp. 2294-2304Gelber, R.P., Kurth, T., Manson, J.E., Buring, J.E., Gaziano, J.M., Body mass index and mortality in men: Evaluating the shape of the association (2007) Int J Obes, 31 (8), pp. 1240-1247Cole, T.J., Roede, M.J., Centiles of body mass index for dutch children aged 0-20 years in 1980 - a baseline to assess recent trends in obesity (1999) Ann Hum Biol, 26 (4), pp. 303-308Luciano, A., Bressan, F., Zoppi, G., Body mass index reference curves for children aged 3-19 years from Verona, Italy (1997) Eur J Clin Nutr, 51, pp. 6-10Turconi, G., Guarcello, M., Maccarini, L., Bazzano, R., Zaccardo, A., Roggi, C., BMI values and other anthropometric and functional mea surements as predictors of obesity in a selected group of adolescents (2006) Eur J Nutr, 45, pp. 136-143Guillaume, M., Defining obesity in childhood: Current practice (1999) Am J Clin Nutr, 70, pp. 126S-30SLivingstone, M.B., Childhood obesity in Europe: A growing concern (2001) Public Health Nutr, 4, pp. 109-116Obesity: Preventing and managing the global epidemic (1998) Report of WHO Consultation On Obesity. Geneva: WHO, , World Health OrganizationBaumgartner, R.N., Heymsfield, S.B., Roche, A.F., Human body composition and the epidemiology of chronic disease (1995) Obes Rev, 3 (1), pp. 73-95Anjos, L.A., Veiga, G.V., Castro, I.R.R., Distribuição dos valores do índice de massa corporal da população brasileira até 25 anos (1998) Rev Panam Salud Publica [online], 3 (3), pp. 164-173McCarthy, H.D., Ellis, S.M., Cole, T.J., Central Overweight and obesity in Bristish youth aged 11-16 years: Cross sectional surveys of waist circumference (2003) BMJ, 326, pp. 624-627Costa, R.F., Cintra, I.P., Fisberg, M., Prevalência de sobrepeso e obesidade em escolares da Cidade de Santos, SP (2006) Arq Bras Endocrinol Metab, 50 (1), pp. 60-67Cintra, I.P., Passos, M.A.Z., Fisberg, M., Machado, H.C., Evolution of body mass index in two historical series of adolescents (2007) J Pediatr (Rio J), 83 (2), pp. 157-162Ferreira, A., Oliveira, C.E.R., França, N.M., Síndrome metabólica em crianças obesas e fatores de risco para doenças cardiovasculares de acordo com a resistência à insulina (2007) J Pediatr (RJ), 83 (1), pp. 21-26Wang, Y., Monteiro, C., Popkin, B.M., Trends of obesity and underweight in older children and adolescents in the United States, Brasil, China and Rusia (2002) Am J Clin Nutr, 75 (6), pp. 971-97

Methodological design for the assessment of physical activity and sedentary time in eight Latin American countries - The ELANS study.

Worldwide studies of physical activity and sedentary time have historically under-represented low- and middle-income countries due to the lack of surveillance data. The purpose of this paper is to describe the methods and procedures used for the assessment of physical activity and sedentary time in the Latin American Study of Nutrition and Health (Estudio Latinoamericano de Nutrición y Salud; ELANS). ELANS is a multicentre, cross-sectional and surveillance study of a nationally representative sample from eight Latin American countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela. Two instruments were used to evaluate different domains and intensities of physical activity and sedentary time: self-reported data and a triaxial accelerometer (model GT3X+). ELANS will generate important self-reported and objective information for the Latin American populations, namely:•evidence on the distribution of physical activity and sedentary time across population subgroups (e.g. sex, age, socioeconomic- and educational level). These sets of information will increase the evidence base and can help to inform future intervention strategies in Latin America;•self-reported and objective information on physical activity and sedentary time