Early-life weight and weight gain as predictors of obesity in Brazilian adolescents

OBJECTIVE: To test whether weight and the weight gain rate during different age periods are associated with being overweight/obese at 10 years of age. METHODS: A nested case-control study was performed in a clinical historic cohort that was selected based on medical records from the Albert Einstein Hospital Social Program in São Paulo, Brazil. A sample of 378 eutrophic and overweight/obese children was analyzed. RESULTS: After adjusting for birth weight and gestational age, the likelihood of being overweight/obese at 10 years of age was 4.04-fold greater when progressing from one quartile of weight gain to the immediately superior quartile in the first semester of life and 3.24-fold greater when this occurred from 2-5 years of age. A one-quartile change in weight gain in the first semester was associated with a 0.5 z-score increase in BMI at age 10. A robust independent effect of weight at age 5 confirmed that earlier weight gain was an important predictor. CONCLUSIONS: The amount of weight gain during the first 6 months of life and between 2 and 5 years of age and weight at age 5 were important predictors of overweight/obesity at 10 years of age

Excess body weight in children may increase the length of hospital stay

OBJECTIVES: To investigate the prevalence of excess body weight in the pediatric ward of University Hospital and to test both the association between initial nutritional diagnosis and the length of stay and the in-hospital variation in nutritional status. METHODS: Retrospective cohort study based on information entered in clinical records from University Hospital. The data were collected from a convenience sample of 91 cases among children aged one to 10 years admitted to the hospital in 2009. The data that characterize the sample are presented in a descriptive manner. Additionally, we performed a multivariate linear regression analysis adjusted for age and gender. RESULTS: Nutritional classification at baseline showed that 87.8% of the children had a normal weight and that 8.9% had excess weight. The linear regression models showed that the average weight loss z-score of the children with excess weight compared with the group with normal weight was −0.48 (p = 0.018) and that their length of stay was 2.37 days longer on average compared with that of the normal-weight group (p = 0.047). CONCLUSIONS: The length of stay and loss of weight at the hospital may be greater among children with excess weight than among children with normal weight

Promoting healthy feeding practices among 0-5 year old children: the contribution of lay community health workers

The prevalence of overweight and obesity is increasing both in the world and in Brazil towards an epidemic level. There are pieces of evidence that suggest that the larger the weight gain between 0 to 5 years of age the greater the risk for future obesity. National studies have shown that preschool children have high level of hydro carbonate intake. However interventions on this topic are mainly punctual in time. Investing in capacity building and supervision of Community Health Workers (CHW) of the Family Health Strategy could help promoting an adequate nutrition in the population. An example: in 2012 a group of students in the Primary Health Care course of the first year of the Medical School of the University of Sao Paulo chose to work with healthy toddler nutrition as a project within the course. CHW were trained to answer questions on this theme that the population could have and to identify diet mistakes. The post-intervention assessment showed that the trained CHW had a better performance in comparison to a control group.A prevalência de sobrepeso e obesidade tem aumentado no mundo e no Brasil em caráter epidêmico. Há evidências de que quanto maior o ganho de peso entre 0 a 5 anos de idade, maior o risco de obesidade futura. Estudos nacionais mostram que nossas crianças pré-escolares ingerem um alto percentual de carboidrato. Mesmo diante desses fatos os trabalhos de intervenção nutricional existentes são, na sua maioria, ações pontuais. Investir na capacitação e supervisão contínua dos Agentes Comunitários de Saúde (ACSs) da Estratégia de Saúde da Família pode auxiliar na promoção de uma nutrição adequada da população. Um exemplo: no ano de 2012 um grupo de alunos da disciplina de Atenção Primária do primeiro ano médico da Faculdade de Medicina da Universidade de São Paulo (FMUSP) optou por trabalhar, como projeto de intervenção obrigatório da disciplina, com o tema alimentação saudável na infância e escolheu treinar ACSs, capacitando-os para saber responder perguntas que lhes fossem feitas pela comunidade e também para identificar erros dietéticos. A avaliação pós-intervenção mostrou que esses ACSs tiveram melhor desempenho em comparação com um grupo controle

The blood pressure alterations in teenagers with nutritional deficit: the programming hypotheis

A hipotese da programacao tem sido estudada desde a decada de 70 e propoe que a desnutricao intra-utero e nos primeiros anos de vida provoca alteracoes metabolicas permanentes que sao amplificadas ao longo da vida pela qualidade da dieta e por fatores ambientais que afetam as pessoas. 0 presente trabalho procurou detectar atraves de um corte transversal a presenca de alteracoes da pressao arterial em adolescentes com deficit nutricional. Para tanto, 53 pacientes foram selecionados em mutiroes de pesagem realizados nas favelas de São Paulo, sendo 27 meninos e 26 meninas, com idade entre 11 e 16 anos. Os resultados antropometricos revelaram que toda a amostra apresentou alteracoes nutricionais. 0 deficit de estatura dos meninos foi em media de 7cm e das meninas foi de 5cm. Quando o peso e a estatura foram ajustados segundo o estadiamento puberal, 84 por cento dos meninos encontram-se abaixo do referencial para o peso e 96 por cento abaixo para a estatura. Nas meninas observou-se que 73 por cento e 69 por cento ficaram abaixo do referencial para peso e estatura, respectivamente. A prevalencia de hipertensao na amostra foi de 13º. Na analise de correlacao, observou-se que a pressao arterial nao foi significantemente associada ao percentual de gordura corporal e de massa magra, revelando que outros mecanismos podem estar relacionados a genese da hipertensao, o que reforca a hipotese da programacaoBV UNIFESP: Teses e dissertaçõe

The current study was carried out in the city of Embu and Taboao da Serra, and its main objective was to detect the presence of non alcoholic fatty liver disease in obese school adolescents

Objetivos: O presente estudo foi realizado no municipio do Embu (São Paulo) e teve como objetivo principal detectar a presenca de Doenca Gordurosa do Figado de Causa nao Alcoolica (DGFCNA) em adolescentes escolares obesos. Foram tambem avaliadas as condicoes socio-demograficas, ambientais, de Saúde, a inGestão alimentar, a composicao corporal e testes laboratoriais dos adolescentes identificando fatores associados a DGFCNA. Metodologia: Os adolescentes obesos foram identificados entre os escolares de uma escola publica do Embu ou encaminhados de ambulatorios de pediatria do Embu e Taboao da Serra. Os criterios de inclusao deste estudo foram a presenca de Indice de Massa Corporal maior que o percentil 95 (NCHS) e idade entre 10 e 19 anos. Os criterios de exclusao deste estudo foram a presenca de doencas endocrinologicas ou neurologicas associadas a obesidade e hepatites. A DGFCNA foi detectada atraves do metodo radiologico de Ultra-Som. O numero total de participantes foi de 90 (36 meninos e 54 meninas). Resultados: A prevalencia de DGFCNA foi de 15,5 por cento. A idade media do grupo foi de 13,1 anos. Nao detectamos diferencas significantes entre os grupo de adolescentes obesos com e sem DGFCNA no que tange as variaveis relacionadas a antecedentes gestacionais, morbidos, familiares e comportamentais. A medida da cintura e a gordura visceral foram maiores no grupo de adolescentes com DGFCNA do que no grupo sem doenca (95,11cm x 90,33cm p=0,04 e 4,46cm x 3,65cm p=O,O1 respectivamente). As variaveis laboratoriais significantemente mais elevadas no grupo com DGFCNA foram o colesterol (p=0,01), colesterol LDL (p=0,01), triglicerides (p=0,05), indice AST/ALT (p=0,04), indice GGT (p=0,03) e ferritina (p=0,03). As variaveis que, apos serem submetidas a analise de regressao logistica com ajuste para idade, sexo e renda familiar, mostraram ser fatores preditivos de DGFCNA foram as seguintes: escolaridade do adolescente (OR=4,64 [1,17-18-42]), colesterol (OR=2,93 [1,23-6,97]), colesterol LDL (OR=2,79 [1,26-6,18]), gordura visceral (OR=1,86 [1,02-3,38]), indice GGT (OR=3,91 [1,01-15,16]). Conclusao: A puberdade em adolescentes obesos com alteracoes hormonais e da homeostase glicemica, associadas a fatores geneticos (antecedentes familiares e raciais) podem predispo-los a DGFCNA. Esta doenca comeca com a esteatose e, ja nesta fase, como pudemos observar no presente estudo, pode apresentar alguns marcadores inflamatorios, de estresse oxidativo e de injuria hepatica (indice AST/ALT, indice GGT, colesterol LDL e ferritina)BV UNIFESP: Teses e dissertaçõe

Relationship between Childhood Growth and Later Outcomes

Many studies in different settings and times provided us with enough evidence of the association between environmental exposures (mainly nutrition) during pregnancy/infancy and later health outcomes, such as adult non-communicable diseases (NCDs). An individual with a given susceptibility will continue to experience new environmental challenges (e.g. growth), and these later experiences will modulate the early ones. Children that are thin in infancy and then become larger are at greater risk for later NCD. Studies demonstrated that rapid weight gain is a strong predictor of later NCD, independently of the birthweight. But which periods imply a greater risk for developing NCD? Two periods in the first years of life have been linked to the early obesity onset: the first 6 months and between 2 and 5 years of age. and when do these later health outcomes appear? the literature suggests that they start long before adulthood. Children with rapid weight gain have greater risk for hypertension and cardiovascular disease in the first years of life. These lines of evidence suggest that future research should be committed with educational programs and preventive actions focusing on better life behavior in childhood, adolescence and pregnancy. Copyright (C) 2013 Nestec Ltd., Vevey/S. Karger AG, BaselUniv São Paulo, Fac Med, Dept Pediat, BR-05403900 São Paulo, BrazilWeb of Scienc

Gender differences in the application of anthropometric measures for evaluation of obstructive sleep apnea

This study aims to investigate anthropometric measures and their effectiveness as screening method for diagnosing obstructive sleep apnea (OSA) in each gender. We also evaluated which measures were associated with OSA in the adult population of a large metropolitan city, Sao Paulo, Brazil. 552 women and 450 men were submitted to polysomnography (PSG), and the anthropometric measurements as body mass index (BMI), waist-to-height ratio, neck and waist circumference were collected. The measurements were then compared with the OSA classification established by the PSG. In women, waist circumference and waist-to-height ratio were found to be the best predictor, while in men, the factors with great potential for identification varied according to severity of the disease, highlighting waist-to-height ratio, neck circumference and BMI had strongest association. The accuracy of the classification in relation to mild-to-severe OSA based on cut-off values of 92.5cm for waist circumference was greater than 72.9% in men, and 78.9% in women based on cut off values of 95cm. Regarding severe OSA, cut-off values of 116.1cm were greater than 91.3% accurate in the male population, and 95.1% in the female population with a cut-off value of 126.5cm. The study found waist circumference and waist-to-height ratio to be the best measure to assess sleep-disordered breathing in women. Waist-to-height ratio and neck circumferences were the best measures in men with mild OSA, but BMI was more closely associated with severe OSA. The present study identified the anthropometric variables with the highest risk for OSA and their respective cutoff value, according to gender