Making Healthy Babies: The Role of a Mother’s Education

The purpose of this research is to synthesize information that expectant parents can use in promoting long term health benefits, both for themselves and their new born baby. To achieve this, an extensive review of the literature review was conducted to identify the most up- to date peer- reviewed information on how the mother’s attitude and lifestyle choices play a role in their health, and how these decisions could ultimately determine their newborns long-term well- being as well. This literature review identifies several important themes for expectant parents and other stakeholders. These themes include: the role of education, prenatal nutrition, behavior, immunization and exercise during pregnancy.https://digitalcommons.brockport.edu/research_posters/1022/thumbnail.jp

Clinical, laboratory and ultrasonographic characteristics of obese adolescents with hepatic steatosis

Orientadores: Gabriel Hessel, Antônio Azevedo Barros FilhoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Introdução: A prevalência da obesidade tem aumentado rapidamente nas ultimas décadas. A preocupação com a obesidade na infância e adolescência relaciona-se ao desenvolvimento das comorbidades e das complicações geradas pelo excesso de peso. A prevenção e vista como a melhor estratégia para reter o continua aumento da prevalência da obesidade. Objetivos: 1. Verificar a prevalência da síndrome metabólica (SM) e da resistência a insulina (RI) em adolescentes obesos e correlacioná-los aos diferentes indicadores bioquímicos, antropométricos e de composição corporal. 2. Descrever a prevalência da esteatose hepática (EH) diagnosticada por ultrassonografia abdominal (US) e avaliar o desempenho de indicadores bioquímicos, antropométricos e de composição corporal para identificar a esteatose hepática em adolescentes obesos. Métodos: Estudo transversal com 79 adolescentes obesos de 10 a 18 anos. A EH foi diagnosticada por US quando o contraste hepatorenal apresentava-se moderado ou intenso e/ou diferença no histograma >8 em relação ao córtex do rim direito. A SM foi diagnosticada segundo os critérios de Cook et al (2003) e a RI pelo índice de HOMA-IR para valores >3,16. Os indicadores antropométricos e de composição corporal avaliados foram: índice de massa corporal (IMC), % gordura corporal circunferência abdominal (CA) e gordura subcutânea. Foram dosadas as enzimas hepaticas: aspartato aminotransferase (AST), alanina aminotransferase (ALT), gama-glutamiltransferase (GGT) e fosfatase alcalina (FALC), glicemia e insulina de jejum e perfil lipidico. A analise de Curvas ROC foi utilizada para avaliar o desempenho dos indicadores antropométricos, bioquímicos e a % gordura corporal em identificar adolescentes com EH, o IMC e a CA em identificar a RI e a SM. Resultados: A SM foi diagnosticada em 45,5% dos pacientes e a RI em 29,1%. A RI apresentou associação com o HDL-colesterol e com a SM e se correlacionou com todos os indicadores antropométricos e de composição corporal avaliados. Na avaliação dos pontos de corte, os valores de 23,5 e 36,3% acima do valor de referencia do IMC mostraram-se capazes em identificar a RI e a SM. O melhor ponto de corte da CA para identificar a RI foi de 40%. A EH esteve presente em 16 pacientes (20,3%). A GGT e o HOMA-IR mostraram ser bons indicadores na predição da EH, com ponto de corte de 1,06 vezes acima do valor de referencia para a GGT e 3,28 para o HOMA-IR. Os indicadores antropométricos, % gordura corporal, perfil lipidico, glicemia e AST não apresentaram resultados significantes. Conclusão: A prevalência de EH em adolescentes obesos foi de 20,3%. Todos os indicadores antropométricos e de composição corporal avaliados apresentaram correlação com a RI e apenas o IMC se correlacionou com a SM. O IMC mostrou-se o indicador antropométrico mais efetivo na identificação da RI. Pacientes com elevação de GGT e/ou com HOMA-IR devem ser submetidos ao exame de US com grande probabilidade de se obter como resultado a EHAbstract: Background: Obesity prevalence has increased rapidly in recent decades. The concern with obesity in childhood and adolescence is related to the development of comorbidities and complications generated by excess weight. Prevention is seen as the best strategy for retaining the continuous increase in obesity prevalence. Objectives: 1. to verify metabolic syndrome (MS) and insulin resistance (IR) prevalence in obese adolescents and correlate them with different biochemical, anthropometric and body composition indicators. 2. To describe hepatic steatosis (HS) prevalence diagnosed by abdominal ultrasound (AU) and evaluates the performance of biochemical, anthropometric and body composition indicators to identify hepatic steatosis in obese adolescents. Methods: A transversal study comprising 79 obese adolescents aged 10-18 years. HS was diagnosed by AU when hepatorenal contrast presented moderated or intense and/or there was a difference greater than 8 in relation to the right kidney cortex in histogram. MS was diagnosed according to the criteria by Cook et al (2003) and IR, by using the homeostatic model assessment (HOMA) index for values greater than 3.16. The following anthropometric and body composition indicators were evaluated: body mass index (BMI), body fat percentage, abdominal circumference (AC) and subcutaneous fat (SF). Hepatic enzymes - aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT) and alkaline phosphatase (FALC) -, glycemia, fasting insulin and lipid profile were measured. ROC Curve analysis was used for accessing the performance of biochemical, anthropometric and body composition indicators, which identified adolescents with HS; BMI and AC identified IR and MS. Results: MS was diagnosed in 45.5% of patients, and IR, in 29.1%. IR showed association with HDL-cholesterol and MS, correlating with all evaluated anthropometric and body composition indicators. In the evaluation of cutoff points, values of 23.5 and 36.3% above the BMI reference value showed capable of identifying IR and MS. The best cutoff point of AC to identify IR was of 40%. Sixteen patients (20.3%) were diagnosed with HS. GGT and HOMA-IR showed to be good indicators in predicting HS, with cutoff point of 1.06 times above the reference values for GGT and 3.28 for HOMA-IR. Anthropometric, body fat percentage, lipid profile, glycemia xi and AST did not present significant results. Conclusion: The HS prevalence in obese adolescents was of 20.3%. All evaluated anthropometric and body composition indicators presented correlation with IR, and only BMI showed correlation with MS. BMI showed to be the most effective anthropometric indicator in identifying IR. Patients with elevation of GGT and/or HOMA-IR should be submitted to US examination with great probability of obtaining HS as a resultMestradoSaude da Criança e do AdolescenteMestra em Ciência

Hepatic steatosis in children and adolescents with cystic fibrosis

Orientador: Gabriel HesselTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: A fibrose cística (FC), é uma doença genética autossômica recessiva caracterizada pela disfunção do gene cystic fibrosis transmembrane conductance regulator (CFTR). É considerada uma doença potencialmente letal e multissistêmica pois afeta glândulas sudoríparas, pâncreas, pulmões, fígado, intestino e ductos de Wolff. Recentemente, tem-se dado maior atenção ao acometimento hepático na fibrose cística (FC), pois é a terceira principal causa de morte, após insuficiência respiratória e complicações relacionadas ao transplante pulmonar. Objetivos: Determinar a prevalência de esteatose hepática (EH) em crianças e adolescentes com FC e associar com o estado nutricional. Associar a EH e o estado nutricional com o perfil metabólico em crianças e adolescentes com fibrose cística. Métodos: Estudo transversal em crianças e adolescentes com diagnóstico de FC. Foram aferidos o peso e altura para o cálculo do IMC/idade e classificação do estado nutricional segundo os pontos de corte da OMS e do Consenso Internacional de FC. A circunferência do braço (CB), a dobra cutânea triciptal (DCT) e a circunferência muscular do braço (CMB) foram empregadas para avaliação da composição corporal. A ultrassonografia abdominal foi realizada para o diagnóstico de EH. O perfil metabólico foi avaliado por meio da atividade das aminotransferases, perfil lipídico, triglicérides, glicemia de jejum e insulina basal para o cálculo do índice de HOMA. Os testes estatísticos empregados foram o teste t de Student, Mann-Whitney, Qui-quadrado e Anova, com nível de significância de 5%. Resultados: Dos 50 pacientes avaliados, com idades entre 2 e 19 anos incompletos (12,28±4,96), 18 (36%) apresentaram EH (Grupo A) e 32 (64%) sem EH (Grupo B). Para as médias de idade (Grupo A = 13,3±5,0 anos e Grupo B = 11,7±5,0 anos), IMC (Grupo A = 18,0±4,1 e Grupo B = 15,7±3,8) e DCT (Grupo A = 8,4mm±3,5 e Grupo B = 7,0mm±2,5), não houve diferença significativa entre os grupos. A média da CB e da CMB diferiram significativamente entre os grupos, sendo mais elevada no grupo com EH com valor de p respectivos de 0,047 e 0,043. Os pacientes do grupo A apresentou média mais elevada da aspartato aminotransferase (AST) (p = 0,034) e 61,1% desse grupo apresentaram níveis elevados de fosfatase alcalina (FALC) (p = 0,012). Nesse mesmo grupo, a média do colesterol total e do HDL apresentaram-se diminuídos (p = 0,029 e 0,018 respectivamente). A associação entre a classificação do estado nutricional e o perfil metabólico não foi significativa. Conclusões: É alta a frequência de EH em pacientes com FC e não está relacionada com a desnutrição segundo os parametros de IMC, DCT e CMB. Os valores de CB e CMB indicaram maior reserva de massa muscular nos pacientes com EH. A EH e o perfil metabólico em pacientes com FC não foi associada com o estado nutricional. A EH mostrou-se associada com elevação da FALC e da AST. No grupo com EH, os pacientes apresentaram média do HDL-colesterol e do colesterol total mais baixaAbstract: Cystic fibrosis (CF), is an autosomal recessive genetic disorder characterized by the dysfunction of the cystic fibrosis transmembrane conductance regulator gene (CFTR). It is considered a potentially lethal and multisystemic disease because it affects sweat glands, pancreas, lungs, liver, intestine and Wolff's ducts. Recently, attention has been paid to hepatic involvement in cystic fibrosis (CF), since it is the third leading cause of death after respiratory failure and complications related to lung transplant. Objectives: To determine the prevalence of hepatic steatosis (HS) in children and adolescents with CF and to associate it with the nutritional status. To associate HS and the nutritional status with the metabolic profile in children and adolescents with cystic fibrosis. Methods: Cross-sectional study in children and adolescents with CF diagnosis. Weight and height were checked for the calculation of BMI/age and classification of the nutritional status classified according to the cut-off points of the WHO and the International Consensus of CF. Arm circumference (AC), triceps skinfold (TSF) and arm muscle circumference (AMC) were used to evaluate body composition. Abdominal ultrasonography was performed for the diagnosis of HS. The metabolic profile was assessed by aminotransferase activity, lipid profile, triglycerides, fasting glycemia and basal insulin for calculating the HOMA index. The statistical tests used were the Student's t-test, Mann-Whitney, Chi-square and Anova, with a significance level of 5%. Results: Of the 50 patients evaluated, between the ages of 2 and 19 y.o. (incomplete) (12.28 ± 4.96), 18 (36%) presented HS (Group A) and 32 (64%) without HS. For the mean age (Group A = 13.3 ± 5.0 years and Group B = 11.7 ± 5.0 years), BMI (Group A = 18.0 ± 4.1 and Group B = 15.7 ± 3 , 8) and TSF (Group A = 8.4mm ± 3.5 and Group B = 7.0mm ± 2.5), there was no significant difference between the groups. Mean AC and AMC differed significantly between the groups, being higher in the group with HS with a respective p value of 0.047 and 0.043. Patients in group A presented a higher mean aspartate aminotransferase (AST) (p 0.034) and 61.1% of this group had elevated levels of alkaline phosphatase (ALP) (p 0.012). In this same group, mean total cholesterol and HDL were decreased (p = 0.029 and 0.018, respectively. The association between nutritional status classification and metabolic profile was not significant. Conclusion: The frequency of HS is high in patients with CF and is not related to malnutrition according to the parameters of BMI, TSF and AMC. AC and AMC values indicated a greater reserve of muscle mass in patients with HS. HS and metabolic profile in CF patients were not associated with nutritional status. HS was associated with elevation of ALP and AST. In the HS group, the patients presented lower mean HDL-cholesterol and total cholesterolDoutoradoSaude da Criança e do AdolescenteDoutora em Ciências02-P-4583/2018CAPE

Biochemical, Anthropometric And Body Composition Indicators As Predictors Of Hepatic Steatosis In Obese Adolescents.

To describe the prevalence of hepatic steatosis and to assess the performance of biochemical, anthropometric and body composition indicators for hepatic steatosis in obese teenagers. Cross-sectional study including 79 adolecents aged from ten to 18 years old. Hepatic steatosis was diagnosed by abdominal ultrasound in case of moderate or intense hepatorenal contrast and/or a difference in the histogram ≥7 on the right kidney cortex. The insulin resistance was determined by the Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) index for values >3.16. Anthropometric and body composition indicators consisted of body mass index, body fat percentage, abdominal circumference and subcutaneous fat. Fasting glycemia and insulin, lipid profile and hepatic enzymes, such as aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase and alkaline phosphatase, were also evaluated. In order to assess the performance of these indicators in the diagnosis of hepatic steatosis in teenagers, a ROC curve analysis was applied. Hepatic steatosis was found in 20% of the patients and insulin resistance, in 29%. Gamma-glutamyltransferase and HOMA-IR were good indicators for predicting hepatic steatosis, with a cutoff of 1.06 times above the reference value for gamma-glutamyltransferase and 3.28 times for the HOMA-IR. The anthropometric indicators, the body fat percentage, the lipid profile, the glycemia and the aspartate aminotransferase did not present significant associations. Patients with high gamma-glutamyltransferase level and/or HOMA-IR should be submitted to abdominal ultrasound examination due to the increased chance of having hepatic steatosis