Influence of early life factors on body mass index trajectory during childhood: a population‐based longitudinal analysis in the Western Brazilian Amazon

Low‐ to middle‐income countries may experience the occurrence of a dual burden of under and overnutrition. To better understand the overall progression of body mass index (BMI) during childhood, we estimated average BMI‐for‐age z‐score (BAZ) growth curves in a population‐based longitudinal study of 255 children living in the Brazilian Amazon. Children were aged 0.1–5.5 years at recruitment (2003). We collected data on socio‐economic and maternal characteristics, children's birthweight and infant feeding practices. Child anthropometric measurements were taken in 2003, 2007 and 2009. BAZ differences among categories of exposure variables were calculated at 6 and 12 months, and 2, 7 and 10 years. At baseline, the mean (standard deviation) age was 2.6 (1.4) years; 12.9% were overweight and 3.9% thin. After adjustment, mean BAZ estimates were mostly negative. Boys were close to the median value for BAZ until 12 months, whereas girls were below the median (P = 0.05). Children from households above the wealth median were 0.36 z‐ and 0.49 z‐less underweight than poorer children at 7 and 10 years, respectively (P < 0.01). Maternal BMI was positively associated with children's BAZ since 12 months old; BAZ in children from overweight mothers was higher by 0.69 compared with their counterparts at 10 years (P < 0.01). Birthweight was positively related to BAZ up until 2 years (P = 0.01). Socio‐economic background and maternal nutritional status are important predictors of BAZ throughout childhood. Although excessive weight gain is a public health concern, it is critical to restrict inequities, while promoting healthier growth in developing countries.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110869/1/mcn12005.pd

Determinants of linear growth from infancy to school-aged years: a population-based follow-up study in urban Amazonian children

Background: Although linear growth during childhood may be affected by early-life exposures, few studies have examined whether the effects of these exposures linger on during school age, particularly in low-and middle-income countries. Methods: We conducted a population-based longitudinal study of 256 children living in the Brazilian Amazon, aged 0.1 y to 5.5 y in 2003. Data regarding socioeconomic and maternal characteristics, infant feeding practices, morbidities, and birth weight and length were collected at baseline of the study (2003). Child body length/height was measured at baseline and at follow-up visits (in 2007 and 2009). Restricted cubic splines were used to construct average height-for-age Z score (HAZ) growth curves, yielding estimated HAZ differences among exposure categories at ages 0.5 y, 1 y, 2 y, 5 y, 7 y, and 10 y. Results: At baseline, median age was 2.6 y (interquartile range, 1.4 y-3.8 y), and mean HAZ was -0.53 (standard deviation, 1.15); 10.2% of children were stunted. In multivariable analysis, children in households above the household wealth index median were 0.30 Z taller at age 5 y (P = 0.017), and children whose families owned land were 0.34 Z taller by age 10 y (P = 0.023), when compared with poorer children. Mothers in the highest tertile for height had children whose HAZ were significantly higher compared with those of children from mothers in the lowest height tertile at all ages. Birth weight and length were positively related to linear growth throughout childhood; by age 10 y, children weighing &gt;3500 g at birth were 0.31 Z taller than those weighing 2501 g to 3500 g (P = 0.022) at birth, and children measuring &gt;= 51 cm at birth were 0.51 Z taller than those measuring &lt;= 48 cm (P = 0.005). Conclusions: Results suggest socioeconomic background is a potentially modifiable predictor of linear growth during the school-aged years. Maternal height and child's anthropometric characteristics at birth are positively associated with HAZ up until child age 10 y.Brazilian National Counsel of Technological and Scientific DevelopmentBrazilian National Counsel of Technological and Scientific DevelopmentCNPq [551359/2001-3, 502937/2003-3, 307728/2006-4, 470573/2007-4]CNPqSao Paulo Research FoundationSao Paulo Research FoundationFAPESP [2007/53042-1, 2008/57796-3]FAPESPOrganization of American StatesOrganization of American States [20100656

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Statement of Second Brazilian Congress of Mechanical Ventilarion : part I

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Determinants of linear growth from infancy to school-aged years: a population-based follow-up study in urban Amazonian children

Abstract Background Although linear growth during childhood may be affected by early-life exposures, few studies have examined whether the effects of these exposures linger on during school age, particularly in low- and middle-income countries. Methods We conducted a population-based longitudinal study of 256 children living in the Brazilian Amazon, aged 0.1 y to 5.5 y in 2003. Data regarding socioeconomic and maternal characteristics, infant feeding practices, morbidities, and birth weight and length were collected at baseline of the study (2003). Child body length/height was measured at baseline and at follow-up visits (in 2007 and 2009). Restricted cubic splines were used to construct average height-for-age Z score (HAZ) growth curves, yielding estimated HAZ differences among exposure categories at ages 0.5 y, 1 y, 2 y, 5 y, 7 y, and 10 y. Results At baseline, median age was 2.6 y (interquartile range, 1.4 y–3.8 y), and mean HAZ was −0.53 (standard deviation, 1.15); 10.2% of children were stunted. In multivariable analysis, children in households above the household wealth index median were 0.30 Z taller at age 5 y (P = 0.017), and children whose families owned land were 0.34 Z taller by age 10 y (P = 0.023), when compared with poorer children. Mothers in the highest tertile for height had children whose HAZ were significantly higher compared with those of children from mothers in the lowest height tertile at all ages. Birth weight and length were positively related to linear growth throughout childhood; by age 10 y, children weighing >3500 g at birth were 0.31 Z taller than those weighing 2501 g to 3500 g (P = 0.022) at birth, and children measuring ≥51 cm at birth were 0.51 Z taller than those measuring ≤48 cm (P = 0.005). Conclusions Results suggest socioeconomic background is a potentially modifiable predictor of linear growth during the school-aged years. Maternal height and child’s anthropometric characteristics at birth are positively associated with HAZ up until child age 10 y.</p

Association between oxygenation and ventilation index with the time on mechanical ventilation in pediatric intensive care patients

OBJECTIVE: To correlate the oxygenation index (OI) and the ventilation index (VI) with the time of invasive mechanical ventilation (IMV) in pediatric patients. METHODS: This prospective and observational study enrolled patients from 28 days to 14 years of age, admitted in the Pediatric Intensive Care Unit of a university hospital. The values of age, weight, pH, partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), OI and VI were measured from day one to the day five and they were correlated with the time on IMV. The total time on mechanical ventilation was divided into: <7 days and &gt;7 days. RESULTS: 28 patients were studied. The time spent on IMV showed a significant negative correlation with the pH on the fourth day and with the PaO2 on the fifth day. The time on IMV showed a positive correlation with the OI on the third and fourth days and with the VI on the third, fourth and fifth days. There were significant differences in the age and pH on the fourth and fifth days and in the VI from the second to fifth days between the group that remained less than seven days and those that remained seven days or more on IMV. CONCLUSIONS: VI, OI, pH and PaO2 measured during the first five days of IMV were associated with prolonged IMV, reflecting the severity of the initial ventilatory disturb.OBJETIVO: Correlacionar o índice de oxigenação (IO) e o de ventilação (IV) com o tempo de ventilação mecânica invasiva (VMI) em pacientes pediátricos. MÉTODOS: Estudo prospectivo, observacional, com pacientes de 28 dias de vida a 14 anos de idade, internados na Unidade de Terapia Intensiva Pediátrica de um hospital universitário. Correlacionaram-se valores de idade, peso, pH, pressão parcial de oxigênio (PaO2), pressão parcial de gás carbônico (PaCO2), IO e IV, nos primeiros cinco dias em VMI, com o tempo em que o paciente permaneceu em VMI. O tempo total de ventilação mecânica foi dividido em <7 dias e &gt;7 dias. RESULTADOS: Foram estudados 28 pacientes. Houve correlação negativa significante do tempo de VMI com o pH no quarto dia e com a PaO2 no quinto dia. Houve correlação positiva com o IO no terceiro e quarto dias e com o IV no terceiro, quarto e quinto dias. Houve diferença na idade e pH no quarto e quinto dias e IV do segundo ao quinto dias entre o grupo que permaneceu menos de sete dias e o que permaneceu sete dias ou mais em VMI. CONCLUSÕES: IO, IV, pH e PaO2, medidos precocemente, associaram-se com VMI prolongada, refletindo a gravidade do distúrbio ventilatório inicial.34835

Ícones para mapas de riscos: uma proposta construída com os trabalhadores Icons for occupational risk maps: a proposal developed with workers

Em estudo realizado na indústria da alimentação de Pelotas, utilizou-se a metodologia do Modelo Operário para elaborar mapas de riscos. Inicialmente, representaram-se os grupos de riscos por meio de figuras geométricas, com graduação de tamanho para caracterizar a intensidade. Notou-se que estas tinham pouco significado para o trabalhador. Além disso, com a agregação de riscos com diferentes impactos sobre a saúde, perdia-se o detalhamento da exposição. Como alternativa, desenvolveu-se uma iconografia, partindo da visão do trabalhador. A investigação foi qualitativa e realizou-se em três etapas com sessenta trabalhadores, que sugeriram e selecionaram os ícones mais adequados. A seguir, utilizando-se processo serigráfico, estes foram digitalizados e impressos em adesivos para que o próprio trabalhador pudesse colá-los no mapa de riscos. Cada risco é representado por um ícone e a intensidade de exposição é expressa pela sua cor. Este artigo apresenta estes ícones e o processo desenvolvido para a sua elaboração.<br>The methodology known as the workers' model was used to design risk maps in a study performed in the food-processing industry in Pelotas, in the State of Rio Grande do Sul in southern Brazil. The various types of occupational risks were initially represented by geometric figures, with a size gradient to represent intensity. Joint investigation of these icons showed that they had little meaning for the workers. In addition, risks from a same group (physical, chemical, etc.) but with different impact on health were grouped, thus missing the specificities of exposure. As an alternative, and starting from workers' own risk perceptions, a set of risk icons was developed. The study was done in three steps involving sixty workers, who proposed and selected the most suitable symbols, which were subsequently printed on stickers using silk-screen so that the workers could glue them on the risk maps. Each risk is represented by one icon, and intensity of exposure is defined by color. This paper presents the icons and the process involved in designing them