Serum Homocysteine and Cysteine Levels and Anthropometric Changes: A Longitudinal Study among Brazilian Children and Adolescents.

OBJECTIVE: This article aimed to identify the influence of high serum homocysteine (Hcy) and cysteine (Cys) levels, alone or in conjunction, on changes in anthropometric parameters in children and adolescents over a 12-month follow-up period. METHODS: This is a cohort study involving 483 boys and girls 7-15 years of age. The outcome variables were body mass index (BMI)-for-age and waist circumference (WC) and the principal exposure variables were serum Hcy and Cys levels, alone or in conjunction. A generalized estimating equation (GEE) approach was used to identify longitudinal changes in the outcome variables. RESULTS: Irrespective of age, sex, socioeconomic conditions, dietary intake, or the practice of physical activity, the children and adolescents in the fifth quintile of distribution of Hcy levels had a z-score increase of 0.50 (p < 0.01) and a 3.62 cm increase (p < 0.01) in mean BMI-for-age and WC, respectively, over the period of the study. In individuals with Cys values above the fifth quintile, a z-score increase of 0.59 (p < 0.01) and a 5 cm increase (p < 0.01) were found in BMI-for-age and WC, respectively. When serum Hcy and Cys levels were both above the fifth quintile of distribution, a z-score increase of 0.87 (p < 0.01) and a 6.57 cm increase (p < 0.01) were found in mean BMI-for-age and WC, respectively, over the 12-month follow-up. CONCLUSION: High serum Hcy and Cys levels contributed to an increase in BMI-for-age and WC in children and adolescents over a 12-month follow-up period, with these increases being even greater when these 2 biochemical parameters were simultaneously high.

Protective effect of human lactoferrin in the gastrointestinal tract.

OBJECTIVE: To describe mechanisms of action of human lactoferrin to protect gastrointestinal morbidities. DATA SOURCES: Nonsystematic literature review using the following databases: SciELO, Lilacs and Medline from 1990 to 2011. The key-words used were lactoferrin, human milk/breastfeeding, gastrointestinal, and immunity, in Portuguese and English. DATA SYNTHESIS: Lactoferrin is the second predominant protein in the human milk, with higher concentrations in the colostrum (5.0 to 6.7mg/mL) if compared to mature milk (0.2 to 2.6mg/mL.) In contrast, cow's milk has lower levels, with 0.83mg/mL in the colostrum and 0.09mg/mL in the mature milk. Lactoferrin has several physiological functions to protect the gastrointestinal tract. The antimicrobial activity is related to the ability to sequester iron from biological fluids and/or to destruct the membrane of microorganisms. Lactoferrin also has the ability to stimulate cell proliferation. The anti-inflammatory action exercised by lactoferrin is associated with its ability to penetrate the core of the leukocyte and to block the Kappa B nuclear factor transcription. Given the importance of lactoferrin to prevent infectious diseases for breastfed children, the industry is using genetic engineering techniques to develop the expression of recombinant human lactoferrin in animals and plants, attempting to adjust the composition of infant formulas to that of human milk. CONCLUSIONS: Human lactoferrin is a peptide with great potential for preventing morbidity, especially in the gastrointestinal tract. Scientific evidence of the protective effects of human lactoferrin strengthens even more the recommendation for breastfeeding.

Hypertriglyceridemic waist phenotype: association with metabolic abnormalities in adolescents.

OBJECTIVE: This study aimed to identify the prevalence of hypertriglyceridemic waist (HTW) phenotype, and to evaluate its association with metabolic abnormalities in adolescents of low socioeconomic status. METHOD: This was a cross-sectional study with a random sample of 1,076 adolescents between 11 and 17 years, of both genders, from public schools. The participants underwent anthropometric measurements (weight, height, and waist circumference), and levels of total cholesterol, low-density-lipoprotein cholesterol (LDL-C), high-density-lipoprotein cholesterol (HDL-C), non-HDL cholesterol, triglyceride (TG), and fasting glucose were measured. Information regarding the socioeconomic status of the participants' families was obtained. The HTW phenotype was defined by the simultaneous presence of increased waist circumference (≥ 90(th) percentile for age and gender) and serum triglyceride levels (≥ 100mg/dL). A logistic regression analysis was used to evaluate the associations of interest. RESULTS: The prevalence of HTW phenotype was 7.2% among the adolescents, being higher in the presence of obesity (63.4%) and high levels of non-HDL cholesterol (16.6%) and LDL-C (13.7%). The bivariate analysis indicated that, of the metabolic variables, only blood glucose was not associated with the HTW phenotype. Multivariate analysis adjusted for age and gender indicated that the HTW phenotype was positively associated with high non-HDL cholesterol (odds ratio: 7.0; 95% CI: 3.9-12.6) and low HDL-C levels (odds ratio: 2.7; 95% CI: 1.5-4.8). CONCLUSIONS: This study demonstrated that the HTW phenotype was associated with an atherogenic lipid profile, and this phenotype is suggested as a screening tool to identify adolescents with metabolic alterations.

Efeito protetor da lactoferrina humana no trato gastrintestinal / Protective effect of human lactoferrin in the gastrointestinal tract / Efecto protector de la lactoferrina humana en el sistema gastrointestinal

OBJETIVO: Descrever os mecanismos de ação da lactoferrina humana na proteção de morbidades gastrintestinais. FONTES DE DADOS: Revisão não sistemática da literatura utilizando como estratégia de busca pesquisa bibliográfica em bases de dados, as quais incluíram SciELO, Lilacs e MedLine entre 1990 e 2011. Os descritores utilizados foram: lactoferrina, leite materno/humano, gastrintestinal e imunidade, nos idiomas português e inglês. SÍNTESE DOS DADOS: A lactoferrina é a segunda proteína predominante no leite humano, com concentrações mais elevadas no colostro (5,0 a 6,7mg/mL) em relação ao leite maduro (0,2 a 2,6mg/mL). Em contraste, o leite de vaca contém teores inferiores, 0,83mg/mL no colostro e 0,09mg/mL no leite maduro. A lactoferrina desempenha diversas funções fisiológicas na proteção do trato gastrintestinal. A atividade antimicrobiana está relacionada à capacidade de sequestrar ferro dos fluidos biológicos e/ou de desestruturar a membrana de micro-organismos. A lactoferrina possui também a capacidade de estimular a proliferação celular. A ação anti-inflamatória desempenhada pela lactoferrina está associada à capacidade de penetrar no núcleo do leucócito e bloquear a transcrição do fator nuclear Kappa B. Diante da importância da lactoferrina na prevenção de doenças infecciosas em crianças aleitadas ao peito, a indústria vem, por meio da engenharia genética, desenvolvendo tecnologias para expressar esta proteína recombinante humana em plantas e animais, na tentativa de adequar a composição das fórmulas infantis àquela do leite humano. CONCLUSÕES: A lactoferrina humana é um peptídeo com potencial para prevenir morbidades, especialmente às gastrintestinais. Evidências científicas dos efeitos protetores da lactoferrina humana fortalecem ainda mais a recomendação para prática do aleitamento materno.

OBJECTIVE: To describe mechanisms of action of human lactoferrin to protect gastrointestinal morbidities. DATA SOURCES: Nonsystematic literature review using the following databases: SciELO, Lilacs and Medline from 1990 to 2011. The key-words used were lactoferrin, human milk/breastfeeding, gastrointestinal, and immunity, in Portuguese and English. DATA SYNTHESIS: Lactoferrin is the second predominant protein in the human milk, with higher concentrations in the colostrum (5.0 to 6.7mg/mL) if compared to mature milk (0.2 to 2.6mg/mL.) In contrast, cow's milk has lower levels, with 0.83mg/mL in the colostrum and 0.09mg/mL in the mature milk. Lactoferrin has several physiological functions to protect the gastrointestinal tract. The antimicrobial activity is related to the ability to sequester iron from biological fluids and/or to destruct the membrane of microorganisms. Lactoferrin also has the ability to stimulate cell proliferation. The anti-inflammatory action exercised by lactoferrin is associated with its ability to penetrate the core of the leukocyte and to block the Kappa B nuclear factor transcription. Given the importance of lactoferrin to prevent infectious diseases for breastfed children, the industry is using genetic engineering techniques to develop the expression of recombinant human lactoferrin in animals and plants, attempting to adjust the composition of infant formulas to that of human milk. CONCLUSIONS: Human lactoferrin is a peptide with great potential for preventing morbidity, especially in the gastrointestinal tract. Scientific evidence of the protective effects of human lactoferrin strengthens even more the recommendation for breastfeeding.

OBJETIVO: Describir los mecanismos de acción de la lactoferrina humana en la protección de morbilidades gastrointestinales. FUENTES DE DATOS: Revisión no sistemática de la literatura utilizando como estrategia de búsqueda investigación bibliográfica en bases de datos, que incluyeron SciELO, Lilacs y MedLine entre 1990 y 2011. Los descriptores utilizados fueron: lactoferrina, leche materna/humana, gastrointestinal e inmunidad, en los idiomas portugués e inglés. SÍNTESIS DE LOS DATOS: La lactoferrina es la segunda proteína predominante en la leche humana, con concentraciones más elevadas en el calostro (5,0 a 6,7mg/mL) respecto a la leche madura (0,2 a 2,6mg/mL). En contraste, la leche de vaca contiene tenores inferiores, 0,83mg/mL en el calostro y 0,09mg/mL en la leche madura. La lactoferrina desempeña diversas funciones fisiológicas en la protección del sistema gastrointestinal. La actividad antimicrobiana está relacionada a la capacidad de secuestrar hierro de los fluidos biológicos y/o de desestructurar la membrana de microorganismos. La lactoferrina posee además la capacidad de estimular la proliferación celular. La acción antiinflamatoria desempeñada por la lactoferrina está asociada a la capacidad de penetrar en el núcleo del leucocito y bloquear la transcripción del nuclear factor Kappa B. Frente a la importancia de la lactoferrina en la prevención de enfermedades infecciosas en niños amamantados al pecho, la industria viene, por medio de ingeniería genética, desarrollando tecnologías para expresar esta proteína recombinante humana en plantas y animales en el intento de adecuar la composición de las fórmulas infantiles a aquella de la leche humana. CONCLUSIONES: La lactoferrina humana es un péptido con potencial para prevenir morbilidades, especialmente las gastrointestinales. Evidencias científicas de los efectos protectores de la lactoferrina humana fortalecen todavía más la recomendación para la práctica de la lactancia materna.

Fenótipo cintura hipertrigliceridêmica: associação com alterações metabólicas em adolescentes / Hypertriglyceridemic waist phenotype: association with metabolic abnormalities in adolescents

OBJETIVO: O presente estudo objetivou identificar a prevalência do fenótipo cintura hipertrigliceridêmica (CHT) e avaliar sua associação com alterações metabólicas em adolescentes de baixa condição econômica. MÉTODO: Estudo transversal com amostra probabilística de 1.076 adolescentes entre 11 e 17 anos, de ambos os sexos, estudantes de escolas públicas. Os participantes foram submetidos à avaliação antropométrica (peso, altura e circunferência da cintura) e à dosagem dos níveis de colesterol total, LDL-C, HDL-C, colesterol não HDL, triglicérides (TG) e glicemia de jejum. Foram obtidas informações referentes às condições econômicas das famílias dos participantes.O fenótipo CHT foi definido pela presença simultânea da circunferência da cintura aumentada (> percentil 90 por idade e sexo) e dos níveis séricos de triglicérides elevados (> 100 mg/dL). A análise de regressão logística foi utilizada para avaliação das associações de interesse. RESULTADOS: A prevalência do fenótipo CHT foi de 7,2% entre os adolescentes, sendo mais elevada na presença de obesidade (63,4%), do colesterol não HDL (16,6%) e do LDL-C (13,7%) altos. A análise bivariada indicou que, das variáveis metabólicas, apenas a glicemia não se associou ao fenótipo CHT. A análise multivariada, ajustada por sexo e idade, indicou que o fenótipo CHT se associou positivamente com o colesterol não HDL alto (odds ratio, 7,0; IC 95% 3,9-12,6) e com o HDL-C baixo (odds ratio, 2,7; IC 95%, 1,5-4,8). CONCLUSÕES: Este estudo mostrou que o fenótipo CHT se associou com um perfil lipídico aterogênico e sugere esse fenótipo como uma ferramenta de screening que pode ser utilizada para identificar adolescentes com alterações metabólicas.

OBJECTIVE: This study aimed to identify the prevalence of hypertriglyceridemic waist (HTW) phenotype, and to evaluate its association with metabolic abnormalities in adolescents of low socioeconomic status. METHOD: This was a cross-sectional study with a random sample of 1,076 adolescents between 11 and 17 years, of both genders, from public schools. The participants underwent anthropometric measurements (weight, height, and waist circumference), and levels of total cholesterol, low-density-lipoprotein cholesterol (LDL-C), high-density-lipoprotein cholesterol (HDL-C), non-HDL cholesterol triglyceride (TG), and fasting glucose were measured. Information regarding the socioeconomic status of the participants' families was obtained. The HTW phenotype was defined by the simultaneous presence of increased waist circumference (> 90th percentile for age and gender) and serum triglyceride levels (> 100 mg/dL). A logistic regression analysis was used to evaluate the associations of interest. RESULTS: The prevalence of HTW phenotype was 7.2% among the adolescents, being higher in the presence of obesity (63.4%) and high levels of non-HDL cholesterol (16.6%) and LDL-C (13.7%). The bivariate analysis indicated that, of the metabolic variables, only blood glucose was not associated with the HTW phenotype. Multivariate analysis adjusted for age and gender indicated that the HTW phenotype was positively associated with high non-HDL cholesterol (odds ratio: 7.0; 95% CI: 3.9-12.6) and low HDL-C levels (odds ratio: 2.7; 95% CI: 1.5-4.8). CONCLUSIONS: This study demonstrated that the HTW phenotype was associated with an atherogenic lipid profile, and this phenotype is suggested as a screening tool to identify adolescents with metabolic alterations.

Predictors of linear growth in the first year of life of a prospective cohort of full term children with normal birth weight.

OBJECTIVE: To investigate covariates that could affect the variation in mean length/age z scores in the first year of life of children born full term with normal birth weight. METHODS: This was a prospective study of a cohort of mother-infant pairs recruited at public maternity units in two municipalities in the Brazilian state of Bahia, from March 2005 to October 2006. This paper reports the results for linear growth of 489 children who were followed-up for the first 12 months of their lives. A mixed-effect regression model was used to investigate the influence of covariates of mean length/age z score during the first year of life. RESULTS: The multivariate mixed effect analysis indicated that mothers not cohabiting with a partner (beta = 0.2347; p = 0.004) and increased duration of exclusive breastfeeding (beta = 0.0031; p < 0.001) had a positive impact, whereas mother's height less than 150 cm (beta = -0.4393; p < 0.001), birth weight of 2,500-2,999 g (beta = -0.8084; p < 0.001) and anemia in the child (beta = -0.0875; p < 0.001) all had a negative impact on the variation in estimated length/age z score. CONCLUSIONS: Therefore, the results of this study indicate that short maternal stature, birth weight < 3,000 g and anemia in the infant had a negative effect on linear growth during the first year of life, whereas longer duration of exclusive breastfeeding and mothers who did not cohabit with a partner had a positive effect.

Preditores do crescimento linear no primeiro ano de vida em uma coorte prospectiva de crianças a termo com peso adequado / Predictors of linear growth in the first year of life of a prospective cohort of full term children with normal birth weight

OBJETIVO: Investigar covariáveis que possam interferir na variação da média do índice comprimento/idade em escore Z no primeiro ano de vida de crianças nascidas a termo com peso adequado. MÉTODOS: Trata-se de um estudo de coorte prospectivo, envolvendo pares de mães e crianças recrutadas nas maternidades públicas de dois municípios do estado da Bahia, entre março de 2005 e outubro de 2006. Neste estudo, apresentam-se os resultados para o crescimento linear de 489 crianças acompanhadas durante os primeiros 12 meses de vida. O modelo de efeitos mistos foi utilizado para explorar a influência de covariáveis na média do índice comprimento/idade em escore Z no primeiro ano de vida. RESULTADOS: Na análise múltipla de efeito misto, observou-se que ausência de coabitação materna com companheiro (β = 0,2347; p = 0,004) e maior tempo de aleitamento materno exclusivo (β = 0,0031; p < 0,001) contribuíram positivamente, enquanto a altura materna menor do que 150 cm (β = -0,4393; p < 0,001), peso ao nascer entre 2.500-2.999 g (β = -0,8084; p < 0,001) e a anemia na criança (β = -0,0875; p < 0,001) contribuíram de forma negativa na variação das estimativas do índice comprimento/idade em escore Z. CONCLUSÕES: Assim, os resultados deste estudo indicam que a baixa estatura materna, o peso de nascimento < 3.000 g e a anemia influenciaram negativamente o crescimento linear no primeiro ano de vida, enquanto a maior duração do aleitamento materno exclusivo e a ausência de coabitação materna com companheiro exerceram influência positiva.

OBJECTIVE: To investigate covariates that could affect the variation in mean length/age z scores in the first year of life of children born full term with normal birth weight. METHODS: This was a prospective study of a cohort of mother-infant pairs recruited at public maternity units in two municipalities in the Brazilian state of Bahia, from March 2005 to October 2006. This paper reports the results for linear growth of 489 children who were followed-up for the first 12 months of their lives. A mixed-effect regression model was used to investigate the influence of covariates of mean length/age z score during the first year of life. RESULTS: The multivariate mixed effect analysis indicated that mothers not cohabiting with a partner (β = 0.2347; p = 0.004) and increased duration of exclusive breastfeeding (β = 0.0031; p < 0.001) had a positive impact, whereas mother’s height less than 150 cm (β = -0.4393; p < 0.001), birth weight of 2,500-2,999 g (β = -0.8084; p < 0.001) and anemia in the child (β = -0.0875; p < 0.001) all had a negative impact on the variation in estimated length/age z score. CONCLUSIONS: Therefore, the results of this study indicate that short maternal stature, birth weight < 3,000 g and anemia in the infant had a negative effect on linear growth during the first year of life, whereas longer duration exclusive breastfeeding and mothers who did not cohabit with a partner had a positive effect.

Prevalência e fatores associados ao excesso de peso em adolescentes de Salvador, Bahia, Brasil / Prevalence and associated factors of surplus weight in adolescents from Salvador, Bahia, Brazil

OBJETIVO: Estimar a prevalência e identificar fatores associados ao excesso de peso em adolescentes. MÉTODOS: Trata-se de um estudo transversal. Foram selecionados 426 adolescentes de 10 a 18 anos, da cidade de Salvador, região Nordeste do Brasil, por um processo de amostragem por conglomerados, aleatória em três estágios. Os dados sobre a frequência de consumo alimentar e atividade física, maturação sexual, medidas antropométricas e covariáveis foram coletados. O estado nutricional foi classificado por meio dos pontos de corte baseados no índice de massa corporal de crianças e adolescentes brasileiros. As características sexuais secundárias foram autorreferidas pelos avaliados. Os adolescentes que realizaram mais de 300 minutos de atividade física moderada por semana, foram considerados fisicamente ativos. A etnia foi classificada pela cor da pele e atributos físicos. RESULTADOS: A prevalência de excesso de peso para ambos os sexos foi de 14,3 por cento. Estimou-se que a maturação sexual precoce (Razão de Prevalência ajustada = 2,12, IC95 por cento = 1,10-4,05) e insuficientes níveis de atividade física (RP ajustada = 1,85, IC95 por cento = 1,01-3,41), ajustados pela idade (RP ajustada = 1,77, IC95 por cento = 0,97-3,24), são associados, de forma independente, ao excesso de peso em adolescentes de Salvador. CONCLUSÕES: O excesso de peso pode ser considerado elevado entre os adolescentes da cidade de Salvador. Consideram-se necessárias a adoção de políticas públicas de prevenção e combate precoce ao excesso de peso corporal que melhorem o estimulo, disponibilidade e acesso à prática continuada e sistemática da atividade física em nível populacional.

OBJECTIVE: To estimate the prevalence and identify associated factors of surplus weight in adolescents. METHODS: a cross-sectional study design was employed. 426 adolescents, 10 to 18 years old, from the city of Salvador, northeast region of Brazil were selected in a three stage stratified random sampling scheme. Data on the frequency of food consumption and physical activity, sexual maturation, anthropometric measurements and covariates were collected. The nutritional status was classified with cutoff points based on body mass index mean values from Brazilian children and adolescents, while the secondary sexual characteristics were self-reported. The adolescents who performed more than 300 minutes of moderate physical activity per week were considered physically active. Ethnicity was classified by skin color and physical attributes. RESULTS: Total prevalence of surplus weight was of 14.3 percent. Early sexual maturation (Prevalence Rate - /PR/_adjusted =2.12, /CI95 percent/=1.10-4.05) and physical inactivity (/PR/_adjusted =1.85, /CI95 percent/=1.01-3.41), adjusted for age (PR/ adjusted =1.77, /CI0.97 percent/=3.24) were independently associated with surplus weight in adolescents from Salvador, Bahia. CONCLUSIONS: Surplus weight was high among adolescents in Salvador. Public prevention policies should be adopted in order to early prevent surplus weight through improved encouragement to continuous and systematic practice of physical activity at population level.

Is malnutrition associated with crowding in permanent dentition?

Evidence suggests that energy-protein malnutrition is associated with impaired growth and development of facial bones. The objective of this study was to investigate the association between nutritional status and reduced space for dental eruption (crowding) in permanent dentition. A cross-sectional study with probabilistic sampling design was used. We evaluated 2,060 students aged 12 to 15 years enrolled in schools in the northeast of Brazil. Crowding was defined according to World Health Organization (WHO) as misalignment of teeth due to lack of space for them to erupt in the correct position. Nutritional status was evaluated by means of body mass index and height-for-age, using the WHO's reference curves. Parents and adolescents responded to a questionnaire about demographic, socioeconomic, biological and behavioral characteristics. The associations were estimated by odds ratio (OR) in multivariate logistic regression analysis (alpha = 0.05). Confounding and effect-modification were taken into account. An association between low height-for-age (z-score < -1SD) and crowding was only observed in adolescents with a prolonged history of mouth breathing (OR = 3.1). No association was observed between underweight and crowding. Malnutrition is related to crowding in permanent dentition among mouth-breathing adolescents. Policy actions aimed at reducing low height-for-age and unhealthy oral habits are strongly recommended. However, further studies are needed to increase the consistency of these findings and improve understanding of the subject.

Impact of a citywide sanitation program in Northeast Brazil on intestinal parasites infection in young children.

BACKGROUND: Sanitation affects health, especially that of young children. Residents of Salvador, in Northeast Brazil, have had a high prevalence of intestinal parasites. A citywide sanitation intervention started in 1996 aimed to raise the level of sewer coverage from 26% to 80% of households. OBJECTIVES: We evaluated the impact of this intervention on the prevalence of Ascaris lumbricoides, Trichuris trichuria, and Giardia duodenalis infections in preschool children. METHODS: The evaluation was composed of two cross-sectional studies (1998 and 2003-2004), each of a sample of 681 and 976 children 1-4 years of age, respectively. Children were sampled from 24 sentinel areas chosen to represent the range of environmental conditions in the study site. Data were collected using an individual/household questionnaire, and an environmental survey was conducted in each area before and after the intervention to assess basic household and neighborhood sanitation conditions. Stool samples were examined for the presence of intestinal parasites. The effect of the intervention was estimated by hierarchical modeling, fitting a sequence of multivariate regression models. FINDINGS: The prevalence ofA. lumbricoides infection was reduced from 24.4% to 12.0%, T. trichuria from 18.0% to 5.0%, and G. duodenalis from 14.1% to 5.3%. Most of this reduction appeared to be explained by the increased coverage in each neighborhood by the sewage system constructed during the intervention. The key explanatory variable was thus an ecological measure of exposure and not household-based, suggesting that the parasite transmission prevented by the program was mainly in the public (vs. the domestic) domain. CONCLUSION: This study, using advanced statistical modeling to control for individual and ecological potential confounders, demonstrates the impact on intestinal parasites of sanitation improvements implemented at the scale of a large population.

[Factors associated with overweight and abdominal fat in adults in Salvador, Bahia State, Brazil]. / Fatores associados a excesso de peso e concentração de gordura abdominal em adultos na cidade de Salvador, Bahia, Brasil.

This cross-sectional study of 570 adults aimed to identify factors associated with overweight and abdominal fat in adults of both sexes in the city of Salvador, Bahia State, Brazil. Body mass index (BMI) and waist circumference were the dependent variables, and Poisson regression was used for statistical analysis. For women, high BMI and waist circumference were associated with increased age and current dieting (< or = 3 meals a day), while family history of obesity was only associated with increased BMI. In men, BMI increased in the 30-39 and 50-59-year age brackets. Waist circumference increased in association with < or = 3 meals a day, arterial hypertension, and alcohol consumption, and was lower among blacks and mixed-race individuals. High BMI and waist circumference were both associated with family history of myocardial infarction. Thus, factors associated with overweight and abdominal fat differ between men and women, but adopting healthier lifestyles can help modify many of these factors.

Fatores associados a excesso de peso e concentração de gordura abdominal em adultos na cidade de Salvador, Bahia, Brasil / Factors associated with overweight and abdominal fat in adults in Salvador, Bahia State, Brazil

O objetivo foi identificar os fatores associados ao excesso de peso e concentração de gordura abdominal em adultos de ambos os sexos. Um estudo transversal envolvendo amostra representativa de 570 adultos de Salvador, Bahia, Brasil. A regressão de Poisson foi utilizada na análise, adotando-se o índice de massa corporal (IMC) e a circunferência da cintura como variáveis dependentes. Para as mulheres, a inadequação do IMC e da circunferência da cintura ocorreu com o aumento da idade e entre as que faziam dieta no momento do estudo, a história familiar de obesidade associou-se apenas com o IMC elevado. Para os homens, o IMC elevou-se na faixa etária de 30 a 39 e 50 a 59 anos. A circunferência da cintura elevou-se com a realização de três ou menos refeições-dia, com a hipertensão arterial, uso de bebida alcoólica e diminuiu entre mulatos e negros. Tanto IMC quanto circunferência da cintura elevaram-se com a historia familiar de infarto. Portanto são distintos os fatores que se associam ao excesso de peso e da gordura abdominal em homens e mulheres. Mas muitos deles podem ser modificados com a adoção do estilo de vida saudável.

This cross-sectional study of 570 adults aimed to identify factors associated with overweight and abdominal fat in adults of both sexes in the city of Salvador, Bahia State, Brazil. Body mass index (BMI) and waist circumference were the dependent variables, and Poisson regression was used for statistical analysis. For women, high BMI and waist circumference were associated with increased age and current dieting (< 3 meals a day), while family history of obesity was only associated with increased BMI. In men, BMI increased in the 30-39 and 50-59-year age brackets. Waist circumference increased in association with < 3 meals a day, arterial hypertension, and alcohol consumption, and was lower among blacks and mixed-race individuals. High BMI and waist circumference were both associated with family history of myocardial infarction. Thus, factors associated with overweight and abdominal fat differ between men and women, but adopting healthier lifestyles can help modify many of these factors.

Determinants of cognitive function in childhood: a cohort study in a middle income context.

BACKGROUND: There is evidence that poverty, health and nutrition affect children's cognitive development. This study aimed to examine the relative contributions of both proximal and distal risk factors on child cognitive development, by breaking down the possible causal pathways through which poverty affects cognition. METHODS: This cohort study collected data on family socioeconomic status, household and neighbourhood environmental conditions, child health and nutritional status, psychosocial stimulation and nursery school attendance. The effect of these on Wechsler Pre-School and Primary Scale of Intelligence scores at five years of age was investigated using a multivariable hierarchical analysis, guided by the proposed conceptual framework. RESULTS: Unfavourable socioeconomic conditions, poorly educated mother, absent father, poor sanitary conditions at home and in the neighbourhood and low birth weight were negatively associated with cognitive performance at five years of age, while strong positive associations were found with high levels of domestic stimulation and nursery school attendance. CONCLUSION: Children's cognitive development in urban contexts in developing countries could be substantially increased by interventions promoting early psychosocial stimulation and preschool experience, together with efforts to prevent low birth weight and promote adequate nutritional status.

Effect of city-wide sanitation programme on reduction in rate of childhood diarrhoea in northeast Brazil: assessment by two cohort studies.

BACKGROUND: A city-wide sanitation intervention was started in Salvador, Brazil, in 1997 to improve sewerage coverage from 26% of households to 80%. Our aim was to investigate the epidemiological effect of this city-wide sanitation programme on diarrhoea morbidity in children less than 3 years of age. METHODS: The investigation was composed of two longitudinal studies done in 1997-98 before the intervention (the sanitation programme) and in 2003-04 after the intervention had been completed. Each study consisted of a cohort of children (841 in the preintervention study and 1007 in the postintervention study; age 0-36 months at baseline) who were followed up for a maximum of 8 months. Children were sampled from 24 sentinel areas that were randomly chosen to represent the range of environmental conditions in the study site. At the start of each study an individual or household questionnaire was applied by trained fieldworkers; an environmental survey was done in each area before and after introduction of the sanitation programme to assess basic neighbourhood and household sanitation conditions. Daily diarrhoea data were obtained during home visits twice per week. The effect of the intervention was estimated by a hierarchical modelling approach fitting a sequence of multivariate regression models. FINDINGS: Diarrhoea prevalence fell by 21% (95% CI 18-25%)-from 9.2 (9.0-9.5) days per child-year before the intervention to 7.3 (7.0-7.5) days per child-year afterwards. After adjustment for baseline sewerage coverage and potential confounding variables, we estimated an overall prevalence reduction of 22% (19-26%). INTERPRETATION: Our results show that urban sanitation is a highly effective health measure that can no longer be ignored, and they provide a timely support for the launch of 2008 as the International Year of Sanitation.

Validity and reliability of the sagittal abdominal diameter as a predictor of visceral abdominal fat.

OBJECTIVES: To evaluate the reliability of the sagittal abdominal diameter and its validity as a predictor of visceral abdominal fat, as well as to identify the most appropriate cut-off points to identify the area of visceral fat that is known to represent a risk factor for cardiovascular disease. DESIGN: Validation study. SUBJECTS: 92 healthy volunteers (57 women, 35 men), age: 20-83 y, body mass index: 19.3 to 35.9 kg/m2. MEASUREMENTS: Sagittal abdominal diameter (SAD), weight, height, circumferences (waist, hip, and thigh), sub-scapular skinfold thickness, abdominal diameter index, and waist-hip ratio (WHR). METHOD OF CHOICE: Computed tomography (CT). STATISTIC: Receiver operating characteristic (ROC) curve. RESULTS: The reliability for SAD measurement was very high (Inter-class coefficient = 0.99). Visceral fat as measured by VAF through CT was highly correlated with SAD (women r = 0.80; men r = 0.64, p < 0.001), waist circumference (women r = 0.77; men r = 0.73, p < 0.001), and WHR (women r = 0.72; men r = 0.58, p < 0.001). The ROC curve indicated 19.3 cm and 20.5 cm as the threshold values for abdominal sagittal diameter in women and men (sensitivity 85% and 83%, specificity 77% and 82%, respectively). CONCLUSIONS: There was a high correlation between SAD and VAF. The cut-off values identified for SAD presented a sensitivity and specificity that were considered adequate.

Desigualdade, pobreza e condições de saúde e nutrição na infância no Nordeste brasileiro / Inequality, poverty, and childhood health and nutritional conditions in Northeast Brazil

Estudo transversal, envolvendo 2.001 crianças das áreas rural e urbana de dez municípios da Bahia, Brasil. Avalia-se a relação entre os gradientes da desigualdade e os fatores do ambiente familiar, de saúde e nutrição, utilizando-se a regressão logística multinomial multivariada. As crianças do tercil intermediário das condições de vida e aquelas do tercil mais pobre têm chances significantes e crescentes de viverem na área rural, em domicílio chefiado pela mulher, ter o pai desempregado, mãe com baixa escolaridade, de dormir com mais de uma pessoa na mesma cama, déficit linear grave e consumir retinol abaixo da mediana. A existência de mais de uma criança no domicílio, ser portadora de déficit ponderal e ter o consumo de lipídeo abaixo da mediana foram eventos também significantes para as crianças mais pobres. A anemia foi identificada entre as crianças do tercil intermediário. A desigualdade expõe as crianças a chances crescentes de inadequado estado de saúde e nutrição. Políticas de saúde podem implementar medidas emergenciais no sentido de minimizar os males impostos pela desigualdade à saúde e nutrição na infância.

This cross-sectional study analyzes the relationship between gradients of social inequalities and the household environment and health and nutritional conditions among 2,001 preschool children in ten counties (municipalities) in the State of Bahia, Brazil. The analysis used multinomial multivariate logistic regression. Children in the middle and lower tertiles on the poverty scale had significant and increasing odds of living in a household headed by a woman, an unemployed father, a mother with £ years of schooling, more than one child sharing the same bed, severe stunting, and retinol consumption below the median as compared to those in the upper tertile. More than one child in the home, weight deficit, and lipid consumption below the median were also significantly associated with the poorest tertile. Specific emergency health policies and measures must be implemented to minimize the burden imposed by poverty and social inequalities on childhood health and nutrition.

[Inequality, poverty, and childhood health and nutritional conditions in Northeast Brazil]. / Desigualdade, pobreza e condições de saúde e nutrição na infância no Nordeste brasileiro.

This cross-sectional study analyzes the relationship between gradients of social inequalities and the household environment and health and nutritional conditions among 2,001 preschool children in ten counties (municipalities) in the State of Bahia, Brazil. The analysis used multinomial multivariate logistic regression. Children in the middle and lower tertiles on the poverty scale had significant and increasing odds of living in a household headed by a woman, an unemployed father, a mother with

Validity and reliability of the sagittal abdominal diameter as a predictor of visceral abdominal fat

OBJECTIVES: To evaluate the reliability of the sagittal abdominal diameter and its validity as a predictor of visceral abdominal fat, as well as to identify the most appropriate cut-off points to identify the area of visceral fat that is known to represent a risk factor for cardiovascular disease. DESIGN: Validation study. SUBJECTS: 92 healthy volunteers (57 women, 35 men), age: 20-83 y, body mass index: 19.3 to 35.9 kg/m². MEASUREMENTS: Sagittal abdominal diameter (SAD), weight, height, circumferences (waist, hip, and thigh), sub-scapular skinfold thickness, abdominal diameter index, and waist-hip ratio (WHR). METHOD OF CHOICE: Computed tomography (CT). STATISTIC: Receiver operating characteristic (ROC) curve. RESULTS: The reliability for SAD measurement was very high (Inter-class coefficient = 0.99). Visceral fat as measured by VAF through CT was highly correlated with SAD (women r = 0.80; men r = 0.64, p < 0.001), waist circumference (women r = 0.77; men r = 0.73, p < 0.001), and WHR (women r = 0.72; men r = 0.58, p < 0.001). The ROC curve indicated 19.3 cm and 20.5 cm as the threshold values for abdominal sagittal diameter in women and men (sensitivity 85 percent and 83 percent, specificity 77 percent and 82 percent, respectively). CONCLUSIONS: There was a high correlation between SAD and VAF. The cut-off values identified for SAD presented a sensitivity and specificity that were considered adequate.

OBJETIVOS: Avaliar a confiabilidade do diâmetro abdominal sagital e a sua validade enquanto preditor de gordura abdominal visceral, assim como identificar os pontos de corte mais apropriados para identificar a área de gordura visceral que é conhecida por representar fator de risco para doença cardiovascular. MÉTODOS: Desenho: Estudo de validação. Amostra: 92 voluntários saudáveis (57 mulheres, 35 homens), idade: 20-83 anos, índice de massa corporal: 19,3 a 35,9 kg/m². Medidas: Diâmetro abdominal sagital (DAS), peso, altura, circunferências (cintura, quadril e coxa), pregas cutâneas tricipital e subescapular, índice diâmetro abdominal e razão cintura-quadril (RCQ). MÉTODO DE ESCOLHA: Tomografia computadorizada (TC). ESTATíSTICA: Curva ROC (receiver operating characteristic). RESULTADOS: A confiabilidade do DAS foi muito alta (coeficiente inter-classe = 0,99). A área de gordura visceral medida pela TC teve uma alta correlação com o DAS (mulheres r = 0,80, homens r = 0,64, p < 0,001), circunferência da cintura (mulheres r = 0,77, homens r = 0,73, p < 0,001) e com a RCQ (mulheres r = 0,72, homens r = 0,58, p < 0,001). A curva ROC indicou 19,3 cm e 20,5 cm como valores limites para o diâmetro abdominal sagital em mulheres e homens (sensibilidade de 85 por cento e 83 por cento, especificidade de 77 por cento e 82 por cento, respectivamente). CONCLUSÕES: Observou-se alta correlação entre o DAS e a área de gordura abdominal visceral. Os pontos de corte identificados para o DAS apresentaram sensibilidade e especificidade adequadas.

[Determinants of linear growth retardation in Brazilian preschool children: a multilevel approach]. / Preditores do retardo de crescimento linear em pré-escolares: uma abordagem multinível.

This study focuses on the determinants of linear growth deficit in under-five children using multilevel modeling. The sample included 3,746 preschoolers from 15 Brazilian municipalities (ten from the State of Bahia and five from São Paulo), with a three-tier analysis (municipalities, households, and children). Municipal data were obtained from the 1991 National Census. Individual and household data were collected from 1999 to 2001 using structured questionnaires and measuring children's weight and height. Analysis used the MLwiN software. In the final multilevel model, low HDI and prenatal care at the municipal level, poor environmental and economic conditions and maternal schooling at the household level, and low birth weight, incomplete immunization, prior history of malnutrition, and no report of breastfeeding at the individual level were strongly associated with linear growth deficit. Total variability of deficit explained by the model was 27.4%, of which 51.3%, 33%, and 15.7% were explained, respectively, by individual, household, and municipal variables.

Preditores do retardo de crescimento linear em pré-escolares: uma abordagem multinível / Determinants of linear growth retardation in Brazilian preschool children: a multilevel approach

Este estudo teve como objetivo identificar os determinantes do déficit de crescimento linear em crianças menores de cinco anos, utilizando modelagem multinível. Foi estudada uma amostra de 3.746 pré-escolares de 15 municípios brasileiros (dez do Estado da Bahia e cinco do Estado de São Paulo), construída em três estágios (municípios, domicílios e crianças). Os dados municipais foram obtidos do censo demográfico de 1991. Os dados referentes aos indivíduos e domicílios foram coletados entre 1999 e 2001, constando de questionários estruturados e medições de peso e altura das crianças. Para análise utilizou-se o programa MLwiN. No modelo multinível final observou-se que baixo IDH e inadequada assistência pré-natal, no nível dos municípios; baixas condições ambientais, econômicas e da escolaridade materna, no nível dos domicílios; o baixo peso ao nascer, esquema vacinal incompleto, história prévia de desnutrição e ausência do aleitamento ao peito, no nível das crianças, mostraram-se fortemente associados ao déficit do crescimento linear das crianças estudadas. A variabilidade total da desnutrição explicada pelo modelo foi de 27,4 por cento, desta, 51,3 por cento, 33 por cento e 15,7 por cento foram explicadas, respectivamente, pelas variáveis dos níveis da criança, do domicílio e do município.

This study focuses on the determinants of linear growth deficit in under-five children using multilevel modeling. The sample included 3,746 preschoolers from 15 Brazilian municipalities (ten from the State of Bahia and five from São Paulo), with a three-tier analysis (municipalities, households, and children). Municipal data were obtained from the 1991 National Census. Individual and household data were collected from 1999 to 2001 using structured questionnaires and measuring children's weight and height. Analysis used the MLwiN software. In the final multilevel model, low HDI and prenatal care at the municipal level, poor environmental and economic conditions and maternal schooling at the household level, and low birth weight, incomplete immunization, prior history of malnutrition, and no report of breastfeeding at the individual level were strongly associated with linear growth deficit. Total variability of deficit explained by the model was 27.4 percent, of which 51.3 percent, 33 percent, and 15.7 percent were explained, respectively, by individual, household, and municipal variables.