Association between Childhood Overweight and Altered Concentrations of Circulating Amino Acids.

(1) Background: Dysregulated serum amino acids (AA) are known to be associated with obesity and risk of Type 2 Diabetes (T2D) in adults, and recent studies support the same notion in the pubertal age. It is, however, unknown whether childhood overweight may already display alterations of circulating AA. (2) Methods: We used liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS)-targeted metabolomics to determine plasma concentrations of AA and AA-related molecules in 36 children aged 7-12 years with normal weight or overweight. Clinical and anthropometric parameters were measured. (3) Results: Overweight in children is associated with an altered AA profile, with increased branched-chain amino acids (BCAA) and decreased glycine levels, with no clinically manifested metabolic conditions. Moreover, z-BMI was positively and negatively correlated with BCAA and glycine levels, respectively, even after adjustment for age and gender. We also found a correlation between the AA profile and clinical parameters such as lipids profile and glycemia. (4) Conclusions: A pattern of low glycine, and increased BCAA is correlated to z-BMI, total cholesterol, and triglycerides in overweight but otherwise healthy children. Our data suggest that, in childhood overweight, AA disturbances may precede other clinical parameters, thus providing an early indicator for the later development of metabolic disease.

Daily consumption of ultra-processed foods and cardiometabolic risk factors in children aged 7 to 10 years in Northeast Brazil.

Background: Ultra-processed foods (UPFs) consumption is associated with pediatric overweight and obesity. Aim: To evaluate the UPFs consumption in children classified either as eutrophic or with excess weight (overweight and obesity). It was also described the fasting plasma glucose, total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) and the correlation between UPFs consumption and cardiometabolic risk factors. Methods: A total of 139 children aged 7-10years of both sexes, living in Northeast Brazil were classified as eutrophic (n = 65) or excess weight (n = 62). Waist circumference (WC), percentage of body fatness (% BF), fat-free-mass and fat mass were evaluated. Fasting blood sample were collected for biochemical analysis. Food consumption was classified according to the degree of processing. Results: Children with excess weight had a reduction in plasma HDL concentration (45.00; IQR:36.00-54.50 mg/dL vs. 40.00; IQR:35.75-45.25 mg/dL; p = 0.021) and an increase in blood glucose (82.00; IQR:79.00-86.00 mg/dL vs. 86.00; IQR:81.00-90.00 mg/dL; p < 0.001) and TG (64.00; IQR:45.00-92.50 mg/dL vs. 81.00; IQR:57.50-111.75 mg/dL; p < 0.021) when compared with the eutrophic children. UPFs accounted for 43.43% of the total calories consumed by children. Children with excess weight had higher total energy consumption resulting from consumption of UPFs (714.30 ± 26.32 kcal vs. 848.06 ± 349.46 kcal; p = 0.011). The absolute consumption of the UPFs showed a positive correlation with WC (r = 0.202; p = 0.023) and %BF (r = 0.198; p = 0.026). Conclusion: UPFs consumption was higher for children with excess weight and positively correlated with two cardiometabolic risk factors, suggesting the need for strengthening public policies that discourage the consumption of these foods.

Adequacy of school menus and national school food program requirements: a systematic review / Adequação dos cardápios escolares e exigências do programa nacional de alimentação escolar: uma revisão sistemática

Abstract Objectives: this review aimed to evaluate the adequacy of school menus regarding the nutritional requirements of the Programa Nacional de Alimentação Escolar (PNAE) in Brazilian public schools regarding the presence of macronutrients and micronutrients and allocation of resources to purchase products from family farming. Methods: a systematic literature review was carried out using the SciELO, Bireme and Lilacs databases to select the articles. The inclusion criteria were articles that presented data on the adequacy of energy, macronutrients, micronutrients, and purchases of products from family farming during the PNAE regiment, as well as quantitative, cross-sectional, and descriptive studies carried out in the Brazilian territory. Review, editorials, letters, case studies, duplicates and those that did not assess the requirements of the PNAE were excluded. Results: at the end, 12 studies were included that showed overestimation and underestimation of nutritional adequacy in the school environment. In relation to purchases of inputs from family farming, it was observed that most of the Brazilian municipalities evaluated fulfilled the requirements for the allocation of resources. Conclusion: school menus need more supervision so that they meet the adjustments proposed by the PNAE. In addition, it is essential to promote a healthy diet that contains all the nutrients necessary to provide nutritional support for child growth and development.

Resumo Objetivo: avaliar a adequação dos cardápios escolares quanto às exigências nutricionais do Programa Nacional de Alimentação Escolar (PNAE) em escolas públicas brasileiras considerando quanto a adequação de macronutrientes e micronutrientes e destinação de recursos para compras de produtos advindos da agricultura familiar. Métodos: foi realizada uma revisão sistemática da literatura utilizando as bases de dados SciELO, Bireme e Lilacs para seleção dos artigos. Os critérios de inclusão foram: Artigos que apresentaram dados sobre a adequação de energia, macronutrientes, micronutrientes e compras de produtos oriundos da agricultura familiar durante o regimento do PNAE, assim como estudos quantitativos, transversais e descritivos realizados no território brasileiro. Foram excluídos artigos de revisão, editoriais, cartas ao editor, estudos de caso, artigos em duplicatas e que não avaliaram as exigências do PNAE. Resultados: ao final, foram incluídos12 estudos que apontaram superestimação e subestimação nas adequações nutricionais no ambiente escolar. Em relação às compras de insumo provenientes da agricultura familiar, observou-se que a maioria dos municípios brasileiros avaliados cumpriam as exigências de destinação dos recursos. Conclusões: os cardápios escolares necessitam de maior fiscalização para que atendam as adequações propostas pelo PNAE. Além disso, é primordial promover uma alimentação saudável que contenha todos os nutrientes necessários para fornecer um aporte nutricional para o crescimento e desenvolvimento infantil.

Food consumption habits, gestational age and birth weight are predictive for children with excess weight: An analysis based on artificial neural network.

The relationship between body weight gain and the onset of obesity is linked to environmental and behavioral factors, and may be dependent on biological predisposing. Artificial neural networks are useful predictive tools in the field of artificial intelligence, and can be used to identify risk factors related to obesity. The aim of this study is to establish, based on artificial neural networks, a predictive model for overweight/obesity in children based on the recognition and selection of patterns associated with birth weight, gestational age, height deficit, food consumption, and the physical activity level, TV time and family context. Sample consisted of 149 children (72 = eutrophic and 77 = overweight/obese). Collected data consisted of anthropometry and demographic characteristics, gestational age, birth weight, food consumption, physical activity level, TV time and family context. The gestational age, daily caloric intake and birth weight were the main determinants of the later appearance of overweight and obesity. In addition, the family context linked to socioeconomic factors, such as the number of residents in the household, had a great impact on excess weight. The physical activity level was the least important variable. Modifiable risk factors, such as the inadequate food consumption, and non-modifiable factors such as gestational age were the main determinants for overweight/obesity in children. Our data indicate that, combating excess weight should also be carried out from a social and preventive perspective during critical periods of development, such as pregnancy, lactation and early childhood, to reach a more effective strategy to combat obesity and its complications in childhood and adult life.

Cardiac autonomic dysfunction in school age children with overweight and obesity.

BACKGROUND AND AIMS: We investigated cardiac autonomic function in overweight and obese school-age children. METHODS AND RESULTS: Quantitative cross-sectional study conducted with children (n = 110) of both genders. Children were divided by normal weight (NW; n = 54), overweight (OW; n = 24) and obese (OB; n = 32). Systolic (SBP) and diastolic (DBP) blood pressure and electrocardiograms were recorded and analyzed for heart rate and the heart rate variability (HRV) in time (SDRR, RMSSD, PRR50, SD1 and SD2) and frequency domains (HF, LF and LF/HF). The OB group presented higher SBP (p ≤ 0.01) and DBP (p ≤ 0.01). For HRV, the OB group had a lower PRR50 (p ≤ 0.01) and HF (p ≤ 0.01), associated with higher LF (p ≤ 0.01). Moderate negative correlations were found between the HF, BMI (r = -0.37; p ≤ 0.01) and WC (r = -0.38; p ≤ 0.01). Positive moderate correlation were found between LF, LF/HF and BMI (LF: r = 0.32; p ≤ 0.01; LF/HF: r = 0.31; p ≤ 0.01) and WC (LF: r = 0.34; p ≤ 0.01; LF/HF: = 0.34; p ≤ 0.01). Multiple linear regression showed a positive association between body fat and the SDRR (ß: 0.48; CI: 0.2-4.2; p = 0.02). No differences were observed in cardiac electrical activity. CONCLUSION: Children with obesity but not overweight presented higher blood pressure and cardiac autonomic dysfunction, with sympathetic predominance on the heart rate. This fact was positively correlated with BMI and may be considered an important marker for cardiovascular risk in children.

Validity and accuracy of body fat prediction equations using anthropometric measurements in children 7 - 10 years old / Validade e acurácia de equações de predição de gordura corporal usando medidas antropométricas em crianças de 7 a 10 anos

abstract Children with a deficit of growth because of perinatal malnutrition present specificities in the percentage of body fat (%BF) that could not be detected by previous fat mass-based equations. This study developed and validated predictive equations of the %BF derived from anthropometric variables in children aged 7 to 10 living in Northeast Brazil, using dual-energy x-ray absorptiometry (DXA) as a reference. Body composition data from 58 children were utilized. DXA was used as a reference. A stepwise (forward) multiple regression statistical model was used to develop the new equations. The Bland-Altman analysis (CI: 95%), paired Student's t-test, and the intraclass correlation coefficient (ICC) was used to validate and compare the developed equations. Two new equations were developed for either gender: boys: %BF: 13.642 + (1.527*BMI) + (-0.345*Height) + (0.875*Triceps) + (0.290* Waist Circumference) and girls: %BF: -13.445 + (2.061*Tight). The Bland-Altman analysis showed good agreement, with limits ranging from -1.33 to 1.24% for boys and -3.35 to 4.08% for girls. The paired Student's t-test showed no difference between %BF-DXA and the two new equations (p> 0.05), and the ICC was 0.948 and 0.915, respectively. DXA-based anthropometric equations provide an accurate and noninvasive method to measure changes in the %BF in children.

resumo Crianças com déficit de crescimento por desnutrição perinatal apresentam especificidades na distribuição do percentual de gordura corporal (%GC) que não puderam ser detectadas por equações anteriores baseadas no %GC. Este estudo desenvolveu e validou equações preditivas do %GC derivadas de variáveis ​​antropométricas em crianças de 7 a 10 anos residentes no Nordeste do Brasil, utilizando como referência a absorciometria radiológica de dupla energia (DXA). Foram utilizados dados de composição corporal de 58 crianças. O DXA foi usado como modelo de referência. Um modelo estatístico de regressão múltipla stepwise (forward) foi usado para desenvolver as equações. A análise de Bland-Altman (IC: 95%), teste t de Student pareado e o coeficiente de correlação intraclasse (CCI) foram utilizados para validar e comparar as equações. Duas novas equações foram desenvolvidas para ambos os sexos: meninos: %GC: 13,642 + (1,527*IMC) + (-0,345*Altura) + (0,875*Tríceps) + (0,290* Circunferência da cintura) e meninas: %GC: - 13,445 + (2,061*coxa). A análise de Bland-Altman mostrou boa concordância, com limites variando de -1,33 a 1,24% para meninos e -3,35 a 4,08% para meninas. O teste t de Student pareado não mostrou diferença entre %GC-DXA e as duas novas equações (p>0,05), e o CCI foi de 0,948 e 0,915, respectivamente.

Development and validation of a food frequency questionnaire for children aged 7 to 10 years / Desenvolvimento e validação de um questionário de frequência alimentar para crianças de 7 a 10 anos de idade

ABSTRACT Objective Food and nutritional evaluation of children can support public policies to combat early overweight and obesity. This study developed and validated a quantitative food frequency questionnaire for assessing the dietary intake of children. Methods This is a cross-sectional study of the development of a food frequency questionnaire for 130 children of both genders aged 7 to 10 years old. For the food frequency questionnaire list, 81 food items were selected. The validity of the food frequency questionnaire was evaluated by comparison with 24-hour recalls and reproducibility was performed by comparing two food frequency questionnaires. Results Most of the foods with 95% relative contribution were ultra-processed, such as packaged snacks and powdered juice. In validation, correlation coefficients were found between 0.45 (p<0.000) for lipids and 0.37 (p<0.000) for carbohydrates. An adjustment for energy reduced the correlations, but there was an increase in the correlation in calcium (r=0.75) and retinol (r=0.20). In terms of reproducibility, all macronutrients and calcium showed a satisfactory intraclass correlation coefficient (>0.400) and moderate correlations [proteins (0.54; p<0.000) and lipids (0.41; p<0.000)]. Conclusion The food frequency questionnaire developed was valid and able to assess the local food consumption by children from northeastern Brazil.

RESUMO Objetivo A avaliação alimentar e nutricional de crianças pode subsidiar políticas públicas de combate ao sobrepeso e à obesidade precoce. Este estudo desenvolveu e validou um questionário quantitativo de frequência alimentar para avaliação do consumo alimentar de crianças de 7 a 10 anos. Métodos Trata-se de um estudo transversal do desenvolvimento de um questionário de frequência alimentar que avaliou 130 crianças de ambos os sexos com idades entre 7 e 10 anos. Para a lista do questionário, foram selecionados 81 itens alimentares. A validade do instrumento foi avaliada por meio da comparação com recordatórios de 24 horas e a reprodutibilidade foi realizada pela comparação de dois questionários de frequência alimentar. Resultados A maioria dos alimentos com 95% de contribuição relativa foi ultraprocessada, como salgadinhos embalados e suco em pó. Na validação, foram encontrados coeficientes de correlação entre 0,45 (p<0,000) para lipídios e 0,37 (p<0,000) para carboidratos. Um ajuste para energia reduziu as correlações, mas houve um aumento na correlação de cálcio (r=0,75) e retinol (r=0,20). Em termos de reprodutibilidade, todos os macronutrientes e o cálcio apresentaram coeficiente de correlação intraclasse satisfatório (>0,400) e correlações moderadas [proteínas (0,54; p<0,000) e lipídios (0,41; p<0,000)]. Conclusão O questionário de frequência alimentar desenvolvido é válido e foi capaz de avaliar o consumo alimentar local de crianças do Nordeste do Brasil.

Can the Consumption of Ultra-Processed Food Be Associated with Anthropometric Indicators of Obesity and Blood Pressure in Children 7 to 10 Years Old?

The consumption of ultra-processed foods plays an important role in the development of obesity and hypertension. The present study investigated the association between consumption of food according to the degree of processing and anthropometric indicators of obesity and blood pressure in children. This is a cross-sectional study with 164 children aged 7-10 years. The body mass index (BMI) for age, waist circumference (WC), and waist-to-height ratio (WHtR) was evaluated. Food consumption was analyzed by three 24-h dietary recalls, and classified as: G1-unprocessed or minimally processed; G2-culinary ingredients and processed food; and G3-ultra-processed food. Linear regression analyses were used to investigate the associations among variables. The average energy consumption was 1762.76 kcal/day, split into 45.42%, 10.88%, and 43.70%, provided by G1, G2, and G3, respectively. Adjusted linear regression analyses identified that the caloric contribution of G1 was inversely associated with DBP, showing that for each 10% increase in the energy intake of minimally processed foods, there was a reduction of 0.96 mmHg in the DBP (ß:-0.10; 95% CI:-0.19 to -0.01; r2 = 0.20). There was no association between the caloric contribution of food groups and BMI, WC, WHtR, and SBP. Increasing consumption of G1 could be a strategy for the prevention and treatment of hypertension in schoolchildren.

Vitamin A and D deficiencies in the prognosis of respiratory tract infections: A systematic review with perspectives for COVID-19 and a critical analysis on supplementation / Vitamin A and D deficiencies: Perspectives for COVID-19

OBJECTIVE: Considering the rapid spread of COVID-19, the scientific community has been looking for ways to recognize factors that may interfere with the outcome of viral infection. Despite the lack of studies with the new coronavirus, it is known that adequate serum levels of micronutrients are essential for the organic response to infectious diseases. Thus, we aim to review the effects of vitamin A, D, iron, zinc, or folate deficiency on the prognosis of patients with respiratory infections with manifestations similar to COVID-19 and discuss about supplementation of the nutrients analyzed in this review. METHODS: The search was conducted in the databases PubMed, Lilacs, and SciELO, including observational studies published between 2010-2020, with results for individuals with respiratory tract infections with manifestations similar to COVID-19. RESULTS: Six articles met the inclusion criteria, all of which were related to deficiencies of vitamins A and D. In general, vitamin A deficiency was associated with cough, fever, and greater total respiratory resistance. Regarding vitamin D, the lack of this nutrient led to higher rates of ICU admission, the need for mechanical ventilation, and mortality. Evidence linking specific relationships between nutritional deficiencies and COVID-19 remain lacking due to the small number of studies and heterogeneities in population subgroups. CONCLUSION: In conclusion, deficiencies of vitamins A and D seem to negatively affect the prognosis of respiratory tract infections. Supplementation of these nutrients for prevention or treatment of patients diagnosed with COVID-19 should respect serum levels, nutritional status and housing conditions (e.g.,endemic location) of individuals.

The mediation effect of anthropometry and physical fitness on the relationship between birthweight and basal metabolic rate in children.

BACKGROUND: Birthweight (BW) has been associated with anthropometry, body composition and physical fitness during growth and development of children. However, less is known about the mediation effect of those variables on the relationship between BW and basal metabolic rate (BMR) in children. OBJECTIVE: To analyse the mediation effect of anthropometry, body composition and physical fitness on the association between BW and BMR in children. METHODS: In total, 499 children (254 boys, 245 girls) aged 7-10 years were included. Anthropometry (weight, height, head, waist and hip circumferences), body composition (skinfolds thickness, body fat percentage), physical fitness (handgrip strength, flexibility, muscular endurance, muscular explosive power, agility, running speed) and BMR were evaluated. The analyses were conducted by: single-mediator analysis (SMA) and multi-mediator analysis (MMA). RESULTS: The SMA indicates height, head, waist and hip circumferences and handgrip strength as significant mediators of BW on BMR for boys and height, hip circumference and handgrip strength as significant mediators of BW on BMR for girls. In MMA for girls, there were significant indirect effects for height, hip circumference and handgrip strength, with 79.08% of percent mediation. For boys, the head and waist circumferences mediation had a significant indirect effect, with 83.37% of percent mediation. CONCLUSION: The anthropometric variables associated with BW were body height, head, hip and waist circumferences for boys and body height and hip circumference for girls. The current study provides new evidence that height and handgrip strength during childhood mediated the relationship between BW and BMR.