Overweight Risk and Food Habits in Portuguese Pre-school Children.

The relationship between dietary intake and overweight-risk was assessed in 4349 children aged 3-5 years. Eating and sedentary behaviours were assessed by questionnaire. Logistic regressions were used. Children who consumed daily soft-drinks were 1.52 times more likely to be obese, and 72% more likely to be classified as overweight children.

GROWING UP IN PORTUGAL: CAPE VERDEAN ANCESTRY CHILDREN EXHIBIT LOW OVERWEIGHT AND OBESITY COMPARED WITH PORTUGUESE IN URBAN LISBON.

Portugal has one of the highest rates of childhood overweight and obesity in Europe. However, little is known about the health of ethnic minorities living in its capital city, Lisbon. The Cape Verdean community in Lisbon tend to have low educational levels, material deprivation and struggle with discrimination and racism, factors that would probably be associated with a higher prevalence of overweight and obesity. Data for the Cape Verdean population were collected in three different time periods by three different research teams in 1993, 2009 and 2013 and included children aged 6-12 years living in the Cova da Moura neighbourhood of the Greater Lisbon Metro Area. The Portuguese national survey was conducted between 2009 and 2010 at public and private schools in mainland Portugal and included height, weight, skinfolds and arm and waist circumferences. From these survey data body mass index (BMI) and prevalence of stunting (chronic malnutrition - low height-for-age) and underweight (low weight-for-age) were calculated according to reference values proposed by Frisancho (2008). Overweight and obesity prevalence values were defined based on the references established by the International Obesity Task Force. The results show significant differences in height between Cape Verdean and Portuguese boys and girls. Generally, Cape Verdeans' growth falls within the healthy range of international growth references across all of the survey data collected. Cape Verdean rates for combined overnutrition (overweight and obesity) in 2013 (9.8% for boys and 16.7% for girls) were lower than those of the Portuguese (33% for boys and 31.7% for girls). Logistic regression models showed that Cape Verdean children had a lower risk of being overweight or obese when accounting for breast-feeding, birth weight, maternal education and occupation. Despite living in a deprived neighbourhood these Cape Verdean children seemed to have grown more healthily than Portuguese ancestry children. The challenge for policymakers will be to support improvement of the poverty-related living conditions of this community without creating a risky environment for increasing prevalence of overweight and obesity.

The lactase -13910C>T polymorphism (rs4988235) is associated with overweight/obesity and obesity-related variables in a population sample of Portuguese young adults.

BACKGROUND/OBJECTIVES: Several studies reported associations of the lactase gene (LCT) polymorphism -13910C>T (rs4988235) with obesity-related variables and obesity in adults. This study aimed to replicate previously reported associations in a population sample of Portuguese young adults. SUBJECTS/METHODS: We genotyped 447 subjects from central and northern regions of Portugal (mean age 20.81±4.24 years) for the lactase variant -13910C>T (rs4988235), using TaqMan probes. Anthropometric variables (weight, height and body fat) were measured using standardized procedures and body mass index (BMI) (kg/m2) was calculated. RESULTS: Frequency of genotypes was 35.8% CC (lactase nonpersistent, LNP), 48.1% CT and 16.1% TT, consistent with Hardy-Weinberg equilibrium (P=1). The frequency for the minor -13910 T allele was 0.402. Assuming a dominance model for the lactase persistence (LP) minor T-allele, linear regression models showed statistically significant associations between the LP genotype CT/TT and BMI, fat mass and weight (ß=1.114, P=0.003; ß=1.309, P=0.007 and ß=2.67, P=0.021, respectively) after adjustment for age and sex. In concordance, logistic regression showed significant association between LP genotype CT/TT and overweight/obesity (OR=1.77; CI 1.08-2.92; P=0.023), as well as with high fat percentage ranges (OR=1.58; CI 1.01-2.46; P=0.041), when adjusting for age and sex. No significant interaction was obtained between the LCT polymorphism and physical activity for BMI (Pint=0.454) or FAT % (Pint=0.421). CONCLUSIONS: In the Portuguese sample of young adults, the lactase -13910C>T polymorphism revealed significant associations with the obesity-related anthropometric variables BMI, fat mass and weight, and previously observed associations with the obesity risk were also confirmed.

Dietary Patterns and Their Socioeconomic and Behavioral Determinants in 6- to 8-Year-Old Portuguese Children.

Adherence to a healthier diet is declining, with children consuming more saturated fats and simple carbohydrates. Factors influencing this choice were studied using a cross-sectional study with children (6 to 8 years old) living in Coimbra. Socioeconomic and behavioral factors were obtained from the parents. Dietary patterns of 1,063 children were identified: Mediterranean (MedDiet), saturated fats (SFatDiet), and base of Portuguese diet (BPDiet). Their relationship with socioeconomic and behavioral determinants was analyzed. SES determined strongly the dietary choices with lower SES being associated with higher consumption of SFatDiet and higher SES with BPDiet. Worse diet quality was shown to coexist with other unhealthy behaviors.

Maternal smoking in pregnancy association with childhood adiposity and blood pressure.

BACKGROUND: Maternal smoking during pregnancy has been associated with increased risk of childhood overweight/obesity defined by body mass index (BMI). We examined its association with a range of adiposity measures and cardiovascular indicators in children aged 3-10 years. METHODS: We used data from a cross-sectional study of schoolchildren across mainland Portuguese districts (2009-2010). We applied quantile regressions to examine maternal smoking associations with adiposity (n = 17 286), blood pressure (BP) and resting pulse rate (RPR) (n ≈ 2500) measures across the age range, adjusting for prenatal and early life factors. RESULTS: Maternal smoking during pregnancy was associated with increases in offspring adiposity levels. The difference in median BMI between children of smokers and non-smokers was 0.39 kg m(-2) (95% confidence interval: 0.25, 0.53) in boys and 0.46 kg m(-2) (0.31, 0.62) in girls; 0.55 cm (0.24, 0.87) and 0.82 cm (0.45, 1.19), respectively, in median waist circumference; and 0.94 mm (0.49, 1.40) and 1.47 mm (0.87, 2.07) in median sum of (triceps, subscapular, suprailiac) skin-folds. The associations appeared to be stronger with increasing age. The differences in the 90th centile tended to be greater than those in median. There was no consistent association of maternal smoking with BP and RPR. CONCLUSIONS: Children whose mother smoked during pregnancy had higher adiposity levels than children of non-smokers, across several measures, particularly among older children. Although there was no consistent association with cardiovascular indicators, maternal smoking association with childhood obesity may have implications for cardiovascular risk factors over the life course.

Exposure to paracetamol and antibiotics in early life and elevated risk of asthma in childhood.

Prospective studies on increased risk of childhood asthma due to exposure to paracetamol and antibiotics in early life have yielded contradictory results. Therefore, the aim of the present study was to investigate the association between administration of paracetamol and antibiotics in the first 12 months of life and delayed asthma symptoms later in childhood. This is a cross-sectional study that included 1,063 children from the primary schools in Coimbra, Portugal. ISAAC-based environmental and core asthma and rhinitis questionnaires were used to obtain information about children's respiratory health and administration of paracetamol and antibiotics. We found that early paracetamol use significantly increased the risk of asthma ever (at least one episode in life) (OR = 2.9; 95 %CI:1.8-4.5), current asthma (OR = 2.4; 95 %CI:1.5-3.6), wheezing ever (OR = 2.5; 95 %CI:1.8-3.4), rhinitis ever (OR = 2.4; 95 %CI:1.7-3.3), and current rhinitis (OR = 2.8; 95 %CI:2.0-3.9). Antibiotic exposure showed a similar effect with the risk for current asthma (OR = 1.6; 95 %CI:1.0-2.5), asthma ever (OR = 2.0; 95 %CI:1.3-3.1), wheeze ever (OR = 2.3; 95 %CI:1.7-3.2), and rhinitis symptoms (OR = 1.8; 95 %CI:1.3-2.6, OR = 1.8; 95 %CI:1.3-2.6, OR = 1.9; 95 %CI:1.2-3.0 for rhinitis ever, current rhinitis, and tearing, respectively). We further found that increased frequency of paracetamol use during the last 12 months preceding the study facilitated the appearance of allergic symptoms, suggesting a dose-dependent associations. In conclusion, the study shows a significant association between exposure to paracetamol and antibiotics in the first 12 months of life and both prevalence and severity of asthma and rhinitis symptoms in children 5-9 years old.

La alimentación preescolar, educación para la salud de los 2 a los 6 años / The pre-school feeding, health education from 2 to 6 years

La alimentación y nutrición infantil constituye una de las áreas de mayor importancia dentro de la Educación para la Salud (EpS). Esta acción promotora de la salud debe iniciarse en la fase temprana del desarrollo y aprendizaje, como es la etapa preescolar. Una valiosa herramienta para iniciar la EpS es la alimentación infantil, la cual puede y debe ser abordada en el ámbito educativo. Por ello, nuestro objetivo de investigación fue recoger, de los principales manuales de nutrición españoles, las características básicas, nutricionales, de la etapa de 2 a 6 años, para ser utilizado por personal docente no sanitario en el ámbito escolar. Mediante análisis de revisión bibliográfica documentada, referente a las características nutricionales de esta etapa de crecimiento. Los resultados indican que las Recomendaciones Diarias Alimenticias (RDA) a partir de los 2 años son muy diferentes respecto a la etapa de lactante, el aporte se balancea hacía los carbohidratos en un 50%, en decremento de grasas <30% y proteínas. Además, la preparación e incorporación de nuevos ingredientes a los platos diarios es ya una constante, obteniendo nuevas y atractivas características organolépticas para conseguir una dieta equilibrada y saludable. Para ello, se seguirá una pauta de 3 comidas, con 2 intermedias de menor cantidad, y donde el desayuno ya tendrá una merecida importancia. Para concluir, además debemos indicar que el educador a través de la EpS debe trasmitir e inculcar, desde esta temprana edad, hábitos de vida saludable a través de la alimentación infantil. Ya que esta dieta infantil será la base de una etapa adulta saludable, pues es en la etapa infantil donde se fraguan futuras patologías como diabetes, cáncer de colon e hipertensión (AU)

The infant feeding and nutrition is one of the most important areas regarding the Health Education (HE). This health-promoting action must start at the early stage of the development and learning, such as the pre-school period. A valuable tool to initiate successfully the HE could be infant nutrition, which can and must be also approached in the educational area. Our objective of the investigation was to gather, from the main Spanish manuals of nutrition, the basic and nutritional characteristics of the stage from 2 to 6 years, in order to be used by educational personnel instead of health personnel in the school area. By the analysis of bibliographical documented review, related to the nutritional characteristics at this stage of growth. The results indicate that the Recommendations Dietary Allowance (RDA) from 2 years are very different with regard to the breast-fed stage, the contribution moves towards the carbohydrates in 50 %, in decline of fats <30 % and proteins. In addition, the preparation and incorporation of new ingredients to the daily foods is already regular, obtaining, in this way, a balanced and healthy diet. For that, we will follow a guideline of 3 daily foods, with 2 intermediate of minor quantity, and the breakfast will have a well-deserved importance. To conclude, we must indicate that the educator has to inculcate healthy habits of feeding in pre-school stage by means of the Health Education. The mentioned infant diet will be the base for a healthy adulthood, since during the infant stage, future pathologies may emerge such as diabetes, cancer of colon and hypertension (AU)

Maternal weight gain during pregnancy and overweight in Portuguese children.

OBJECTIVE: The objective of our study was to assess the association between maternal weight gain during pregnancy and childhood overweight. DESIGN: This study was a cross-sectional analysis. SETTING: The data were derived from a community-based survey of children from primary schools of Portugal. SUBJECTS: The study was performed in a sample of 6-12-year-old Portuguese school children (2445 girls and 2400 boys; age was 8.5+/-0.91 years). MEASUREMENTS: Height and weight were measured according to international standards, and body mass index (BMI) was calculated. The definition of overweight was based on average centiles according to the International Obesity Task Force cutoffs. Children's parents completed a self-administered questionnaire, which provided information on general family background characteristics, maternal weight gain during pregnancy and children's physical activity. The response rate was 70.6%. Children's dietary intake was measured using a 24-h dietary recall. Logistic regression models were fitted to estimate the magnitude of the association between maternal weight gain during pregnancy and overweight in their children, adjusting for confounders (gender, age, birthweight, order of birth, breastfeeding, smoking during pregnancy, physical activity, parental BMI, parental education, calcium to protein ratio and energy intake). RESULTS: The prevalence of overweight (including obesity) was 29% in boys and 33% in girls. The odds favouring overweight (including obesity) increased significantly for those women who gained > or =16 kg during pregnancy, compared to those with <9 kg , even after adjustment for confounders (crude odds ratio (OR)=1.53, confidence interval (CI) 95% 1.27-1.84, P-trend <0.001; Adjusted OR=1.27, CI 95% 1.01-1.61, P-trend=0.038). CONCLUSION: Large maternal weight gain during pregnancy (> or =16 kg) was significantly associated with higher risk of overweight in Portuguese children.

Secular trends in age at menarche among Caboclo populations from Pará, Amazonia, Brazil: 1930-1980.

The present study is part of a large research project on growth, development, nutrition, and health of Caboclo populations from the Brazilian Amazon. The aim of this paper is to analyze the age of menarche in adolescents (N=164) and adult women (219) in the studied populations. Caboclo are admixed rural, peasant groups that live along the Amazon river and its tributaries, and there are few previous studies about them. Probit analysis of the status quo data yielded a median age at menarche of 12.29+/-1.76 years. The retrospective method was applied to recall data of the 77 post-menarcheal adolescents, yielding an average of 13.06+/-1.27 years. Number of children in the family did not show any statistical influence on age at menarche in any age group. In adult women, age at menarche decreased from 14.50 in those born in 1930 to 12.88 for those born in 1980 (F=4.371, P=0.001). The downward trend found was, on average, 0.237 year per decade in the study period. The median age at menarche in the adolescents (12.29 years) is one of the lowest values found for Central and South American populations. In the ecological context, a low age at menarche could be an adaptive advantage because it provides a greater chance for reproduction at a young age in an environment where, until recently, life expectancy was low. As has been reported for other developing countries, the change found in age at menarche in the women born from the 1930s to the 1980s is likely to be related to changes in health and nutritional factors that occurred in Brazil because this country experienced significant improvement in living standards related to education, vaccination, and health conditions, which, although not equally, reached all regions after the 1960s.

Dietary calcium and body mass index in Portuguese children.

OBJECTIVE: The objective of our study was to assess nutritional intake in school children (7-9-y-old) and relate calcium intake to body mass index (BMI). DESIGN: This study was a cross-sectional analysis. SETTING: The data were derived from a community-based survey of children from primary schools of Portugal. SUBJECTS: In all, 3044 Portuguese children (1503 girls and 1541 boys) from a community-based sample of 7-9-y-olds. METHODS: Height and weight were measured according to international standards, and BMI was calculated. Children's parents completed a self-administered questionnaire that provided information on general family background characteristics and children's physical activity. Children's dietary intake was measured using a 24-h dietary recall. Calcium intake was expressed as the calcium-to-protein ratio, and regression analysis was used to estimate the association between calcium intake and BMI, adjusting for energy intake and confounders. RESULTS: The prevalence of children with calcium intake below the Dietary Reference Intake was higher in girls (36.4 vs 33.0%, P = 0.053). Calcium-to-protein ratio predicts BMI only in girls (beta = -0.052, P = 0.002), even after adjusting for age, energy intake, parental education, and physical activity. CONCLUSION: We found an inverse relationship between calcium intake and BMI only in girls. These data reinforce the need for controlled trials to assess the effects of dietary calcium on body mass in each gender.

Prevalence of overweight and obesity in 7-9-year-old Portuguese children: trends in body mass index from 1970-2002.

The aim of this study was to assess the prevalence of overweight and obesity in Portuguese children age 7-9 years and to analyze trends in body mass index (BMI) from 1970-2002. Data were collected from October 2002 to June 2003 in a random sample of Portuguese children. Height and weight were measured and BMI (Kg/m(2)) was calculated. The International Obesity TaskForce (IOTF) cutoffs to define overweight and obesity were used. In the total sample we found 20.3% of overweight children and 11.3% of obese children. These results indicate a prevalence of overweight/obesity of 31.5%. Girls presented higher percentages of overweight than boys except at age 7.5. Girls also showed a higher percentages of obesity than boys except at age 9. From 1970 to 1992 and 1992 to 2002, height, weight, and BMI increased at different velocities: weight increased faster than height, and, consequently, BMI increased more in the last period than in the first one, leading to an increase in obesity values. Compared to published data by IOTF on other European countries, who applied the same methods to define overweight and obesity, Portuguese children showed the second-highest mean values in overweight/obesity. Italy showed the highest values (36%). The present study shows a very high prevalence of overweight/obesity (31.5%) in Portuguese children compared to other European countries. Portugal followed the trend of other Mediterranean countries like Spain (30%), Greece (31%), and Italy (36%). These high values require a national intervention program to control childhood obesity.

Age at menarche in Coimbra (Portugal) school girls: a note on the secular changes.

The age at menarche and several menstrual symptoms were reported by 516 Portuguese school girls who took part in a cross-sectional anthropometric study in Coimbra, Portugal. The mean ages of menarche calculated using the recall method and also using probit analysis were 12.53 +/-1.27 and 12.03 +/- 1.26 years, respectively. Parents'educational level, place of residence and size of the family did not have any significant effect on the mean age at menarche in this sample of adolescents. The order of birth was the only variable that indicated a significative effect: the first borns reported a lower mean age at menarche (12.34 years) than the later borns (12.6 years). In this sample, 47% of the girls had a cycle length of >or = 29 days, 23.4% had irregular cycles, 59% reported that the duration of bleeding was 3-5 days and the majority, 49%, did not report any pain during the bleeding days. However, 14.3% and 24.45% reported severe and medium pain. The age at menarche has declined from 15.0 (girls born in 1880-1890) to 12.03 (girls born in 1970-1980) years in the Portuguese population. This decrease in age, and also the lack of influence of the family characteristics, appear as a result of the great improvements in the social and economic living conditions that occurred in Portugal, especially after the 1970s. These improvements are mainly related to better nutrition and better health care along with many other environmental factors.

Secular trend in stature in the Portuguese population (1904-2000).

The records of height of 995 101 18-year-old Portuguese males were analysed as well as the relation between localities of the subject's residence (districts) and final height. The sample includes all the Portuguese 18-year-old males born between 1966 and 1982 and examined between 1985 and 2000, in the north, centre and south of Portugal, representing all the social strata. Statistically significant differences (p

Age at menarche of schoolgirls in Maputo, Mozambique.

Age at menarche was analysed in 753 Mozambican schoolgirls taking part in across-sectional anthropometric study in Maputo, Mozambique, in 2000. The probit analysis of the status quo data yielded an median age at menarche of 13.20 +/- 1.18 years. The retrospective method was applied only to recall data of the 396 post-menarcheal girls and it yielded an average of 13.91 +/- 1.29 years. Mean age at menarche in girls living in the urban centre of Maputo was 13.35 and 12.96 years, for recall age and probit analysis, respectively, and 14.51 and 13.68 years for girls living in the slums surrounding the centre. The differences in age at menarche, calculated by recall method, between girls from central Maputo and girls from the slums were statistically significant (p = 0.000). Parent's educational level also revealed a significant effect on age at menarche. Girls whose parents had a lower educational level showed a later age at menarche. For the size of the family, girls who were later borne had a higher age at menarche. In the 1960s, the age at menarche was 13.55 and 13.83 years in urban and rural girls, respectively. In this study, we found a lack of decrease in the mean age at menarche (13.9 years), which could be due to the poor living conditions in Mozambique between 1960 and 2000 as a result of the civil war from 1976 to 1990. Despite the economic growth of the country in the last decade, Mozambique is still in the group of the poorest countries in the world; in spite of this fact, the mean menarcheal age in these girls are amongst the lowest values presented for African countries.

Social background and age at menarche in Portuguese university students: a note on the secular changes in Portugal.

Menarcheal age of a sample of Portuguese university students (n = 3366), born between 1972 and 1983, age 18-23 years, was analyzed. The influence of parents' educational level and occupation, family size, birth order, and degree of urbanization of girl's locality of residence during childhood and adolescence were analyzed as well as secular trend in the Portuguese population. Mean age at menarche for girls born in 1983 was 12.32 years. Parents' educational level and occupation did not show any significant influence on mean age at menarche. Place of residence during childhood years and adolescence showed a significant effect on mean age at menarche, with girls from rural places with a later age at menarche than those who spent their childhood or adolescence in urban areas (P

Secular trends in male adult height 1904-1996 in relation to place of residence and parent's educational level in Portugal.

The records of height of 22841 18-year-old Portuguese males were analysed as well as their parents educational level and localities of subject's residence (districts). The sample includes all the Portuguese 18-year-old males, born in 1978 and examined in 1996, in central and southern Portugal, representing all the social strata. Statistically significant differences (p < or = 0.001) among the districts were found: males from Setúbal (172.75 cm) and Lisboa (172.64 cm), the most developed districts, are the tallest, and those from C. Branco (170.79cm) and Coimbra (171.19 cm) are the shortest. Comparing to published data from 1904, a positive secular trend in height was found. The average increase was 8.99 cm, which yields a rate of 0.99 cm per decade. This positive trend must be related to the general improvement in the population's standard living conditions, as the striking drop of post-neonatal mortality rate shows after the 1960s and 1970s. Despite this positive trend, great social difference still exists: the gap between the two extremes of parents' educational level is almost 4 cm for height. Analysis of variance (ANOVA) showed significant effects of father's and mother's educational level as well as subject's locality of residence, but the influence of parents' educational level was stronger than that of geographic residence. These results suggest that the secular trend in height will continue for the Portuguese population in the future decade.

Influence of industrialisation on marital behaviour in Beduído (Estarreja), Portugal.

From marriage records of a Northern Portuguese parish for 1900-80, endogamy and exogamy rates were calculated for birthplace and residence in order to analyse the effect of industrialisation on the population structure after 1940. Marriages that were endogamous relative to birthplace decreased between 1940-49 (58.9%) and 1988 (20.5%), while exogamy increased. Exogamous marriages in which people came from outside the municipality (51.92%) were greater than those of the surrounding region (42.04%). After industrialisation, the pattern of marriages changed for residence, with an increase in the number of individuals who came from the district to work in the factories and married. Industrialisation advanced the start of exogamy which, for most Portuguese populations, began later, in the 1960s.