[Dietary pattern, asthma, and atopic and non-atopic wheezing in children and adolescents: SCAALA study, Salvador, Bahia State, Brazil]. / Padrão alimentar, asma e sibilo atópico e não atópico em crianças e adolescentes: estudo SCAALA, Salvador, Bahia, Brasil.

A cross-sectional study was conducted on dietary patterns and their influence on the occurrence of wheezing and atopic and non-atopic asthma in a sample of 1,168 children and adolescents in Salvador, Bahia State, Brazil. Wheezing and asthma symptoms in the previous 12 months were obtained using the ISAAC questionnaire. The presence of aeroallergen-specific IgE was identified. A food frequency questionnaire was used to define dietary patterns. The study applied logistic regression and multinomial polytomous logistic regression. Fish consumption was associated with a 27% reduction in wheezing (95%CI: 0.56-0.94), 37% in asthma (95%CI: 0.47-0.83), 51% in non-atopic asthma (95%CI: 0.31-0.79), and 38% in non-atopic wheezing (95%CI: 0.46-0.83). The highest tertile of dietary patterns reduced wheezing by 27% (95%CI: 0.57-0.95), atopic wheezing by 46% (95%CI: 0.30-0.98), asthma by 36% (95%CI: 0.49-0.83), and atopic asthma by 50% (95%CI: 0.28-0.89). Fish consumption may thus have a protective effect against wheezing and non-atopic asthma and dietary pattern against atopic asthma and wheezing.

Padrão alimentar, asma e sibilo atópico e não atópico em crianças e adolescentes: estudo SCAALA, Salvador, Bahia, Brasil / Dietary pattern, asthma, and atopic and non-atopic wheezing in children and adolescents: SCAALA study, Salvador, Bahia State, Brazil / Patrón dietético, asma y sibilancias atópicas y no atópicas en niños y adolescentes: estudio SCAALA, Salvador, Bahía, Brasil

Avaliou-se, em estudo transversal, a influência do padrão alimentar sobre a ocorrência de sibilo e asma atópica e não atópica em 1.168 crianças e adolescentes em Salvador, Bahia, Brasil. Sibilo e sintomas de asma nos últimos 12 meses foram obtidos por meio do questionário ISAAC. Atopia foi definida pela presença de IgE específica a aerolérgenos. Questionário de frequência alimentar foi usado para definir padrões alimentares. Empregou-se regressões logística e logística politômica multivariadas. O consumo de pescados reduziu a ocorrência de sibilo em 27% (IC95%: 0,56-0,94) e asma em 37% (IC95%: 0,47-0,83); asma não atópica em 51% (IC95%: 0,31-0,79) e sibilo não atópico em 38% (IC95%: 0,46-0,83). O maior tercil do padrão alimentar reduziu o sibilo em 27% (IC95%: 0,57-0,95), sibilo atópico em 46% (IC95%: 0,30-0,98), asma em 36% (IC95%: 0,49-0,83) e asma atópica em 50% (IC95%: 0,28-0,89). O consumo de pescados pode conferir efeito protetor para sibilo e asma não atópica e o padrão alimentar para sibilo e asma atópica.

A cross-sectional study was conducted on dietary patterns and their influence on the occurrence of wheezing and atopic and non-atopic asthma in a sample of 1,168 children and adolescents in Salvador, Bahia State, Brazil. Wheezing and asthma symptoms in the previous 12 months were obtained using the ISAAC questionnaire. The presence of aeroallergen-specific IgE was identified. A food frequency questionnaire was used to define dietary patterns. The study applied logistic regression and multinomial polytomous logistic regression. Fish consumption was associated with a 27% reduction in wheezing (95%CI: 0.56-0.94), 37% in asthma (95%CI: 0.47-0.83), 51% in non-atopic asthma (95%CI: 0.31-0.79), and 38% in non-atopic wheezing (95%CI: 0.46-0.83). The highest tertile of dietary patterns reduced wheezing by 27% (95%CI: 0.57-0.95), atopic wheezing by 46% (95%CI: 0.30-0.98), asthma by 36% (95%CI: 0.49-0.83), and atopic asthma by 50% (95%CI: 0.28-0.89). Fish consumption may thus have a protective effect against wheezing and non-atopic asthma and dietary pattern against atopic asthma and wheezing.

Este estudio transversal se llevó a cabo para estudiar la influencia de los hábitos alimentarios en la aparición del asma y sibilancias atópicas y no atópicas en una muestra de 1.168 niños y adolescentes en Salvador, Bahía, Brasil. Las sibilancias y síntomas de asma en los últimos 12 meses se han obtenido a partir del cuestionario ISAAC. Se identificó la presencia de IgE específica de alérgeno aéreo. Se utilizó un cuestionario de frecuencia de alimentos para definir hábitos alimentarios. Se aplicó la regresión logística y el modelo logístico multinomial. El consumo de pescado redujo las sibilancias en un 27% (IC95%: 0,56-0,94) y el asma en un 37% (IC95%: 0,47-0,83), las sibilancias atópicas en un 51% (IC95%: 0,31-0,79) y no atópicas en un 38% (IC95%: 0,46-0,83). El tercil más alto de los hábitos alimentarios reduce sibilancias en un 27% (IC95%: 0,57-0,95), sibilancias atópicas en un 46% (IC95%: 0,30-0,98), el asma en un 36% (IC95%: 0,49-0,83) y un 50% en el asma atópico (IC95%: 0,28-0,89). El consumo de pescado puede promover un efecto protector, dentro el patrón de dieta, contra sibilancias atópicas y no atópicas y asma.

Weight gain in the first two years of life, asthma and atopy: the SCAALA cohort study.

OBJECTIVE: To evaluate the association between weight gain in the first two years of life and the occurrence of wheezing, asthma, serum IgE, skin reactivity and pulmonary function. DESIGN: Cohort study. SETTING: The metropolitan region of Salvador, Bahia, Brazil. SUBJECTS: The association was studied between 1997 and 2005 in 669 children up to 11 years of age. Data were collected on asthma and risk factors, both current factors and those present in the first years of life. Weight gain was considered fast when the Z-score was >0·67. Poisson regression was used in the multivariate statistical analysis. RESULTS: Wheezing was reported in 25·6 % of the children. Weight gain was considered fast (Z-score >0·67) in 29·6 % of the children and slow (Z-score <-0·67) in 13·9 %. Children in the slow weight gain group had 36 % fewer symptoms of asthma (prevalence ratio = 0·65; 95 % CI 0·42, 0·99). CONCLUSIONS: Slower weight gain in the early years of life may constitute a protective factor against symptoms of asthma. The relevance of this finding for public health is not yet certain, since it is known that children with slow and fast weight gain may be more likely to develop adverse health consequences related to both these situations.

Factors associated with body image dissatisfaction among adolescents in public schools students in Salvador, Brazil.

OBJECTIVE: To identify the prevalence of body image dissatisfaction and associated factors among students in Salvador, Brazil. METHODS: A cross-sectional study involving a random sample of 1,494 (852 girls and 642 boys) adolescents between 11 and 17 years of age who were students in the public schools in Salvador, Brazil. Participants completed the Body Shape Questionnaire and the Eating Attitudes Test-26. Body image was characterized as satisfactory or unsatisfactory. We obtained demographic, anthropometric and economic information and information regarding the stage of maturation, self-perception of body weight, and consumption of sweetened beverages and diet soft drinks. To identify associated factors we used Poisson regression analysis. RESULTS: Body image dissatisfaction was present in 19.5% of the adolescents, with a prevalence of 26.6% among the girls and 10% among the boys. Independent of sex, the prevalence of body image dissatisfaction was higher among adolescents who were overweight or obese (girls, PR: 1.38, CI: 1.09-1.73 and boys, PR: 2.26, CI: 1.08-4.75), higher among those who perceived themselves as fat (girls, PR: 2.85, CI: 2.07-3.93 and boys, PR: 3.17, CI: 1.39-7.23), and higher among those who had negative attitudes toward eating (girls, PR: 2.42, CI: 1.91-3.08 and boys, PR: 4.67, CI: 2.85-7.63).. A reduction in body image dissatisfaction was only identified among underweight girls (PR: 0.12, CI: 0.03-0.49). CONCLUSIONS: A high occurrence of body image dissatisfaction was observed among the adolescents, and biological and behavioral factors were associated with this dissatisfaction.

Objetivo: Identificar la prevalencia de insatisfacción corporal y factores asociados entre estudiantes de Salvador en Brasil. Métodos: Estudio transversal realizado en una muestra aleatoria de 1494 adolescentes (852 niñas y 642 niños) de entre 11 y 17 años de edad estudiantes de escuelas públicas en Salvador (Brasil). Los participantes completaron los cuestionarios: Cuestionario de La Figura Corporal y el Inventario de Actitudes Alimentarias. La imagen corporal pudo ser considerada satisfactoria o insatisfactoria. Se obtuvieron datos demográficos, antropométricos y económicos e información sobre la etapa de maduración sexual, la auto-percepción del peso corporal y el consumo de bebidas azucaradas y gaseosas. Para identificar los factores asociados se utilizó el análisis de regresión de Poisson. Resultados: La insatisfacción corporal estuvo presente en el 19,5% de los/as adolescentes, con una prevalencia del 26,6% entre las chicas y el 10% entre los chicos. Independientemente del sexo, la prevalencia de la insatisfacción corporal fue superior entre los/as adolescentes con sobrepeso u obesos (en las niñas, PR: 1,38, IC: 1,09-1,73 y en los niños, PR: 2,26, IC: 1,08-4,75), mayor entre los/as que percibían a sí mismos como "gordos" (en las niñas, PR: 2,85, IC: 2,07-3,93 y en los niños, PR: 3,17, IC: 1,39- 7,23), y entre los/as que tenían actitudes alimentarias negativas (en las niñas, PR: 2,42, IC: 1,91-3,08 y en los niños, PR: 4,67, IC: 2,85-7,63). Una reducción en la insatisfacción corporal se identificó sólo entre las niñas con bajo peso (RP: 0,12, IC: 0,03-0.49).Conclusiones: Se observó una alta ocurrencia de la insatisfacción corporal entre los adolescentes, y que factores biológicos y del comportamiento se asocian con dicha insatisfacción.

Influence of domestic violence on the association between malnutrition and low cognitive development.

OBJECTIVES: To investigate the size and direction of the association between malnutrition and low cognitive performance and to evaluate the effect of domestic violence on this association. METHODS: This cross-sectional study enrolled students of both sexes, aged 7 to 14 years old, attending public elementary schools. The Raven's Progressive Matrices Test was used to measure cognitive development, the Revised Conflict Tactics Scales (CTS2), to measure domestic violence, and the body mass index (BMI) for age and sex, to define anthropometric indices. Socioeconomic data and information about food intake were also collected. Malnutrition was defined as BMI < 3rd percentile. Cognitive deficit was defined when the results of Raven's test were ≤ 25th percentile. Family violence was defined as a positive answer in at least one item about severe physical violence in the last 12 months. The size of the associations of interest was expressed as prevalence ratio (PR) and 95% confidence interval (95%CI). RESULTS: Below-average intellectual development was found for 63.3% of the participants. Malnutrition was identified in 9.5%. Malnutrition had a negative effect on cognitive performance (adjusted prevalence ratio [aPR] = 1.60, 95% CI = 1.01 - 2.52; p = 0.042) when adjusted for the association between exposure to domestic violence and age. CONCLUSION: The association between malnutrition and below-average intellectual development found in this study was affected by domestic violence, which must be taken into account when addressing the problem.

Influência da violência familiar na associação entre desnutrição e baixo desenvolvimento cognitivo / Influence of domestic violence on the association between malnutrition and low cognitive development

OBJETIVO: Verificar a direção e a magnitude da associação entre desnutrição e baixo desempenho cognitivo. Além disso, avaliar a influência da violência familiar nessa relação. MÉTODOS: Trata-se de um estudo transversal em que participaram estudantes, de ambos os sexos, com idade entre 7 e 14 anos, provenientes da rede pública do ensino fundamental. O teste das matrizes progressivas de Raven foi utilizado para mensurar desenvolvimento cognitivo; as escalas táticas de conflito revisadas, para mensurar a violência familiar; e o índice de massa corporal, para diagnóstico do estado nutricional. Foram ainda obtidas informações socioeconômicas e aquelas referentes ao consumo alimentar. A desnutrição foi classificada com base no índice de massa corporal < percentil 3; o baixo nível cognitivo, nos resultados do Raven < percentil 25. Considerou-se caso de violência familiar uma resposta positiva a qualquer um dos atos de violência física grave durante os últimos 12 meses. A magnitude das associações de interesses foi expressa em razão de prevalência e respectivos intervalos de confiança de 95%. RESULTADOS: Identificou-se que 63,3% dos participantes encontravam-se com desenvolvimento intelectual abaixo da média. A desnutrição foi identificada em 9,5%. Os dados revelaram a influencia negativa da desnutrição sobre o baixo desempenho cognitivo (razão de prevalência ajustada= 1,60; intervalo de confiança de 95% = 1,01-2,52; p = 0,042), associação observada quando ajustada pela exposição a violência doméstica e idade. CONCLUSÃO: Constatou-se associação entre desnutrição e desenvolvimento intelectual abaixo da média, a qual é influenciada pela violência familiar, o que deve ser levado em consideração na abordagem do problema.

OBJECTIVE: To investigate the size and direction of the association between malnutrition and low cognitive performance and to evaluate the effect of domestic violence on this association. METHODS: This cross-sectional study enrolled students of both sexes, aged 7 to 14 years old, attending public elementary schools. The Raven's Progressive Matrices Test was used to measure cognitive development, the Revised Conflict Tactics Scales (CTS2), to measure domestic violence, and the body mass index (BMI) for age and sex, to define anthropometric indices. Socioeconomic data and information about food intake were also collected. Malnutrition was defined as BMI < 3rd percentile. Cognitive deficit was defined when the results of Raven's test were < 25th percentile. Family violence was defined as a positive answer in at least one item about severe physical violence in the last 12 months. The size of the associations of interest was expressed as prevalence ratio (PR) and 95% confidence interval (95%CI). RESULTS: Below-average intellectual development was found for 63.3% of the participants. Malnutrition was identified in 9.5%. Malnutrition had a negative effect on cognitive performance (adjusted prevalence ratio [:aPR]:=1.60, 95% CI = 1.01 - 2.52; p = 0.042) when adjusted for the association between exposure to domestic violence and age. CONCLUSION: The association between malnutrition and below-average intellectual development found in this study was affected by domestic violence, which must be taken into account when addressing the problem.

Overweight, asthma symptoms, atopy and pulmonary function in children of 4-12 years of age: findings from the SCAALA cohort in Salvador, Bahia, Brazil.

OBJECTIVE: To evaluate the association between overweight and the occurrence of asthma and atopy in a cohort of children of 4-12 years of age living in the city of Salvador in 2005. DESIGN: Cross-sectional study nested in a cohort. SETTING: The metropolitan region of Salvador, Bahia, Brazil. SUBJECTS: The study included 1129 children of 4-12 years age who presented complete information on the variables used here. Skin tests for allergy, spirometry, faecal parasitology, serum IgE and anthropometric surveys were conducted. Poisson's multivariate regression was adopted. RESULTS: Wheezing was found in 29·1% and asthma in 22·8% of children, both conditions being more common in those under 6 years of age and 34% more common in overweight children (prevalence ratio (PR) = 1·34; 95% CI 1·07, 1·67) following adjustment. The ratio between forced expiratory volume in 1s and forced vital capacity was associated with overweight (PR = 1·35; 95% CI 1·11, 1·61). No statistically significant association was found between overweight and allergen-specific IgE or with wheezing. CONCLUSIONS: These results are in agreement with the hypothesis that overweight is associated with asthma and pulmonary function, even following adjustment for intervening variables known to be associated with the pathogeny of asthma.

Condições socioeconômicas e padrões alimentares de crianças de 4 a 11 anos: estudo SCAALA - Salvador/ Bahia / The socio-economic conditions and patterns of food intake in children aged between 4 and 11 years: the SCAALA study - Salvador/ Bahia

OBJETIVOS: identificar os padrões alimentares de crianças e sua associação com o nível socioeconômico das famílias. MÉTODOS: estudo transversal com 1260 crianças de 4 a 11 anos, residentes em Salvador-Bahia que incluiu aplicação de um Questionário de Frequência Alimentar semi-quantitativo. Os padrões alimentares foram identificados, empregando-se análise fatorial por componentes principais. O nível socioeconômico foi avaliado por meio de um indicador socioeconômico composto. Regressão logística multivariada foi empregada. RESULTADOS: identificaram-se quatro padrões que explicaram 45,9 por cento da variabilidade dos dados de frequência alimentar. Crianças que pertencem ao nível socioeconômico mais alto têm 1,60 vezes mais chance (p<0,001) de apresentarem maior frequência de consumo de alimentos do padrão 1 (frutas, verduras, leguminosas, cereais e pescados) e 3,09 vezes mais chance (p<0,001) de apresentarem maior frequência de consumo dos alimentos do padrão 2 (leite/ derivados, catchup/ maionese/ mostarda e frango), quando se compara com aquele de crianças de nível socioeconômico mais baixo. Resultado inverso foi observado no padrão 4 (embutidos, ovos e carnes vermelhas); isto é, quanto maior o nível socioeconômico menor a chance da adoção desse padrão. Tendência similar foi notada para o padrão 3 (frituras, doces, salgadinhos, refrigerante/ suco artificial). CONCLUSÕES: padrões alimentares de crianças são dependentes das condições socioeconômicas das famílias e a adoção de itens alimentares mais saudáveis associa-se aos grupos de mais altos níveis socioeconômicos.

OBJECTIVE: to identify the patterns of food intake in children and the association between these and the socio-economic conditions of their families. METHODS: a cross-sectional study was carried out with 1260 children aged between 4 and 11 years, resident in the city of Salvador, in the Brazilian State of Bahia, including application of a semi-quantitative Food Intake Frequency questionnaire. The pattern of food intake of the children was assessed using factorial analysis by principal components. socio-economic level was assessed using a compound socio-economic indicator. Multivariate logistic regression was employed. RESULTS: four food groups were identified that explained 45.9 percent of the variability in food intake frequency data. Children from a more privileged socio-economic background were found to be 1.6 times more likely (p<0.001) to have a higher frequency of intake of food from group 1 (fruit, vegetables, pulses, cereals and sea food) and 3.09 times more likely (p<0.001) to have a higher frequency of consumption of food from group 2 (milk and dairy products, ketchup/mustard/mayonnaise and chicken), compared with children from a less privileged background. The opposite was found for group 4 (processed meat products, eggs, and red meat); with the children from more privileged backgrounds less likely to consume food from this group. A similar tendency was found for food from group 3 (fried food, sweets, snacks, soda/artificial fruit juice). CONCLUSION: patterns of food intake in children depend on the socio-economic conditions of their families and the choice of healthier food is associated with a more privileged socio-economic background.

Random-effects models in investigating the effect of vitamin A in childhood diarrhea.

PURPOSE: By adopting more appropriate and powerful statistical methods that fully exploit longitudinal structure, we re-analyze and extend previously published results from a large community trial to investigate the effect of vitamin A supplementation on the prevalence and severity of diarrhea in young children. METHODS: Generalized linear mixed models were used to allow for repeated measures in a reanalysis of a double-blind, randomized, placebo-controlled community trial conducted in a cohort of children in northeastern Brazil during 1 year. The response variable was weekly number of days with diarrhea for each child, and Markov Chain Monte Carlo methods were used to estimate model parameters. RESULTS AND CONCLUSIONS: Random effects suitably accounted for the underlying heterogeneity between and within children, and our longitudinal analysis shows a significant beneficial effect of vitamin A supplementation that was inconclusive in previously reported simple summary analyses of these data. Risk for diarrhea infection was estimated to be 1.57 times greater for a child administered a placebo as opposed to vitamin A (95% credible interval, 1.17-2.12). Additionally, we identified previously unreported temporal effects in these data, showing a decreasing daily probability of diarrhea for both groups during the trial and treatment-time interaction.