The role of exclusive breastfeeding and sugar-sweetened beverage consumption on preschool children's weight gain.

BACKGROUND: Sugar-sweetened beverages (SSBs) and breastfeeding practices have been recognized as important factors linked to children's weight status. However, no other studies have simultaneously investigated the role of each factor on children's conditional weight gain (CWG). OBJECTIVE: To evaluate the role of exclusive breastfeeding (EB) and the SSBs consumption on CWG from birth to the survey date among Brazilian preschool children (24-59 months old). METHODS: A nationally represented cross-sectional survey with complex probability sampling (n = 2421) was conducted. The outcome variable - CWG - represents how much an individual has deviated from its expected weight gain, given his or her prior weight. The multivariate linear regression to analyse the effects of EB and the consumption of SSBs on CWG were adjusted for economic status and maternal variables. RESULTS: There was a significantly protective effect of EB duration during the first year of life on CWG from birth to the survey date (-0.02 [-0.03; 0.00 95% confidence interval]); however, the SSBs intake promoted an effect on the weight gain that was 2.5-fold higher (0.05 [0.02; 0.08 95% confidence interval]) than the EB. CONCLUSION: As hypothesized, the exposure variables acted in opposite directions, but the harmful effect of SSBs intake had greater magnitude than the beneficial effect of EB on children's CWG.

Waiting for a kidney transplant: association with anxiety and stress.

BACKGROUND: The pretransplantation period is characterized by many stressful events that can result in symptoms of anxiety and stress and ultimately can have a negative impact on graft outcome. Our objective was to evaluate the association between symptoms of anxiety and stress in patients awaiting kidney transplantation. METHODS: This was a transversal study describing 50 randomly selected patients undergoing hemodialysis and waitlisted for kidney transplantation. We collected social and demographic data, and adopted the Beck Anxiety Inventory and the Lipp Stress Symptoms for Adults Inventory to respectively evaluate anxiety and stress. RESULTS: The mean age was 50.2 ± 11.7 years, 54% of patients were female, time on dialysis was 6.5 ± 4.5 years, and transplant waitlist time was 5.9 ± 4.4 years. Forty-six percent of patients were married or had a stable relationship, 50% were illiterate or had only finished primary school, and 64% were pensioners. Stress was documented in 60% of patients, of which 30% had severe stress, whereas 56% of patients showed symptoms of anxiety. The presence of stress was associated with longer waitlist time (P = .006) and longer time on dialysis (P = .052). Less severe stress was associated with higher education level (P = .031), whereas patients in more advanced phases of stress showed higher levels of anxiety. After a multivariate analysis, stress was 3.6 times (CI 1.34 to 9.89) more frequent among individuals with anxiety. CONCLUSIONS: Stress and anxiety were prevalent in patients on a waitlist and were associated with social and chronic kidney disease-related patterns. This observation can stimulate the adoption of strategies for the prevention of stress and anxiety, avoiding posttransplantation complications, such as nonadherence to treatment.

Excessive immunosuppression in kidney transplant patients: prevalence and outcomes.

BACKGROUND: Death with a functioning graft is currently one of the main causes of kidney graft loss. A large proportion of cases is attributed to infectious complications that can be related to overimmunosuppression. We retrospectively studied 80 kidney transplant patients, grafted from January 2005 to December 2009, to assess the prevalence of excessive immunosuppression, and its possible correlation with infections and infection-related death. METHODS: Excessive immunosuppression was defined by a prescribed dosage above the expected to the time point or an elevated drug blood level according to the Kidney Disease: Improving Global Outcomes (2009) recommendations at 1, 3, 6, and 12 months, and then annually. RESULTS: Death with a functioning graft accounted for 76.5% of losses. Overall, 53.8% of deaths were from infections, and 38.5% from cardiovascular causes. Acute rejection episodes were noted in 8.8% of patients. Only 10% of patients had adequate immunosuppression throughout the follow-up. Seventy-two percent of patients showed adequate immunosuppression at least half of the 18 evaluated points, although 50% showed between 1 and 3 drugs administered above recommended dosages during the whole period. Infections were recorded in 78.8% patients, with a median of 3 episodes per patient. Any level of excessive immunosuppression was associated with infections (odds ratio, 11.2; P < .001), but not with death caused thereby. CONCLUSION: Excessive immunosuppression among this cohort was associated with a greater incidence of infections, but not with death from this cause.

Influence of genetic ancestry on the risk of obstructive sleep apnoea syndrome.

The aim of the present study was to evaluate the influence of ethnicity on the risk of developing obstructive sleep apnoea syndrome (OSAS) using genomic analysis methods to estimate ancestry. DNA samples were obtained from 1,010 individuals participating in the São Paulo Epidemiologic Sleep Study, who underwent full-night polysomnography. A total of 31 genetic ancestry-informative markers were selected in order to estimate individual admixture proportions. Of patients with a diagnosis of OSAS, a higher number self-reporting Caucasian ethnicity (65.3%), as well as an increased percentage of European ancestry (78.2±16.7%) and lower percentage of West African ancestry (16.1±15.3%), than among individuals without OSAS (53.6, 73.5±18.1 and 20.1±16.8%, respectively) (p<0.001) was observed. Moreover, after correcting for sex, age, body mass index and socioeconomic status, logistic regression demonstrated that European ancestry was significantly associated with an increased risk of manifesting OSAS (OR 2.80, 95% CI 1.11-7.09). Conversely, West African ancestry was associated with a reduced risk of the OSAS phenotype (OR 0.26, 95% CI 0.09-0.72). This is the first study to incorporate genomic analysis methods to measure the influence of ethnicity on the risk of OSAS. Since genetically determined ancestry may not capture unmeasured cultural and lifestyle differences, the contribution of environmental factors to the current findings should not be disregarded.

Resting energy expenditure and its determinants in hemodialysis patients.

OBJECTIVE: Chronic kidney disease is associated with several metabolic disturbances that can affect energy metabolism. As resting energy expenditure (REE) is scarcely investigated in patients on hemodialysis (HD) therapy, we aimed to evaluate the REE and its determinants in HD patients. DESIGN: Cross-sectional study. SETTING: Dialysis Unit of the Nephrology Division, Federal University of São Paulo, Brazil. SUBJECTS: The study included 55 patients (28 male, 41.4+/-12.6 years old) undergoing HD therapy thrice weekly for at least 2 months, and 55 healthy individuals pair matched for age and gender. Subjects underwent fasting blood tests, as well as nutritional assessment, and the REE was assessed by indirect calorimetry. RESULTS: REE of HD patients was similar to that of pair-matched controls (1379+/-272 and 1440+/-259 kcal/day, respectively), even when adjusted for fat-free mass (P=0.24). REE of HD patients correlated positively with fat-free mass (r=0.74; P<0.001) and body mass index (r=0.37; P<0.01), and negatively with dialysis adequacy (r=-0.46; P<0.001). No significant univariate correlation was found between REE and age, dialysis vintage, serum creatinine, urea, albumin, bicarbonate, parathyroid hormone (PTH) or high-sensitivity C-reactive protein (CRP). In the multiple linear regression analysis, using REE as dependent variable, the final model showed that besides the well-recognized determinants of REE such as fat-free mass and age, PTH and CRP were the independent determinants of REE in HD patients (R (2)=0.64). CONCLUSIONS: In this study, the REE of HD patients was similar to that of healthy individuals, even with the positive effect of secondary hyperparathyroidism and inflammation on REE of these patients.

Accuracy of obesity diagnosis in Brazilian adolescents: comparison of Cole et al and Must et al criteria with DXA percentage of fat mass.

OBJECTIVES: to assess the accuracy of the two most used anthropometric criteria: Must and Cole to diagnose obesity in adolescence comparing with percentage of fat mass determined by DXA. METHODOLOGY: cross-sectional study with 418 adolescents (52.4% males) attending a private school in São Paulo/Brazil. Anthropometric measures of height and weight were taken and BMI was calculated. Analysis of body composition was performed using the DXA to detect percentage of fat mass. Using the method proposed by Ellis & Wong (ERM) two sex-specific linear regression models of fat percentage for age in years were fitted. The comparison between the methods was carried out through the analyses of specificity and sensitivity with two residual percentiles as cutoff points (ERM85th and ERM95th) as standards. A logistic model was fitted to estimate the probability curves of obesity classification. RESULTS: the comparison of the two classic criteria for the diagnosis of obesity with the ERM85th and ERM 95th, yields for females the same sensitivities of 0.50 and 0.20 for both criteria. For males sensitivities for ERM 85th were 0.61 (Must) and 0.49 (Cole); while for ERM95th the sensitivities were 0.81 (Must) and 0.64 (Cole). Therefore, there are high probabilities that those criteria diagnose adolescents as obese, when actually they are not. CONCLUSION: the Must and Cole criteria were similar and present flaws for the diagnosis of obesity. In clinical practice and field studies anthropometric criteria should be evaluated as to the diagnostic accuracy along with other clinical parameters and, when feasible, the analysis of fatness percentage. However, the anthropometric criteria evaluated are efficient in the identification of non-obese adolescent in the two cutoff points considered.

An application of bootstrap resampling method to obtain confidence interval for percentile fatness cutoff points in childhood and adolescence overweight diagnoses.

OBJECTIVE: To present a resampling approach to obtain confidence intervals (CIs) and the empirical distributions for the studentized regression residuals percentiles when used as cutoff points for overweight and obesity diagnosis in children and adolescents. METHOD: A tutorial for the nonparametric bootstrap with bias accelerating correction is presented. A classical method, the Binomial interpretation, is used as comparing criterion. SUBJECTS: A case study comprising 418 randomly selected subjects from a private secondary school (age: 10-17 y, boys: 52%). MEASUREMENTS: Body fat percentage (by), age (y) and Tanner criteria. RESULTS: The empirical distributions presented skewness suggesting that the CIs should not be symmetric. CIs obtained by the proposed approach were more realistic than the classical ones. CONCLUSIONS: We propose a simple and efficient way to obtain the interval estimates and the distribution properties of cutoff points for overweight and obese classification using a sample-based method that allows the comparison of cutoffs among many subpopulations.

Anthropometry and body composition in ethnic Japanese and Caucasian adolescent girls: considerations on ethnicity and menarche.

OBJECTIVE: This study aimed to compare the various anthropometric and body composition parameters based on the ethnicity and the absence or presence of menarche. DESIGN: A cross-sectional study with incomplete sampling, using the subject as the evaluation unit. SUBJECTS: The final sample of 550 subjects was composed of 122 Japanese and 179 Caucasian premenarcheal adolescents, and 72 Japanese and 177 Caucasian postmenarcheal adolescents. METHODS: The variables of body composition were measured through the following methods: bioelectrical impedance analysis, near-infrared interactance (NIR), Slaughter cutaneous skinfold equations and body mass index. Weight, height and sitting height were also evaluated. RESULTS: The Japanese pre- and postmenarcheal girls presented lower weight and height values when compared with the Caucasian girls. In general, the Japanese premenarcheal girls presented less fat and fat-free mass than the premenarcheal Caucasian girls. This fact was demonstrated through NIR results. Conversely, the Japanese postmenarcheal adolescents accumulated more fat than their Caucasian counterparts. However, significant differences were solely encountered in the values of cutaneous skinfold percent body fat. With regard to menarche, it was verified that, regardless of ethnicity, all the anthropometric and body composition variables reached higher values among postmenarcheal adolescents when compared with premenarcheal adolescents. CONCLUSION: Different results of weight and height between the ethnic groups may bring back the discussion concerning separate growth curves for different ethnic groups. The results of the body composition analysis indicated high adiposity levels among postmenarcheal adolescents.

High sodium chloride intake is associated with low bone density in calcium stone-forming patients.

BACKGROUND: Although renal stone disease has been associated with reduced bone mass, the impact of nutrient intake on bone loss is unknown. SUBJECTS AND METHODS: The present study was undertaken to investigate the influence of nutrient intake on bone density of 85 calcium stone-forming (CSF) patients (47 male and 38 premenopausal females) aged 41+/-11 years (X+/-SD). Bone mineral density (BMD) was measured using dual energy X-ray absorptiometry at the lumbar spine (L2-L4) and femoral neck sites, and low BMD was defined as a T score < -1 (WHO criteria). A 4-day dietary record and a 24-hour urine sample were obtained from each patient for the assessment of nutrient intake and urinary calcium (U(Ca)), sodium (U(Na)), phosphate and creatinine excretion. RESULTS: Forty-eight patients (56%) presented normal BMD and 37 (44%) low BMD. There were no statistical differences regarding age, weight, height, body mass index, protein, calcium and phosphorus intakes between both groups. The mean U(Ca), phosphorus and nitrogen appearance also did not differ between groups. However, there was a higher percentage of hypercalciuria among low vs normal BMD patients (62 vs 33%, p < 0.05). Low BMD patients presented a higher mean sodium chloride (NaCl) intake and excretion (UNa) than normal BMD (14+/-5 vs 12+/-4 g/day and 246+/-85 vs 204+/-68 mEq/day, respectively p < 0.05). The percentage of patients presenting NaCl intake > or = 16 g/day was also higher among low vs normal BMD patients (35 vs 12%, p < 0.05). After adjustment for calcium and protein intakes, age, weight, body mass index, urinary calcium, citrate and uric acid excretion, and duration of stone disease, multiple-regression analysis showed that a high NaCl intake (> or = 16 g/day) was the single variable that was predictive of risk of low bone density in CSF patients (odds ratio = 3.8). CONCLUSION: These data suggest that reducing salt intake should be recommended for CSF patients presenting hypercalciuria and osteopenia.