The low prevalence of weight-for-height deficits in Brazilian children is related to body proportions.

Compared with children from other regions, Latin American children living in poverty have much lower prevalences of weight-for-height deficits than would be expected given the observed rates of stunting. This study was aimed at investigating whether variations in body proportions, particularly abdominal circumference, could explain this paradoxical finding. In a cross-sectional study, children aged 12-35 mo (n = 197) were studied in Southern Brazil. Half of these children were from a high socioeconomic status (SES) group whose growth closely resembled that of the National Center for Health Statistics (NCHS)/WHO reference; the other half were from low income families. The following 11 anthropometric measurements were collected: weight, height, sitting height/crown-rump length, head, chest, upper arm and abdominal circumference, triceps, biceps, subscapular and suprailiac skinfolds. These measures were compared between the two groups of children and with values for North American children [mostly from Second National Health and Nutrition Examination Survey (NHANES II)]. For nearly all measures, low SES Brazilian children tended to be smaller than both high SES and North American children. However, when body proportionality was assessed by dividing the measurements by the child's height, these differences tended to disappear or even to change direction, as was the case for head, chest and abdominal circumferences. Mean abdominal circumference was virtually identical between low and high SES children, and the former had larger abdomens for a given height. Despite slight differences in measuring techniques, Brazilian children had larger abdomens than North Americans. These findings may explain in part why deprived Latin American children have higher weights for their height compared with the NCHS/WHO reference.

The epidemiological transition in maternal and child health in a Brazilian city, 1982-93: a comparison of two population-based cohorts.

Two studies carried out in 1982 and 1993 in the city of Pelotas, Southern Brazil, provide a unique opportunity for assessing the impact on maternal and child health of the economic and health care changes, which took place in Brazil in this period. The cohorts of mothers and infants of 1982 and 1993 were studied from the time of delivery. In both years, all mothers identified in the city's maternity hospitals answered a standardised questionnaire and their infants were examined. Over 99% of all children born in the city in each of the 2 years were included in the cohorts. Deaths occurring among these children were monitored prospectively, as well as all hospital admissions in the 1993 cohort. In the 1982 study, attempts were made to locate a 25% sample of the children at the mean age of 12 months using the addresses collected at the hospital (82% of the children were located), and all of the cohort children at the mean age of 20 months and 42 months, through a city census (87% were located in both follow-ups). In the 1993 study, 20% of all children plus all low birthweight infants were sought at 12 months of age, using the addresses collected at the hospital, and 95% were successfully traced. There was a 12% fall in the number of births occurring in 1993 (5,304 births), in comparison with 1982 (6,011 births), in spite of the increase in the population of reproductive age in the city during the decade. There was a marked difference in maternal height and weight at the beginning of pregnancy, with women giving birth in 1993 being, on average, 3.4 cm taller and 2.5 kg heavier than those who gave birth in 1982. The proportion of preterm babies (<37 weeks), measured by the date of last menstrual period, increased from 5.6% in 1982 to 7.5% in 1993. The median duration of breast feeding increased from 3.1 months in 1982 to 4.0 months in 1993. At 12 months of age, the prevalence of deficit of weight for age decreased from 5.4% in 1982 to 3.7% in 1993. The prevalence of deficit of height for age, however, increased from 5.3% to 6.1%. The perinatal mortality rate dropped 31%, from 32.2 per 1,000 births in 1982 to 22.1 deaths per 1,000 births in 1993. There was also a marked reduction in the infant mortality rate, from 36.4 per 1,000 livebirths in 1982 to 21.1 per 1,000 livebirths in 1993. The findings of the study indicate that there were improvements in the decade for most of the indicators evaluated, with the exception of birthweight and gestational age. It appears that improvements in perinatal and infant mortality rates are largely due to improvements in the health care sector.

[Understanding the low prevalence of weight-for-height deficit in lower-income Brazilian children: correlations among anthropometric values]. / Entendendo a baixa prevalência de déficit de peso para estatura em crianças brasileiras de baixo nível sócio-econômico: correlação entre índices antropométricos.

The sample for this study consisted of 386 children from six to 59 months of age. The objective was to study the association between wasting and abdominal circumference. Thirteen anthropometric measurements were taken: weight, height or length, crown-rump length, 4 circumferences, 4 skin fold thicknesses, and 2 breadths. Muscle, fat, and total upper arm areas and leg length were calculated. Indices of body proportionality were obtained by dividing the anthropometric variables by height. Height-for-age, weight-for-age, and weight-for-height deficits were 25.9%, 14.4%, and 3.5%, respectively. The smallest and lightest children were those with the highest abdominal circumferences divided by height. According to this study, abdominal circumference for Brazilian children without height-for-age deficit is, on average, 1.2 cm larger than for US children. Using this as a basis, the study calculated that prevalence of weight-for-height deficit would increase from 3.5% to 7.0% by increasing 2 cm in the abdominal circumference. The low prevalence of wasting and the high prevalence of stunting as indicated by several Brazilian studies could be explained partially by larger mean abdominal circumference values.

[Low prevalence of bodyweight-for-height deficit: comparison of stunned and no-stunned Brazilian children]. / Baixa prevalência de déficit de peso para estatura: comparação de crianças brasileiras com e sem déficit estatural.

OBJECTIVES: The aim of this study was to investigate the relationship between abdominal circumference and weight-for-height in children. The average of 18 anthropometric and body proportionality indexes were compared among four groups of children: stunted and non-stunted Brazilians, Peruvians and North-Americans. METHODS: There were studied 386 children aged 6-59 months living in a poor neighborhood in Pelotas, Brazil. Anthropometric measurements (weight, recumbent length or height, sitting height or crown-rump length; head, chest, upper arm and abdominal circumferences; triceps, biceps, subescapular and suprailiac skinfold thickness; biacromial and biiliac breadths) were obtained. Muscle, fat, total upper arm areas, leg length and body proportionality indexes were calculated. RESULTS AND CONCLUSIONS: The study sample showed high levels of morbidity, low parental educational levels, poor access to health services and poor housing conditions. Stunted Brazilian children had lower means for most of the anthropometric measurements when compared to non-stunted Brazilians and North-American children. However, stunted children showed larger abdominal, head and thoracic circumference in relation to their stature than non-stunted children. The low prevalence of weight-for-height among the children of this study is not a result of excess of fat or muscle tissue, and may be partly explained by an increase in head and trunk dimensions (including abdominal circumference) relative to the child's stature.

[Prevalence and risk factors of obesity in adults]. / Prevalência de obesidade em adultos e seus fatores de risco.

INTRODUCTION: A population-based cross-sectional study was conducted in Pelotas, Southern Brazil, with the objective of determining the prevalence of obesity and identify associated, variables as this condition increased markedly in the country between 1974 and 1989. MATERIAL AND METHODS: One thousand and thirty-five adults between 20 and 69 years of age were studied. Obesity was defined as a Body Mass Index--BMI--equal to or over 30 Kg/square meter). The multivariate analyses took into account the hierarchical model of the variables associated with obesity for both men and women. RESULTS: The prevalence for the overall population was of 21% (CI 18-23). It was higher among women--25% (CI 22-29) than for men--15% (CI 12-18). Socioeconomic status was positively associated with obesity among men, whereas the opposite situation was reported for women, with those belonging to the poorest social strata presenting increased BMI. Reported obesity in their parents was associated with increased BMI in the subjects, and this association remained statistically significant even after compensating for the effect of possible confounding variables. Self-reported diabetes and arterial hypertension doubled the risk of obesity, whereas non-smoking was associated with obesity only among women. Variables which were not associated with obesity after adjusting for confounders were alcohol consumption, marital status and parity. Women having more daily meals were less prone to obesity, even after controlling for confounders, and this association was not quite significant for men (p = 0.07). CONCLUSIONS: The prevalence of obesity was higher among women, and important differences in risk factors were noticed when the population was considered by sex.

[Prognostic factors of hospital mortality from diarrhea or pneumonia in infants younger than 1 year old. A case-control study]. / Fatores prognósticos de letalidade hospitalar por diarréia ou pneumonia em menores de um ano de idade. Estudo de caso e controle.

Diarrhea and pneumonia are common diseases in children aged under one year, for which there are simple therapeutic measures. However, infant mortality due to these diseases is still very high, varying markedly according to socio-economic status. The characteristics of children who died (cases) and of those who were hospitalized with diarrhea or pneumonia, but survived (controls), were studied. The following groups of variables were studied: socio-economic, environmental and biological conditions, nutritional status and breast-feeding. Information on cases and controls was collected from hospital records and through home interviews. Important losses occurred in the latter: 40% of cases and 50% of controls were not interviewed. There were no significant differences between cases who were included and those who were not, in terms of age, sex or place of residence. To estimate relative risks of prognostic factors unconditional Logistic Regression was used to calculate the odds ratios and their 95% confidence intervals. Prematurity, low birth weight, weight/age deficit, presence of edema and poor general status at hospital admission were prognostic factors for hospital case-fatality. In relation to the anthropometric variables, it was not possible to conclude for certain whether the increased case-fatality was linearly or non-linearly (threshold) associated with nutritional deficit. The duration of breast-feeding was only associated with case-fatality for pneumonia. Socio-economic factors were not important for the prognosis of children admitted to hospital with diarrhea or pneumonia. Some of the expected risk factor associations were not detected, maybe due to the small sample size (resulting from the high losses) which was insufficient to show small differences. In this study the biological conditions of children with diarrhea or pneumonia appeared to be the important prognostic factors for hospital case-fatality.