Ana M. Oliveira

C-reactive Protein and Metabolic Syndrome in Youth: A Strong Relationship?

Retraction: Note from the Editor‐in‐Chief: This paper is retracted

Alanine Aminotransferase and High Sensitivity C-Reactive Protein: Correlates of Cardiovascular Risk Factors in Youth

OBJECTIVE The association between high-sensitivity C-reactive protein (hs-CRP) and alanine aminotransferase (ALT) with clinical/metabolic variables was evaluated in overweight Brazilian children and adolescents. STUDY DESIGN Oral glucose tolerance test was performed in 407 students (273 overweight/obese, 11.3 +/- 3.1 y). Measurements included body mass index (BMI), waist circumference (WC), blood pressure, lipids, insulin, hs-CRP, and ALT. Overweight/obese was defined using BMI z-score; insulin resistance (IR) by homeostatic model assessment: insulin resistance (HOMA-IR); and metabolic syndrome (MS) in accordance with the modified NCEP-ATPIII. RESULTS As weight increased, systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides (TG), insulin, HOMA-IR, hs-CRP, ALT, ALT, hs-CRP, and AST and the number of MS components (nMSc) also increased (P </= .001 for all). Subjects with hs-CRP and ALT above the median had higher BMI z-score, WC, SBP, DBP, TG, AST, insulin, HOMA-IR, and nMSc than those with both markers below the median (P </= .002 for all). After adjustment for age, sex and ethnicity, BMI z-score (OR, 1.5; CI, 1.38 to 1.86; P < .001), WC (OR,1.3; CI, 1.19 to 1.43; P < .001) SBP (OR, 1.2; CI, 1.03 to 1.38; P = .015), DBP (OR, 1.4; CI, 1.15 to 1.69; P < .001), TG (OR, 1.8; CI, 1.29 to 2.62; P < .001), insulin (OR, 1.4; CI, 1.23 to 1.71; P < .001), HOMA-IR (OR, 1.2; CI, 1.09 to 1.29; P < .001) and nMSc (OR, 2; CI, 1.16 to 3.47; P = .012) were independently associated with high ALT and hs-CRP. For every 5-cm increase in WC and every 1-point increase in BMI z-score, there were a 1.3- and 1.5-fold greater chance of having increased ALT and hs-CRP, respectively. CONCLUSIONS Simultaneous measurements of ALT and hs-CRP should be considered as a screening test for metabolic syndrome and cardiovascular disease risk factors in overweight/obese children/adolescents.

Triglycerides and Alanine Aminotransferase as Screening Markers for Suspected Fatty Liver Disease in Obese Children and Adolescents

Background/Aims: Metabolic syndrome (MS) and fatty liver disease (FLD) are on the rise. The association between these conditions in Brazilian youth is analyzed. Methods: 354 subjects (11.2 ± 3.1 years) were evaluated. FLD was suspected by ultrasound and computed tomography; weight and MS by BMI z-score and NCEP-ATPIII respectively. Results: Subjects were classified as: group 1 with suspected FLD and group 2 without and group 2 as ‘a’ (overweight/obese) and ‘b’ (normal weight). Comparing group 1 with 2a and 2b, differences in age (p = 0.016; p = 0.075), triglycerides (TG) (p = 0.021; p = 0.002), insulin (p = 0.652; p = 0.015) and homeostasis model assessment method of IR (HOMA-IR) (p = 0.737; p = 0.003) were found. Group 2a was divided into low/high alanine aminotransferase (ALT). A decrease in waist circumference and TG was found going from those with suspicion of FLD to obese with high and low ALT. Insulin and HOMA-IR in group 1 and high ALT were similar. Gender (OR 6.6; CI 1.9–22.5; p = 0.025), age (OR 1.3; CI 1.1–1.6; p = 0.006), TG (OR 10.4; CI 3.1–34.4; p = 0.005) were associated with suspected FLD. For every 10 U/l increase in ALT, there was a 4-fold greater chance of probable FLD (OR 4.01; CI 2.06–9.40; p < 0.001). Conclusion: Measurements of ALT and TG should be considered as screening for suspected FLD in overweight/obese youth.

Determinants of postpartum weight variation in a cohort of adult women: a hierarchical approach

INTRODUCTION Retention of the weight gained during pregnancy or the weight gain postpartum has been associated with increased prevalence of obesity in women of childbearing age. OBJECTIVE To identify determinants of weight variation at 24 months postpartum in women from 2 towns in Bahia, Brazil. METHODS Dynamic cohort data of 325 adult women were collected for 24 months postpartum. Weight variation at 24 months postpartum was considered a response variable. Socioeconomic, demographic, reproductive, related with childbirth variables and lifestyle conditions were considered exposure variables. A linear mixed-effects regression model with a hierarchical approach was used for data analysis. RESULTS Suitable sanitary conditions in the household (2.175 kg; p = 0.001) and participation social programs for income transfer (1.300 kg; p = 0.018) contributed to weight gain in distal level of determinants, while at intermediate level, pre gestational overweight and surgical delivery had effects on postpartum weight, causing an average increase of 3.380 kg (p < 0.001) and loss of 2.451 kg (p < 0.001), respectively. At proximal level, a score point increase for breastfeeding yielded an average postpartum loss of 70 g (p = 0.002). CONCLUSION Our results indicate the need to promote weight control during and after pregnancy, encourage extended breastfeeding, and improve living conditions through intersectoral interventions.

Prevalence and associated factors for early interruption of exclusive breastfeeding: meta-analysis on Brazilian epidemiological studies

Objetivos: sumarizar estudos brasileiros que analisaram os fatores de risco para interrupcao do aleitamento materno exclusivo (AME) antes dos seis meses de vida da crianca. Metodos: revisao sistematica e metanalise de artigos indexados na base de dados Bireme, Scielo e Pubmed, publicados no periodo de janeiro 2000 a dezembro de 2015. Resultados: 22 artigos foram incluidos na metanalise. Observou-se que os fatores relacionados ao recem-nascido como o baixo peso ao nascer (OR= 1,17; IC95%: 1,05-1,29), sexo feminino (OR= 1,09; IC95%: 1,04-1,13) e uso de chupeta (OR= 2,29; IC95%: 1,68- 2,91) foram os principais fatores de exposicao responsavel pelo aumento da ocorrencia de interrupcao do AME. No que se refere aos fatores de exposicao relacionados a mae, a idade materna inferior a vinte anos (OR= 1,22; IC95%: 1,12-1,33), a baixa escolaridade (OR=1.28; CI 95%: 1,11-1,45), a primiparidade (OR= 1,17; IC95%: 1,02-1,32), o trabalho materno no puerperio (OR= 1,26; IC95%: 1,11-1,41) e a baixa renda familiar (OR= 1,22; IC95%: 1,08-1,37) contribuiram significativamente para ocorrencia de interrupcao do AME. Conclusoes: a metanalise de estudos epidemiologicos brasileiros registrou evidencias para concluir que a idade inferior a vinte anos, baixa escolaridade, primiparidade, trabalho materno no puerperio e a baixa renda familiar estao associados com a interrupcao do aleitamento materno exclusivo ate os seis meses de idade. Criancas com baixo peso ao nascer, do sexo feminino e que usaram chupeta tiveram maior vulnerabilidade de nao serem amamentadas exclusivamente. Conclui-se, que a maioria deste fatores podem ser modificados por meio de politicas publicas de acompanhamento adequado durante todo o pre-natal,com acoes de promocao do aleitamento materno exclusivo.

Retraction: Update to "C-reactive protein and metabolic syndrome in youth: a strong relationship?".

TO THE EDITOR: We are part of a research group on childhood obesity and made a cross-sectional study with a large sample of normal weight and overweight/obese children and adolescents that had never been studied before under these conditions. Based on the literature, C-reactive protein (CRP) and alanine aminotransferase (ALT) are defined as good markers for cardiovascular disease (CVD) and type 2 diabetes mellitus (DM2), respectively, but separately. As obesity, CVD, and DM2 are increasing in this age group, one of our objectives was to find a reliable and readily available surrogate marker for both CVD and DM. In this way, we divided the population into four groups by BMI and these groups were further subdivided into four groups based on ALT and CRP median scores, trying to confirm our hypothesis that simultaneous measurements of ALT and CRP are better than the isolated measures as a screening test for metabolic disturbances and CVD. These conclusions we sent to a journal and after several contacts/corrections/improvements were accepted by the Journal of Pediatrics (date of submission 19 March 2007; date of decision: 6 July 2007). In the same period, we hypothesized that CRP is related to metabolic syndrome (MS). To confirm our hypothesis, we studied the same population based on the presence or absence of MS and the analyses were performed based on MS. Then, the population was divided according to CRP quartiles, in an attempt to confirm the importance of this marker in MS. As we believe that obesity is the basis of insulin resistance, and that this state is very important with regard to the development of MS, our aim was to carry out a statistical analysis of all MS components, in order to find the most important element that influences CRP levels. We concluded that obesity, in this population, never studied before, is probably the major determining factor for elevated CRP, an indication of a precocious proinflammatory state. These data were sent almost simultaneously to Journal of Pediatrics and then to Obesity and once again after much work the paper was accepted (date of submission: 24 May 2007; date of decision: 6 September 2007). These data were sent to different journals just because the focuses of the two papers are different. We realized that we had different ideas, objectives, and hypotheses, leading to different statistical analyses, results, and conclusions and we didn’t send copies of the papers to the journals (Journal of Pediatrics and Obesity) just because we didn’t know whether the data would be accepted and published. We are aware of the rules for publications and author guidelines, and would never intentionally publish the same data in two journals, for ethical reasons. If you still consider our arguments inconclusive, our team of researchers respectfully requests that you retract the publication of our article from Obesity.

Epidemiology of vitamin D insufficiency and deficiency in a population in a sunny country: geospatial meta-analysis in Brazil.

ABSTRACT Studies conducted among populations of tropical countries have reported high prevalences of vitamin D deficiency and insufficiency. Information resulting from meta-analyses on the spatial distribution of vitamin D deficiency and insufficiency in tropical countries is still rare. The aim of this review was investigated the prevalence of vitamin D deficiency and insufficiency among the Brazilian population. Observational studies were searched in eight electronically databases. Additionally, theses and dissertations and abstracts were screened. Details on study design, methods, population, mean and data on serum concentrations of vitamin D in different age groups in Brazil were extracted. Data were pooled using a random-effects model and choropleth maps were created based on the geopolitical regions of the country. 72 published paper met the inclusion criteria. The mean vitamin D concentration among the Brazilian population between 2000 and 2017 of 67.65 nmol/L (95% CI: 65.91, 69.38 nmol/L).The prevalences of vitamin D deficiency and insufficiency were 28.16% (95% CI: 23.90, 32.40) and 45.26% (95% CI: 35.82, 54.71), respectively, for the Brazilian population. The highest prevalence of deficiency were observed in the southern and southeastern regions and the highest occurrence of vitamin D insufficiency was among the populations of the southeastern and northeastern regions. Finally, there are high prevalence of inadequate vitamin D concentrations among the population, regardless of age group in Brazil. The development of vitamin D food fortification policies in needs to be cautious and carefully planned.