Antonio de Azevedo Barros-Filho

Tendência secular da idade da menarca avaliada em relação ao índice de massa corporal

OBJECTIVE: To evaluate the secular trend of menarche according to body mass index (BMI). SUBJECTS AND METHODS: Six hundred and eighty five girls (7-18 years) assessed in 2001 were compared with 750 evaluated in 2010. They were grouped by BMI Z-score: (thin + normal) and (overweight + obese). Menarche was reported by status quo and age at menarche estimated by a logit model. We used the Qui-square test, Mann-Whitney test, and Logistic Regression, at a 5% significance level. RESULTS: Menarche advanced 3.24 months. There was an increase in obesity, and a decrease of the prevalence of normal girls. Menarche was anticipated by 1.44 month in the thin + normal group and by 5.76 months in the overweight + obese group. There was no interaction between the effects determined by the evaluated period and nutritional diagnosis. CONCLUSIONS: Although both the period and BMI influence the menarche, one cannot attribute this advance only to changes in the nutritional profile of the sample. Other factors that were not tested may also contribute to this finding.

Atherogenic lipid profile of Brazilian near-term newborns

Cardiovascular disease is the primary cause of death in Brazil. Recent studies have shown that low birth weight and preterm birth are linked to a higher prevalence of cardiovascular disease. The aim of the present study was to compare the levels of lipids and apolipoproteins and atherogenic indexes between term and near-term newborn infants. A sample of umbilical cord blood was obtained from 135 newborns (66 males) divided into two groups: 25 near-term neonates (35-36.6 weeks of gestational age) and 110 term neonates (37-42 weeks of gestational age). The total cholesterol concentrations were higher in the near-term neonates than in the term group (94.04 +/- 8.02 vs 70.42 +/- 1.63 mg/dl, P < 0.01), due to an increase in the LDL-cholesterol fraction in the near-term group (57.76 +/- 6.39 vs 34.38 +/- 1.29 mg/dl, P < 0.001). The atherogenic indexes (total cholesterol/HDL-cholesterol, LDL-cholesterol/HDL-cholesterol and apolipoprotein B/apolipoprotein A-I) were higher in the near-term group (P < 0.001, P < 0.001, and P < 0.05, respectively). The gestational age of the newborns was inversely correlated with total cholesterol and LDL-cholesterol, and also with the total cholesterol/HDL-cholesterol and LDL-cholesterol/HDL-cholesterol indexes. These findings demonstrate that the lipid profile is worse in the group of near-term neonates compared with the term group. Future studies are needed to determine if this atherogenic profile in near-term neonates can affect body metabolism, increasing the risk for cardiovascular diseases in adult life.

Antropometria, maturação sexual e idade da menarca de acordo com o nível socioeconômico de meninas escolares de Cascavel (PR)

OBJECTIVE: To evaluate age of menarche and anthropometric data of schoolgirls of different socioeconomic levels in Cascavel, state of Parana, in Southern Brazil. METHODS: A cross-sectional study was carried out in 2006 with 2,761 girls evaluated in 27 private and public schools. Age at menarche was obtained by the status quo method. Sexual maturity was assessed by self evaluation, according to Tanners criteria. Socioeconomic level was obtained through the ABEP (2003) questionnaire. Data of weight, stature and Body Mass Index (BMI) were obtained. Data were analyzed by descriptive statistics and Mann-Whitney test at 5% significance. RESULTS: Age at menarche was 12.2±1.2 years in the whole sample, and was 12.1±1.1; 12.3±1.2 and 12.4±1.2 in girls from high, medium and low socioeconomic levels, respectively. Post-menarche girls aged 10-17 years had higher values of stature and weight and girls aged 11-14 years had higher BMI. CONCLUSIONS: Age at menarche was lesser in girls from a higher socioeconomic level. Although these differences had been found in distinct socioeconomic levels, they were considered biologically small.

Brazilian Pediatric Reference Data for Quantitative Ultrasound of Phalanges According to Gender, Age, Height and Weight

Aims To establish normative data for phalangeal quantitative ultrasound (QUS) measures in Brazilian students. Methods The sample was composed of 6870 students (3688 females and 3182 males), aged 6 to 17 years. The bone status parameter, Amplitude Dependent Speed of Sound (AD-SoS) was assessed by QUS of the phalanges using DBM Sonic BP (IGEA, Carpi, Italy) equipment. Skin color was obtained by self-evaluation. The LMS method was used to derive smoothed percentiles reference charts for AD-SoS according to sex, age, height and weight and to generate the L, M, and S parameters. Results Girls showed higher AD-SoS values than boys in the age groups 7–16 (p<0.001). There were no differences on AD-SoS Z-scores according to skin color. In both sexes, the obese group showed lower values of AD-SoS Z-scores compared with subjects classified as thin or normal weight. Age (r2 = 0.48) and height (r2 = 0.35) were independent predictors of AD-SoS in females and males, respectively. Conclusion AD-SoS values in Brazilian children and adolescents were influenced by sex, age and weight status, but not by skin color. Our normative data could be used for monitoring AD-SoS in children or adolescents aged 6–17 years.

Growth Curves for Girls with Turner Syndrome

The objective of this study was to review the growth curves for Turner syndrome, evaluate the methodological and statistical quality, and suggest potential growth curves for clinical practice guidelines. The search was carried out in the databases Medline and Embase. Of 1006 references identified, 15 were included. Studies constructed curves for weight, height, weight/height, body mass index, head circumference, height velocity, leg length, and sitting height. The sample ranged between 47 and 1,565 (total = 6,273) girls aged 0 to 24 y, born between 1950 and 2006. The number of measures ranged from 580 to 9,011 (total = 28,915). Most studies showed strengths such as sample size, exclusion of the use of growth hormone and androgen, and analysis of confounding variables. However, the growth curves were restricted to height, lack of information about selection bias, limited distributional properties, and smoothing aspects. In conclusion, we observe the need to construct an international growth reference for girls with Turner syndrome, in order to provide support for clinical practice guidelines.

Trends of body composition among adolescents according to maturation stage and body mass index

Abstract Background: Excessive increases in percentage body fat (%BF) according to sex may pose greater risks of chronic diseases. Objective: To evaluate trends of body composition according to sexual maturation stage and body mass index (BMI) of adolescents. Method: Data about weight, height, lean mass, fat mass, %BF, BMI and sexual maturation of 1345 private school students (685 girls) aged from 7 to 18 years were collected in 2001 and compared with data of 1450 students (750 girls) collected in 2010 in Campinas, Brazil. χ2-test, ANOVA and logistic regression were used for statistical analyses (p<0.05). Results: Obesity prevalence increased, and number of boys and girls with normal BMI (p=0.0183 and p=0.0041) decreased. Differences in the median values of the study variables according to time point and nutritional diagnosis were not significant, except for lean mass (p=0.0484) and height (p=0.0275) in B2 (Breast stage) and %BF (p=0.0324) in G5 (Genitalia stage). Conclusion: Body composition did not change significantly, although overweight increased.

Association of growth and nutritional parameters with pulmonary function in cystic fibrosis: a literature review

Abstract Objective: To review the literature addressing the relationship of growth and nutritional parameters with pulmonary function in pediatric patients with cystic fibrosis. Data source: A collection of articles published in the last 15 years in English, Portuguese and Spanish was made by research in electronic databases - PubMed, Cochrane, Medline, Lilacs and Scielo - using the keywords cystic fibrosis, growth, nutrition, pulmonary function in varied combinations. Articles that addressed the long term association of growth and nutritional parameters, with an emphasis on growth, with pulmonary disease in cystic fibrosis, were included, and we excluded those that addressing only the relationship between nutritional parameters and cystic fibrosis and those in which the aim was to describe the disease. Data synthesis: Seven studies were included, with a total of 12,455 patients. Six studies reported relationship between growth parameters and lung function, including one study addressing the association of growth parameters, solely, with lung function, and all the seven studies reported relationship between nutritional parameters and lung function. Conclusions: The review suggests that the severity of the lung disease, determined by spirometry, is associated with body growth and nutritional status in cystic fibrosis. Thus, the intervention in these parameters can lead to the better prognosis and life expectancy for cystic fibrosis patients.

Anthropometry in Relation to Sexual Maturation

The wide variability in timing, sequence, duration and magnitude of pubertal events determines the need for assessing adolescents in relation to sexual maturation instead of age. During the maturation process there is a growth spurt, characterized by acceleration on growth velocity with an increase in weight, height and body mass index, change in body proportions and diameters and increase in muscle and fat tissue, which will determine the phenotype of each sex. Acknowledging this process, allows the correct understanding and assessment of anthropometric changes that may pose risks to an adolescent’s current and future health. During the spurt, they gain ∼20% of final height and ∼50% of final weight. While muscle mass doubles in boys, it increases only 50% in girls, who in turn accumulate more adipose tissue, reaching ∼25% of relative body fat (%BF), while boys reach ∼15% in adulthood. Therefore, during maturation, girls gain fat-free mass index and fat mass index while boys gain fat-free mass index and lose fat mass index. Proportionally girls gain fat and lose fat-free mass, while boys present a large increment of fat-free mass and lose fat mass. These findings appoint toward the need to assess body composition of adolescents for a correct nutritional diagnosis.

Competitive Swimming and Handball Participation Have a Positive Influence on Bone Parameters as Assessed by Phalangeal Quantitative Ultrasound in Female Adolescents

PURPOSE To examine the influence of participation in competitive sports on bone parameters, as assessed by quantitative ultrasound (QUS) of the phalanges in female adolescents. METHODS Female adolescents (n = 329, 13.0-16.7 years old) were classified into handball (n = 55), swimming (n = 49) and control (n = 225) groups. QUS was used to evaluate the amplitude-dependent speed of sound (AD-SoS) and bone transmission time (BTT), and their z-scores (zAD-SoS and zBTT) were calculated. Anthropometric measurements and Tanners stages were also obtained. RESULTS Swimmers had higher AD-SoS (2089 ± 43.8 m/s) and zAD-SoS (0.47 ± 0.8) than controls (2060 ± 54.0 m/s; 0.09 ± 1.0; both p ≤ .05) and both groups of athletes had higher BTT (handball: 1.44 ± 0.2 μs; swimming: 1.45 ± 0.2) and zBTT (handball: 0.71 ± 0.8; swimming: 0.72 ± 1.1) than the control group (1.37 ± 0.2 μs; 0.32 ± 0.9; all p ≤ .05). Swimmers had a higher total training time (TTT: 52.5 ± 27.6 months) and frequency of training per week (FT: 5.38 ± 0.1) compared with the handball group (35.9 ± 18.1; 3.32 ± 0.8; p ≤ .05). zAD-SoS, BTT and zBTT were positively correlated with FT, while BTT and zBTT showed a positive correlation with TTT. CONCLUSIONS Sports practice influences bone parameters and higher bone parameter values are related to the amount of time and frequency of weekly training. The differences in phalangeal QUS parameters are independent of the impact of weight-bearing exercise.

Comparação do estado nutricional de meninas de acordo com diferentes referências para índice de massa corporal

Objectives: to compare the nutritional status of girls aged between nine and seventeen years in the city of Cascavel (in the Brazilian State of Parana) according to three body mass index (BMI) references. Methods: a cross-sectional study was conducted with 2759 girls. Weight and height were measured to obtain the BMI and the sexual maturity and socioeconomic status of the girls evaluated. Nutritional status was classified using the BMI cut-off points proposed by Conde & Monteiro, the WHO, and the CDC. Results: the frequencies for different nutritional states did not differ significantly when the same BMI reference was used according to age, socioeconomic status or type of school attended. In terms of sexual maturity, only the WHO reference WHO produced higher levels of obesity and overweight for girls with Stage 5 breasts. However, when the three references were compared with one another, the CDC produced significantly lower frequencies for overweight and obesity by age group, level of sexual maturity, socioeconomic status and type of school. All three references were in agreement, this was greater between Conde & Monteiro, and the WHO. Conclusions: the CDC reference identified a smaller percentage of overweight and obese girls. The references proposed by Conde & Monteiro and the WHO produced similar results.