António Guerra

Validity of BMI based on self-reported weight and height in adolescents

Aim:  To assess in a subset of a nationally representative sample of Portuguese adolescents, the validity of Body Mass Index (BMI) based on self‐reported weight and height.

Leukocyte activation, erythrocyte damage, lipid profile and oxidative stress imposed by high competition physical exercise in adolescents.

BACKGROUND The aim of this study was to evaluate and to compare the lipid profile and the levels of leukocyte activation, red blood cell (RBC) damage and of oxidative stress in two groups of adolescents, with similar body mass index: high competition swimmers and adolescents practising moderate regular physical exercise. METHODS As markers of leukocyte activation, we measured plasma lactoferrin, elastase and granulocyte-monocyte colony stimulating factor. We studied RBC membrane band 3 profile and membrane-bound hemoglobin, as markers of RBC damage and aging; total and differential leukocyte count and RBC count, hematocrit, hemoglobin concentration and hematimetric indexes were also measured. Lipid profile included the evaluation of triglycerides (TG), total cholesterol (Chol), high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol (LDLc), apolipoproteins AI and B (Apo AI and B), and lipoprotein (a) (Lp(a)). To evaluate oxidative stress, lipoperoxidation products and total antioxidant capacity were measured. RESULTS We found that high competition adolescents presented increased plasma levels of leukocyte activation products, increased RBC damage suggesting aging and premature removal, and higher oxidative stress. Lipid profile showed some risk and some protective changes. CONCLUSIONS Our data suggest that high competition exercise, by imposing a higher and sustained oxidative and proteolytic stress, may contribute in the future to a higher risk of cardiovascular disease. We believe these findings warrant a reevaluation of current views in the intensity, duration and regularity of physical exercise, and that the evaluation of leukocyte activation products, RBC damage, oxidative stress and lipid profile may represent good markers to establish putative protective thresholds.

Are overweight and obese adolescents different from their peers

OBJECTIVE To identify psychosocial and lifestyle indicators including alcohol consumption, that may distinguish overweight and obese adolescents from their peers, and align them with other adolescents with chronic conditions. METHODS The sample included 6 131 6th, 8th, and 10th grade public school Portuguese students, aged 11-16 years, who participated in the Health Behavior in School-Aged Children (HBSC)/WHO survey of adolescent health. Body mass index (BMI) was based on self reported weight and height. Separate analyses of psychosocial and behavioral variables were conducted by gender, age group, and BMI, using Chi square, and ANOVA. RESULTS Obese and overweight teens when compared with non-overweight teens, were more likely to report a negative attitude towards their appearance; to believe that others made negative comments about them; had a lower level of life satisfaction; had more difficulty in making new friends, and were more likely to describe themselves as unhappy. Moreover, obese teens were significantly more likely than their non-obese peers to describe themselves as having health problems, to report drinking alcohol daily, as well as having been drunk more than 10 times. CONCLUSIONS The present study provides further evidence regarding the association between overweight and obesity in adolescence, and body image dissatisfaction, poorer self-assessed health status, potential social isolation, decreased life satisfaction, and problematic alcohol consumption patterns. Overweight and obese adolescents should, where possible, be reached with appropriate interventions addressing the broad spectrum of their psychological needs, enhancing their skill development for behavioral change, and providing support for dealing with potentially harmful behaviors.

Comparative Study of the Antipyretic Effect of Ibuprofen (Oral Suspension) and Paracetamol (Suppositories) in Paediatrics

Thirty-five pyrexial children with varying pathologies were entered into an open study to compare the antipyretic effect of Ibuprofen oral suspension and paracetamol suppositories. Temperature was recorded at intervals up to 11 hours after dosing. It was found that both treatments had an antipyretic effect, but that the magnitude and duration of the antipyretic effect was greater with ibuprofen.

Three-Year Tracking of Fatty Acid Composition of Plasma Phospholipids in Healthy Children

Objectives: The fatty acid composition of plasma phospholipids reflects the dietary fatty acid intake as well as endogenous turnover. We aimed at investigating the potential tracking of plasma phospholipid fatty acid composition in children that participated in a prospective cohort study. Methods: 26 healthy children participated in a longitudinal study on health risks and had been enrolled after birth. All children were born at term with birth weights appropriate for gestational age. Follow-up took place at ages 24, 36 and 60 months. At each time point a 24-hour dietary recall was obtained, anthropometric parameters were measured and a blood sample for phospholipid fatty acid analysis was taken. Results: Dietary intake of saturated (SFA), monounsaturated (MUFA) and polyunsaturated (PUFA) fatty acids at the three time points were not correlated. We found lower values for plasma MUFA and the MUFA/SFA ratio at 60 months compared to 24 months. In contrast, total PUFA, total n–6 and n–6 long-chain polyunsaturated fatty acids (LC-PUFA) were higher at 60 months. Significant averaged correlation coefficients (average of Pearson’s R for 24 versus 36 months and 36 versus 60 months) were found for n–6 LC-PUFA (r = 0.67), n–6/n–3 LC-PUFA ratio (r = 0.59) and arachidonic acid/linoleic acid ratio (r = 0.64). Partial tracking was found for the docosahexaenoic acid/α-linolenic acid ratio (r = 0.33). Body mass index and sum of skinfolds Z-scores were similar in the three evaluations. Conclusions: A significant tracking of n–6 LC-PUFA, n–6 LC-PUFA/n–3 LC-PUFA ratio, arachidonic acid/linoleic acid ratio and docosahexaenoic acid/α-linolenic acid ratio may reflect an influence of individual endogenous fatty acid metabolism on plasma concentrations of some, but not all, fatty acids.

Maternal child-feeding practices and dietary inadequacy of 4-year-old children

This study aimed to evaluate the association between maternal perceived responsibility and child-feeding practices and dietary inadequacy of 4-year-old children. We studied 4122 mothers and children enrolled in the population-based birth cohort - Generation XXI (Porto, Portugal). Mothers self-completed the Child Feeding Questionnaire and a scale on covert and overt control, and answered to a food frequency questionnaire in face-to-face interviews. Using dietary guidelines for preschool children, adequacy intervals were defined: fruit and vegetables (F&V) 4-7 times/day; dairy 3-5 times/day; meat and eggs 5-10 times/week; fish 2-4 times/week. Inadequacy was considered as below or above these cut-points. For energy-dense micronutrient-poor foods and beverages (EDF), a tolerable limit was defined (<6 times/week). Associations between maternal perceived responsibility and child-feeding practices (restriction, monitoring, pressure to eat, overt and covert control) and childrens diet were examined by logistic regression models. After adjustment for maternal BMI, education, and diet, and childrens characteristics (sex, BMI z-scores), restriction, monitoring, overt and covert control were associated with 11-18% lower odds of F&V consumption below the interval defined as adequate. Overt control was also associated with 24% higher odds of their consumption above it. Higher perceived responsibility was associated with higher odds of children consuming F&V and dairy above recommendations. Pressure to eat was positively associated with consumption of dairy above the adequate interval. Except for pressure to eat, maternal practices were associated with 14-27% lower odds of inadequate consumption of EDF. In conclusion, children whose mothers had higher levels of covert control, monitoring, and restriction were less likely to consume F&V below recommendations and EDF above tolerable limits. Higher overt control and pressure to eat were associated, respectively, with higher possibility of children consuming F&V and dairy above recommendations.

Influence of Apolipoprotein E Polymorphism on Cardiovascular Risk Factors in Obese Children

Aim: The main objective of the study was to determine whether risk factors associated with obesity are influenced by genetic variation of apolipoprotein E (ApoE). Methods: 81 obese children (mean age 9.4 ± 2.8 years) and an age-matched control group were included. Body composition, lipid profile, and glucose and insulin levels were evaluated according to international recommendations, and the blood pressure was measured by an oscillometric method. Results: The calculated frequencies of the ApoE alleles *2, *3, and *4 (0.04, 0.88 and 0.08) in obese children were similar to those of eutrophic age-matched controls (0.07, 0.82, and 0.11) and fitted the range of variation generally observed in southern European populations. Age, anthropometric parameters, body fat mass, and blood pressure were similar in E2/3, E3/3 and E4/3 genotypes. Total/high-density lipoprotein cholesterol and low-density lipoprotein/high-density lipoprotein cholesterol ratios were higher in the E4/3 group as compared with E3/3 (p < 0.01) and E2/3 (p < 0.05) groups. No differences concerning clusters of risk factors were observed among the three genotypes. No associations were found between ApoE polymorphism and glucose levels (fasting and at 2 h) and between fasting insulin levels and HOMAIR results. Higher levels of fasting and 2-hour insulin and higher HOMAIR values were significantly associated with a higher fat mass. Conclusions: ApoE polymorphism seems to influence some lipid profile abnormalities associated with obesity in childhood. However, clustering of risk factors and insulin resistance seem not to be dependent on ApoE polymorphism.

Are overweight adolescents at higher risk of engaging in unhealthy weight-control behaviours?

Aim: To examine correlates of unhealthy weight‐control behaviours (UNWCB), and to explore possible associated variables.

Handgrip Strength and Nutrition Status in Hospitalized Pediatric Patients

BACKGROUND Handgrip strength (HGS) is a useful indicator of nutrition status in adults, but evidence is lacking in pediatric patients. The aim of this study was to describe the association between undernutrition and HGS in pediatric patients at hospital admission, quantifying the modifying effect of disease severity, anthropometrics, and other patient characteristics on HGS. MATERIALS AND METHODS Eighty-nine inpatients aged ≥6 years consecutively admitted were recruited in a longitudinal study. Nutrition status was evaluated using body mass index (BMI) z scores, and HGS was evaluated at admission and discharge. RESULTS In the total sample, 30.3% of patients were undernourished at admission, and 64% lost HGS during the hospital stay. This study showed that HGS at admission was independently associated with undernutrition defined by BMI z scores (β = 0.256, P = .037). In this multivariate analysis, sex, age, height, and BMI z scores explained 67.1% of HGS at hospital admission. CONCLUSION Lower HGS may be a potential marker of undernutrition in hospitalized pediatric patients, although HGS data should be interpreted according to sex, age, and height of the patient.

Lipid Profile in Portuguese Obese Children and Adolescents Interaction of Apolipoprotein E Polymorphism With Adiponectin Levels

OBJECTIVE To evaluate how the lipid profile associates with apolipoprotein (apo) E gene polymorphism, plasma adiponectin level, and body mass index (BMI) z score in Portuguese youth. DESIGN Transversal cohort study. SETTING Hospital de São João and Hospital de Crianças Maria Pia, Porto, Portugal, between May 2006 and March 2007. PARTICIPANTS One hundred thirty-eight obese children and adolescents (62 boys; mean age, 10.8 years [range, 4-16 years]). Participants were grouped according to (1) apo E polymorphism: presence of the apo E alleles 2 or 4 in E2 (n = 11) and E4 (n = 31) carriers, respectively, or as E3/E3 (n = 94) (carriers of E2/E4 [n = 2] were excluded from apo E analysis because they carry both alleles) and (2) BMI z score: group 1, BMI z score less than 2 (n = 31); group 2, BMI z score of 2 or more and less than 2.5 (n = 65); and group 3, BMI z score of 2.5 or more (n = 42). MAIN OUTCOME MEASURES Lipid variable comparisons between apo E polymorphism and BMI z score groups and influence of BMI z score and adiponectin level, adjusted for apo E polymorphism, on total cholesterol to high-density lipoprotein cholesterol and apo A-I to apo B ratios. RESULTS E4 carriers presented with a worse lipid profile when compared with E2 and E3/E3 carriers. There was also a clear risk of worsening for the group with the highest BMI z score. Apolipoprotein E polymorphism, BMI z score, and adiponectin level were significantly associated with total cholesterol to high-density lipoprotein cholesterol (standardized beta coefficient = 0.283, 0.354, and -0.292, respectively; P < .001 for all) and apo A-I to apo B (standardized beta coefficient = -0.372, -0.284, and 0.327, respectively; P < .001 for all) ratios. CONCLUSION Our data suggest a more atherogenic lipid profile for some apo E genotypes and for increasing BMI z score, whereas adiponectin level seems to play a protective role.