Ciro João Bertoli

Prevalence of overweight preschool children in public day care centers: a cross-sectional study

CONTEXT AND OBJECTIVE Brazil is undergoing a period of epidemiological transition associated with demographic and nutritional changes. The prevalence of obesity is also increasing in children and is causing numerous health problems that are becoming public health issues. The aim here was to evaluate the prevalence of overweight among children of two and three years of age. DESIGN AND SETTING Cross-sectional study in municipal day care centers in Taubaté, state of São Paulo, Brazil. METHODS Weight and height measurements were made on 447 preschool children forming a probabilistic randomized sample. Their body mass index (BMI) was calculated. Their nutritional status was classified using the World Health Organization reference cutoff points (2006). Their mean weight, height and BMI were compared according to their age and sex. RESULTS The mean values for the final sample (n = 447) were as follows: mean age: 38.6 months (± 3.5) and Z scores for: weight/height (W/H): 0.50 (± 1.22); height/age: -0.03 (± 1.07); weight/age (W/A): 0.51 (± 1.23); and BMI: 0.51(± 1.23). The prevalence of overweight children (BMI > 1 z) was 28.86%, while the prevalence of underweight children (BMI < -2 z) was 0.89%. There were no differences in mean BMI among the two and three-year age groups (P = 0.66). CONCLUSION A high prevalence of overweight was observed in the sample of two and three-year-old children, with practically no malnutrition, thus showing that a significant nutritional transition may already be occurring, even in medium-sized cities of developing countries.

Novas curvas de crescimento da Organização Mundial da Saúde: comparação com valores de crescimento de crianças pré-escolares das cidades de Taubaté e Santo André, São Paulo

OBJECTIVE: The World Health Organization (WHO), in 2007, proposed a growth reference standard from five to 19 years to be used in continuation to the 2006 one (for children younger than five years-old). This growth chart shows a satisfactory adjustment at five years with the 2006 curve. This study aims to compare WHO references with the growth observed in Brazilian preschool children. METHODS: 2,830 children between three and six years old from Taubate and Santo Andre cities, in Sao Paulo State, Brazil, were studied regarding weight, height and body mass index (BMI). The 5th, 50th and 95th percentiles (P) were calculated in several ages for both genders and compared to the WHO reference values. RESULTS: Concerning height, the WHO reference values were closer to or a little higher than the Brazilian studied samples until five years. At this time, an opposed tendency was noticed with WHO height percentiles becoming progressively below the Brazilian samples until the age of seven. For weight and BMI in all considered ages, the 5thP and the 50thP of the WHO referential were slightly lower than the childrens ones, but the 95thP shows a trend of a progressively lower growth close to seven years: the BMI 95thP from the preschool samples were around 4kg/m2 higher than WHO values. CONCLUSIONS: The use of WHO reference growth chart will produce a lower prevalence of malnutrition and short stature between five and seven years and, at the same time, an important rise of obesity prevalence between ages three and seven.

Ratio of weight to height gain: a useful tool for identifying children at risk of becoming overweight or obese at preschool age

PURPOSE: To analyze the usefulness of the weight gain/height gain ratio from birth to two and three years of age as a predictive risk indicator of excess weight at preschool age. METHODS: The weight and height/length of 409 preschool children at daycare centers were measured according to internationally recommended rules. The weight values and body mass indices of the children were transformed into a z-score per the standard method described by the World Health Organization. The Pearson correlation coefficients (rP) and the linear regressions between the anthropometric parameters and the body mass index z-scores of preschool children were statistically analyzed (alpha = 0.05). RESULTS: The mean age of the study population was 3.2 years (±0.3 years). The prevalence of excess weight was 28.8%, and the prevalence of overweight and obesity was 8.8%. The correlation coefficients between the body mass index z-scores of the preschool children and the birth weights or body mass indices at birth were low (0.09 and 0.10, respectively). There was a high correlation coefficient (rP = 0.79) between the mean monthly gain of weight and the body mass index z-score of preschool children. A higher coefficient (rP = 0.93) was observed between the ratio of the mean weight gain per height gain (g/cm) and the preschool children body mass index z-score. The coefficients and their differences were statistically significant. CONCLUSION: Regardless of weight or length at birth, the mean ratio between the weight gain per g/cm of height growth from birth presented a strong correlation with the body mass index of preschool children. These results suggest that this ratio may be a good indicator of the risk of excess weight and obesity in preschool-aged children.

Evaluation of Mid-upper Arm Circumference in Pre-school Children: Comparison Between NCHS/CDC-2000 and WHO-2006 References

We aimed to evaluate the classification of arm circumference (AC) in pre-school children by using National Center for Health Statistics (NCHS/CDC-2000) and World Health Organization (WHO-2006) references. We evaluated 205 children: weight, height and AC were assessed and the body mass index (BMI) was calculated. The BMI values were classified into Z-scores by the WHO referential. The AC was classified into Z-cores by two references, comparing the whole-sample value and among groups (tercis) of BMI Z-score. The correlation was also evaluated between differences of AC with BMI Z-score. The WHO referential classified the AC in Z-scores greater than the NCHS/CDC, which is more specific and less sensitive than the NCHS/CDC for lean children and at the same time more sensitive and less specific for children with overweight. In conclusion, a significant difference in the AC classification occurs according to the referential used.

Maternal breastfeeding, early introduction of non-breast milk, and excess weight in preschoolers

Abstract Objective: Investigate associations between excess weight in preschool children, breastfeeding duration and age of non-breast milk introduction. Methods: Cross-sectional study of a representative sample of 817 preschool children, aged 2-4 years, attending municipal day care centers in the city of Taubaté. The weight and height of children were measured in the day care centers in 2009, 2010 and 2011. The body mass index z-score (BMIz) was calculated and children were classified as risk of overweight (BMIz≥1 to<2) or excess weight (BMIz≥2). Data analysis was carried out by comparison of proportions, coefficient of correlation and multivariate linear regression. Results: The prevalence of risk of overweight was 18.9% and of excess weight (overweight or obesity) was 9.3%. The median duration of breastfeeding and age of introduction of non-breast milk was 6 months. The childs BMIz showed direct correlation with birth weight (r=0.154; p<0.001) and maternal body mass index (BMI) (r=0.113; p=0.002). The correlation was inverse with the total duration of breastfeeding (r=−0.099; p=0.006) and age at non-breast milk introduction (r=−0.112; p=0.002). There was no correlation between the childs BMIz with birth length, duration of exclusive breastfeeding and mothers age. Conclusions: The earlier the introduction of non-breast milk, the higher the correlation with excess weight at preschool age.

Mothers' conceptions about excess weight in infancy and the nutritional status of their children.

OBJECTIVE: To analyze maternal conceptions about excess weight in infancy and the nutritional status of their preschool-aged children. METHODS: A mixed, exploratory study was performed using semi-structured interviews. Two study groups were defined: a group of 16 mothers of children with excess weight and a group of 15 mothers of eutrophic children. The interviews were submitted to content analysis using CHIC software (Classification Hiérarchique Implicative et Cohésitive®). RESULTS: The mothers of children with excess weight tended to conceive thin children as malnourished, while those of normal weight children emphasized the influence of family and genetics as determinants of a child’s nutritional status. Although there was a certain consensus among the mothers that an unhealthy diet contributes to the risk of a child developing excess weight, the concept of genetics as a determinant of a child’s nutritional status was also present in the dialogue from the mothers of both groups. This result indicates a lack of clarity regarding the influence of eating behavior and family lifestyle on weight gain and the formation of a child’s eating habits. Both groups indicated that the mother has a decisive role in the eating habits of her child; however, the mothers of children with excess weight did not seem to take ownership of this concept when addressing the care of their own children. CONCLUSION: Differences in conceptions, including taking ownership of care, may contribute to the development of excess weight in preschool-aged children.

Body composition of preschool children and relation to birth weight

OBJECTIVE to evaluate the relationship between body composition of preschool children suffering from excess weight and birth weight (BW). METHODS probabilistic sample, by conglomerates, with 17 daycare centers (of a total of 59) composing a final sample of 479 children. We used Z-score of Body Mass Index (zBMI) ≥ +1 and ≥ +2, respectively, to identify preschool children with risk of overweight and excess weight (overweight or obesity). The arm muscle area (AMA) and the arm fat area (AFA) were estimated from measurements of arm circumference, triceps skin fold thickness. RESULTS the prevalence of risk of overweight was 22.9% (n=110) and excess weight was 9.3% (n=44). The risk of overweight and excess weight in children did not show correlation between BW and AFA, but it did with adjusted arm muscle area (AMAa) (rp= 0.21; p= 0.0107). The analysis of the group with excess weight alone also showed a positive correlation between BW and AMAa (rp= 0.42; p= 0.0047). CONCLUSION among overweight children, lower BW is associated with a lower arm muscle area in early preschool age, regardless of the fat arm area presented by them.

NÍVEL DE ATIVIDADE FÍSICA EM ADOLESCENTES SAUDÁVEIS

Introducao: A recomendacao atual para pratica de atividades fisicas na infância e adolescencia e de que todo jovem deveria envolver-se diariamente por 60 minutos ou mais em atividades fisicas moderadas em cinco ou mais dias da semana, somando-se pelo menos 300 minutos de atividades fisicas por semana. Poucos estudos sobre o nivel de atividade fisica foram encontrados com amostras de criancas e adolescentes brasileiros. Objetivo: Esta pesquisa tem como objetivo a aplicacao de um questionario para avaliar o nivel de atividade fisica realizada e suas correlacoes com estagios da puberdade e indice de massa corporal (IMC) em adolescentes saudaveis matriculados na rede municipal de ensino da cidade de Taubate, SP, Brasil. Metodos: Foi realizado um estudo transversal por meio de aplicacao de um questionario (IPAQ) para avaliar o nivel de atividade fisica e sua correlacao com peso, altura e IMC de 202 adolescentes saudaveis. Resultados: O grupo de 15 a 17 anos, considerado pos-pubere nesta pesquisa, apresentou tempos significantemente maiores do que os demais grupos, quanto a resposta da questao 4b (p = 0,002), que indaga sobre o tempo total gasto sentado durante um dia de final de semana. Conclusao: O grupo de 9 a 11 anos, considerado pre-pubere nesta pesquisa, apresentou numeros significantemente maiores do que os demais grupos quanto as atividades ludicas moderadas.

Crescimento de lactentes durante o primeiro ano de vida

The aim of this study was to describe and analyse the profile of growth in normal infants during the first year of life, including their patterns of weight and length, and the duration of breastfeeding METHODS: This is a retrospective cohort study conducted based on 85 records of infants who met the inclusion criteria. The total duration of breastfeeding was recorded along with weight and length at three ages: birth, 6 and 12 months. The data were analysed as Z-scores based on WHO (2006) using the software products MedCalc 12.0 and GraphPad Prism 6.0 RESULTS: Although 76.5% of the infants showed a growth pattern compatible with WHO references at 12 months of age, the others presented as overweight as at risk of being overweight. A significant correlation was observed between birth weight and BMI Z-score at two ages: 6 months (r = 0.26; p = 0.01) and 12 months (r = 0.32; p = 0.002). A correlation between birth weight and length Z-score was also found at 6 months (r = 0.4034; p = 0.0001) and 12 months (r = 0.3309; p = 0.002). Birth length was also correlated with length Z-score at 6 months (r = 0.4829; p Analisar o perfil do crescimento durante o primeiro ano de vida em lactentes normais e suas relacoes com o peso e o comprimento ao nascer e com o aleitamento materno METODO: Estudo de coorte retrospectiva com levantamento de dados de prontuarios de 85 criancas que preencheram os criterios de inclusao. Registrou-se com peso e comprimento ao nascer, aos 6 e 12 meses de vida, e o tempo total de aleitamento materno. Os dados de crescimento foram analisados em escores z com base na referencia da OMS (2006), utilizando os softwares MedCalc 12.0 e GraphPad Prism 6.0 RESULTADOS: Aos 12 meses de vida 76,5% dos lactentes apresentavam valores de crescimento compativeis com o referencial da OMS, enquanto os demais estavam em risco de sobrepeso e sobrepeso. Observou-se correlacao entre o peso de nascimento e o escore z do Indice de Massa Corporal aos 6 meses (r = 0,26; p= 0,01) e aos 12 meses (r = 0,32; p = 0,002) e tambem com o escore z do comprimento para idade aos 6 (r = 0,4034; p = 0,0001) e 12 meses (r = 0,3309; p = 0,0020). O comprimento ao nascer tambem mostrou correlacao com o escore z de comprimento aos 6 (r = 0,4829; p

Relato de um caso de neutropenia congênita grave em um lactente jovem

OBJECTIVE: To report a case of severe congenital neutropenia and alert pediatricians about its diagnosis in young patients with recurrent infectious diseases. CASE DESCRIPTION: Young infant with 45 days of life, with a history of high fever, lethargy, poor feeding and repeated blood counts showing significant leucopenia due to a significant decrease of polymorphonuclear cells. The diagnosis was confirmed by bone marrow aspirate showing hypoplasia of the granulocytic series and complete absence of mature neutrophils. Treatment was started with broad-spectrum antibiotic therapy and granulocyte colony-stimulating factor, but the patient died due to infectious complications 21 days after hospital admission. COMMENTS: This is a young infant with a rare congenital disorder that leads to severe neutropenia and, therefore, susceptible to potentially fatal infections. In the hospital the infant showed signs and symptoms of sepsis. The diagnosis was based on the clinical history and the presence of repeated altered white cell counts and it was confirmed by bone marrow aspirate. Granulocyte colony-stimulating factor is generally effective, but, in this case, the patient died with a severe infection.