Gilberto Kac

Reference values of handgrip dynamometry of healthy adults: a population-based study.

BACKGROUND & AIMS Although maximal voluntary handgrip strength (HGS) is considered a reliable tool in nutritional assessment there are few reference data available. This paper presents reference values for handgrip strength of healthy adults (age > or = 20 years) from a household survey. METHODS Data were obtained from a representative sample of adults (1122 males and 1928 females) living in Niterói, Rio de Janeiro, Brazil. HGS was measured three times with a Jamar mechanical dynamometer in both hands and the highest value used in the analysis. The percentile distribution of HGS was calculated according to sex and age categories. RESULTS Mean values of right and left HGS were 42.8 and 40.9 kg for males, and 25.3 and 24.0 kg for females, respectively. HGS increased with age and significantly decreased after 40 and 50 year-olds for women and men, respectively. Body mass index (BMI) was associated with HGS in both sexes but only underweight male subjects had significantly lower HGS values. CONCLUSIONS The highest HGS values are observed at the 4th decade of life with significant declines thereafter. HGS is significantly associated with BMI. The reference values of HGS may be useful in assessing the nutritional status of similar adult urban population.

Physical activity during pregnancy and maternal-child health outcomes: a systematic literature review

A systematic literature review was conducted to investigate the effects of physical activity during pregnancy on selected maternal-child health outcomes. The search included articles published from 1980 to 2005 in the MEDLINE and LILACS databases using key words such as physical activity, physical exercise, pregnancy, and gestation. The methodological quality of 37 selected articles was evaluated. It appears to be a consensus that some light-to-moderate physical activity is not a risk factor and may even be considered a protective factor for some outcomes. However, some studies found an association between specific activities (e.g., climbing stairs or standing for long periods) and inadequate birth weight, prematurity, and miscarriage. Few studies found an association between physical activity and maternal weight gain, mode of delivery, or fetal development. Further research is needed to fill these gaps and provide guidelines on the intensity, duration, and frequency of physical activity during pregnancy.

Evaluation of waist circumference to predict general obesity and arterial hypertension in women in Greater Metropolitan Belo Horizonte, Brazil

This study examined the capacity of waist circumference (WC) to identify subjects with overweight (BMI >/=25) and obesity (BMI >/=30), in agreement with internationally recommended levels of action. Data were obtained from 791 women, 15-59 years old. After identifying overweight and obesity according to WC values, sensitivity and specificity were calculated to verify whether WC could be a good risk predictor for hypertension. Associations were tested by linear regression and logistic regression, controlling for confounding. WC cut-off points of 80cm and 88cm correctly identified 89.8% and 88.5% of women with overweight and obesity, respectively. Abdominal obesity (WC >/=88cm) was statistically associated with hypertension in the multivariate analysis (OR = 2.88; 95% CI: 1.77-4.67). Hypertension was identified with a sensitivity of 63.8% and 42.8%, and with a specificity of 68.0% and 83.3%, for WC >/=80 and >/=88, respectively. The proposed cut-off points for abdominal obesity can potentially distinguish individuals at risk for future obesity, but has only moderate power to predict individuals with high blood pressure.

Nine months postpartum weight retention predictors for Brazilian women

OBJECTIVE To identify factors potentially associated with weight retention measured 9 months after childbirth. DESIGN Prospective study with four follow-up waves in time (0.5, 2, 6 and 9 months postpartum). SETTING Rio de Janeiro, Brazil. SUBJECTS AND METHODS Two hundred and sixty-six Brazilian women of childbearing age. Analysis was based on hierarchical logistic regression. The dependent variable was weight retention and was defined as the difference between weight at 9 months postpartum and pre-pregnancy weight, with a dichotomised cut-off at 7.5 kg. Covariates included demographic and socio-economic data, obstetric history, anthropometric data, and data on the infant. These data were grouped in blocks and ordered according to their influence on the dependent variable. RESULTS Of the women studied, 19.2% presented weight retention values > or =7.5 kg. According to the logistic regression analysis, the following variables remained associated with weight retention > or =7.5 kg: total family income, difficulty or inability to read a letter, age category > or =30 years, age at first childbirth <23 years, gestational weight gain > or =12 kg, body fat at baseline > or =30% and infant birth weight <3500 g. Infant hospitalisation was only marginally significant. CONCLUSIONS Determinant factors identified by the analysis highlight the need for nutritional intervention policies during pregnancy and in the first months postpartum as a way of minimising obesity and the diseases resulting from it.

Epidemiologia do sobrepeso e da obesidade e seus fatores determinantes em Belo Horizonte (MG), Brasil: estudo transversal de base populacional

OBJETIVO: Determinar a prevalencia do sobrepeso e da obesidade e investigar os fatores de risco na populacao maior de 18 anos residente na regiao metropolitana de Belo Horizonte, Brasil. METODOS: Foram analisados dados obtidos pela pesquisa sobre padroes de vida realizada pelo Instituto Brasileiro de Geografia e Estatistica entre 1996 e 1997 a partir de uma amostra probabilistica de 1 105 individuos. Medidas de peso e altura foram realizadas por equipes treinadas. O sobrepeso (indice de massa corporal >25,0 kg/m²) e a obesidade (indice de massa corporal > 30,0 kg/m²) foram definidos como variaveis dependentes. Os potenciais fatores associados foram estudados a partir de analises bivariadas e da tecnica de regressao logistica multivariada. RESULTADOS: A prevalencia do sobrepeso e da obesidade foi de 31,1% (IC95%: 27,3 a 35,2) e 5,7% (IC95%: 4,0 a 8,1) nos homens e 25,9% (IC95%: 22,4 a 29,8) e 14,7% (IC95%: 11,9 a 17,9) nas mulheres. Na analise multivariada, a idade e o estado marital permaneceram como fatores de risco independentes para o sobrepeso, enquanto a idade, o sexo e a escolaridade permaneceram como fatores independentes para a obesidade. A interacao entre o sexo feminino e a alta escolaridade constituiu-se em fator protetor para o sobrepeso (OR = 0,52; IC95%: 0,33 a 0,83), mas nao para a obesidade. As mulheres de baixa escolaridade apresentaram alto risco (OR = 5,95; IC95%: 2,51 a 14,12) de desenvolver obesidade em comparacao aos homens. CONCLUSOES: Os resultados indicam que o sobrepeso e a obesidade podem vir a se tornar um serio problema de saude publica na regiao metropolitana de Belo Horizonte. E importante desenvolver estudos que enfoquem a relacao entre o sobrepeso e a obesidade e variaveis comportamentais, como o fumo e o consumo de alcool.

Association of Second and Third Trimester Weight Gain in Pregnancy with Maternal and Fetal Outcomes

Objective To investigate the association between weekly weight gain, during the second and third trimesters, classified according to the 2009 Institute of Medicine (IOM/NRC) recommendations, and maternal and fetal outcomes. Methods Gestational weight gain was evaluated in 2,244 pregnant women of the Brazilian Study of Gestational Diabetes (Estudo Brasileiro do Diabetes Gestacional – EBDG). Outcomes were cesarean delivery, preterm birth and small or large for gestational age birth (SGA, LGA). Associations between inadequate weight gain and outcomes were estimated using robust Poisson regression adjusting for pre-pregnancy body mass index, trimester-specific weight gain, age, height, skin color, parity, education, smoking, alcohol consumption, gestational diabetes and hypertensive disorders in pregnancy. Results In fully adjusted models, in the second trimester, insufficient weight gain was associated with SGA (relative risk [RR] 1.72, 95% confidence interval [CI] 1.26–2.33), and excessive weight gain with LGA (RR 1.64, 95% CI 1.16–2.31); in third trimester, excessive weight gain with preterm birth (RR 1.70, 95% CI 1.08–2.70) and cesarean delivery (RR 1.21, 95% CI 1.03–1.44). Women with less than recommended gestational weight gain in the 2nd trimester had a lesser risk of cesarean deliveries (RR 0.82, 95% CI 0.71–0.96) than women with adequate gestational weight gain in this trimester. Conclusion Though insufficient weight gain in the 3rd trimester was not associated with adverse outcomes, other deviations from recommended weight gain during second and third trimester were associated with adverse pregnancy outcomes. These findings support, in part, the 2009 IOM/NRC recommendations for nutritional monitoring during pregnancy.

Mild but Not Light or Severe Food Insecurity Is Associated with Obesity among Brazilian Women

Our aim was to determine whether food insecurity was associated with a higher prevalence of obesity in a large random sample of Brazilian women of reproductive age. The data were derived from the 3rd edition of the Childrens and Womens National Demographic and Health Survey conducted in 2006-07. This was a nationally representative cross-sectional study. Obesity (BMI ≥ 30 kg/m(2)) was the outcome variable. Associations were measured using crude and adjusted prevalence ratios (PR) with 95% CI through Poisson regression models taking into account the complex sampling design. The sample included 10,226 women from 18 to 45 y of age. The prevalence of any level of food insecurity measured by the Brazilian Food Insecurity Scale was 40.9%, with 25.5% light, 10.1% mild, and 5.3% severe food insecurities. The prevalence of obesity was 17.4%. We found a borderline effect of light food insecurity and increased prevalence of obesity in Brazil (PR = 1.16; 95% CI = 0.98-1.38; P = 0.08). Women with mild food insecurity had a higher risk of being obese than their food-secure counterparts (PR = 1.49; 95% CI = 1.17-1.90; P = 0.010) after adjustment for skin color/ethnicity, years of schooling, geographical region, income, age, and marital status. In conclusion, this study suggests that mild but not light or severe food insecurity was associated with obesity as assessed by BMI, even after adjusting for various confounding factors in this large cross-sectional survey performed in a middle-income country undergoing the nutrition transition.

High cesarean prevalence in a national population‐based study in Brazil: the role of private practice

Background. Excessive use of cesarean sections (CSs) is a serious problem worldwide. Objective. To estimate the frequency and identify factors associated with cesarean deliveries in Brazil. Design. Cross‐sectional study conducted in 2006–2007 as part of the third edition of the Childrens and Womens National Demographic and Health Survey. Setting. Brazil. Sample. Brazilian women in reproductive age. Methods. Socioeconomic and demographic data were utilized, including maternal age, education level, per capita income, skin color, smoking habit, marital status, age at first delivery, parity, and type of prenatal services. Main outcome measures. Adjusted estimate of the prevalence ratios of the type of delivery performed (cesarean or vaginal). Results. Cesarean prevalence was 43.9% (95% CI: 40.9–46.9), 68.7% for women who had per capita income greater than US

[Obesity prevalence and associated factors in the elderly in Pelotas, Rio Grande do Sul State, Brazil: obesity classification according to two cutoff points for body mass index].

125 per month, and 77.2% for those who had attended private or privately insured prenatal services. In the adjusted analysis, the variables that presented significant prevalence ratios (95% confidence interval) were macro‐region [southeast = 1.45 (1.21–1.73); south = 1.48 (1.24–1.77), and midwest = 1.43 (1.21–1.71)], maternal age above 25 years [26–30 years = 1.57 (1.25–1.97); ≥ 31 years = 1.77 (1.39–2.27)], education levels ≥ 9 years (PR = 1.86, 95% CI: 1.55–2.23), and having attended private or privately insured prenatal services (PR = 1.87, 95% CI: 1.65–2.12) and parity [primipara = 1.87 (1.47–2.36)]. Conclusions. CS rates are generally very high in Brazil. They are significantly higher than the average among women attending private/insured antenatal care, among the highly educated, and in provinces with higher socioeconomic levels.

Normal weight obesity is associated with metabolic syndrome and insulin resistance in young adults from a middle-income country.

The aim of this study was to estimate obesity prevalence and associated factors in the elderly, according to two cutoff points for body mass index (BMI). This was a cross-sectional, population-based study of a sample of 596 elderly residents in Pelotas, southern Brazil. Nutritional status was evaluated through BMI based on self-reported weight and stature. Poisson multiple regression with hierarchical analysis was applied, with two dependent variables for definition of obesity: BMI > 27 kg/m(2) and BMI > or =30 kg/m(2), the cutoff points proposed by Lipschitz and the World Health Organization, respectively. Prevalence of obesity was 48.7% (95%CI: 44.6-52.7) for BMI > 27 kg/m2 and 25.3% (95%CI: 21.9-29.0) for BMI > or =30 kg/m(2). Two multiple regression models showed an association between obesity and female gender and age. BMI > 27 kg/m(2) showed an association with age and smoking and BMI > or =30 kg/m(2) with sedentary lifestyle. Obesity prevalence was high in this group of elderly. For the Brazilian elderly population and from a public health perspective, the study suggests the use of a more sensitive cutoff point, namely BMI > 27 kg/m(2).