Haroldo da Silva Ferreira

Short stature, obesity and arterial hypertension in a very low income population in North-eastern Brazil

BACKGROUND AND AIM This cross-sectional study involved the adult population (age >18 and <60 years) of a 315-shack slum on the outskirts of the city of Maceió in North-eastern Brazil. The purpose was to investigate whether short stature in adults (an indicator of undernutrition in early life) is associated with arterial hypertension and obesity. METHODS AND RESULTS We collected the subjects socio-economic data, and arterial hypertension (AH), weight, height, waist circumference and waist/hip (W/H) circumference ratio measurements. Hypertension was diagnosed as diastolic AH f 90 mmHg and/or systolic AH f 140 mmHg. The body mass index (BMI) was used to determine nutritional status, with overweight/obesity being defined on the basis of a cut-off point of 25 kg/m2. A W/H ratio of f 0.80 for women or f 0.95 for men was considered indicative of abdominal obesity. Short stature was defined as falling into the 1st quartile (Q) of height distribution. Hypertension was prevalent in 28.5% of the population (women=38.5%; men=18.4%). The systolic and diastolic AH readings were significantly higher in women in the 1st Q than in those in the 4th Q, and the same was true of W/H. The prevalence of hypertension was statistically significant for the first two Qs in comparison with the last two: 22.1% vs 14.6% (men), and 42.4% vs 34.6% (women). Hypertension was more prevalent in women who were obese and short (50%) than in those who were obese but not short (OR=1.98; CI=1.22-2.96). CONCLUSIONS Living conditions were extremely precarious and the prevalence of hypertension was quite high. Stature negatively correlated with hypertension and overweight in women but not in men.

Short stature of mothers from an area endemic for undernutrition is associated with obesity, hypertension and stunted children: a population-based study in the semi-arid region of Alagoas, Northeast Brazil

The objectives of the study were to investigate whether the health conditions of mothers with short stature differed from those with normal stature, and to establish if these aspects were associated with the health of the offspring. Data relating to health and socio-economic, demographic and anthropometric conditions were collected from a probabilistic sample population consisting of 1180 mothers and 1511 children ( < 10 years) living in the semi-arid region of the State of Alagoas, Brazil. Mothers were categorised according to stature, with those in the 1st quartile being defined as of short stature and those in the 4th quartile being defined as of normal stature and serving as a reference for the comparison of variables of interest. Following verification that maternal stature fulfilled parametric assumptions, its associations with the other variables were determined by calculating Pearson correlation coefficients. After excluding strongly self-correlated variables (r >or= 0.70), the remaining variables were analysed by multiple linear regression. The results showed that low maternal stature was independently associated with obesity (percentage body fat >or= 30; P = 0.045), abdominal adiposity (waist:hip ratio >or= 0.85; P = 0.007) and high systolic blood pressure ( >or= 140 mmHg; P = 0.006). Short maternal stature was associated with low birth weight ( < 3000 g; P = 0.01) and stunting (height-for-age Z score < - 2; P = 0.019) in the offspring. Thus, in the semi-arid region of Alagoas, women of short stature presented a higher prevalence of chronic degenerative diseases and produced less healthy children than women of normal stature.

Food consumed does not account for the higher prevalence of obesity among stunted adults in a very-low-income population in the Northeast of Brazil (Maceió, Alagoas)

Objective: To study the food pattern of stunted and nonstunted, obese and nonobese individuals in a very-low-income population.Design: A household survey.Setting: Slum set up by the ‘Homeless Movement’, city of Maceió (Alagoas), Brazil.Subjects and methods: A total of 532 adults classified by sex, stature (Z≤ and Z > −2s.d. of the NCHS curves), and body mass index (BMI) were compared using the following variables: waist circumference, waist–hip circumference ratio (W/H), percentage body fat (skinfold thickness and bioelectrical impedance), and food intake (24-h recall).Results: The prevalence of stunting was 22.6%. In all, 30% of the stunted subjects were overweight or obese, compared with 23% for the nonstunted individuals (P<0.05). In women, logistic regression analysis showed a strong association among weight, abdominal fat, and stunting (r=0.81). No significant differences were observed in the values of W/H or in the qualitative menu of the different categories. Energy intake was below the RDA figures (about 63%). There was similarity among the groups regarding the proportion of macronutrients, except for the fact that stunted obese women ingested less fat and protein than nonstunted obese women. Stunted obese individuals consumed less energy (5962 kJ) than the population as a whole (6213 kJ), an amount far lower than their average needs, which were calculated on the basis of their shorter stature (8109 kJ).Conclusion: The observed energy consumption seems compatible with the panorama of undernutrition present in the population, but it does not explain the high prevalence of obesity detected.Sponsorship: Alagoas State Foundation for the Support of Research (FAPEAL) and the National Agency for the Advancement of College Graduates (Ministry of Education and Sports), Brazil.

Evolution of nutritional status in hospitalized children

Objective: to assess the evolution of nutritional status in children admitted to the Teaching Hospital of Universidade Federal de Alagoas. Methods: a retrospective study was performed on 52 children (0 - 10yrs) whose length of hospital stay exceeded 10 days (from February to July/2001). We compared their nutritional status, expressed in terms of Z score of the weight-for-age ratio at the beginning (T1) and at the end of the hospitalization period (T2). Results: the predominant age range (44.2%) was less than 1 year (median=1.4yrs). The hospitalization period varied from 10 to 77 days (median=20 days). Although the prevalence rates of protein-energy malnutrition (PEM) in T1 and T2 were, respectively, 71.2% and 69.2%, only 15.4% had this diagnosis on the medical records. These children diagnosed with protein-energy malnutrition presented extreme wasting and greater length of hospital stay than the others (PEM, n=8: -4.38±2.1, T=30 ± 4.5; undiagnosed PEM, n=13: -3.13±0.9, T=23±18; other conditions, n=31: -0.63±1.1, T=21±13). Among the 52 children analyzed, only 29 showed positive weight variation. However, the average magnitude of negative Z values was higher than that of positive values: -0.56 and 0.50. Children who remained in hospital for a longer period of time showed larger weight deficits, indicating that hospitalization did not contribute towards the improvement of their initial nutritional status. Conclusion: the prevalence of weight-for-age deficit among children at hospital admission was very high. This situation remained unchanged at hospital discharge.

Prevalência e fatores associados à anemia em gestantes da região semi-árida do Estado de Alagoas

PURPOSE to determine the prevalence and risk factors associated to anemia in pregnant women from the semiarid region of Alagoas, Brazil. METHODS transversal study comprising a sample (n=150) obtained taking into consideration the prevalence estimated by World Health Organization of 52%, an error of 8% and a confidence interval of 95%. Sampling has been done in three stages: 15 towns among the 38 in the region, four census sectors by town and 24 residences by sector. All the resident pregnant women were eligible, and their socio-economic, demographic, anthropometric and health data have been collected. Anemia was identified at the <11 g/dL hemoglobin level (Hemocue), and its association with risk factors, tested by multiple linear regression analysis. RESULTS anemia prevalence was 50%. Seventy eight per cent of the pregnant women were under pre-natal care. From those, 79.3% were in the second or third trimester of gestation. Nevertheless, only 21.2% of them were taking iron supplementation. Variables (p<0.05) independently associated with anemia (anemic versus not-anemic pregnant women) were: larger number of family members (4.5+/-2.3 versus 4,3+/-2.3; p=0.02), lower age group of the pregnant woman (23.9+/-6.3 versus 24.7+/-6.7; p=0.04), or of her partner (34.5+/-15.8 versus 36+/-17.5; p=0.03), no toilet in the house (30.7 versus 24%; p<0.001), history of child abortion and/or death (32.4 versus 16.4%; p<0.001), living in the country (60 versus 46.7%; p=0.03), average per capita income <US

Short stature, abdominal obesity, insulin resistance and alterations in lipid profile in very low-income women living in Maceió, north-eastern Brazil

1.00/day (60.3 versus 52.1%; p=0.02), pre-gestational weight <50 kg (33.3 versus 24.6%; p=0.03), pre-natal care onset after the first trimester of gestation (45.3 versus 18%; p=0.002). CONCLUSIONS anemia prevalence in pregnant women from the semiarid region of Alagoas constitutes a major health problem, deserving special attention by the people in charge of public policy.

Prevalência e fatores de risco para anemia em crianças pré-escolares do Estado de Alagoas, Brasil

Objective To test the hypothesis that short stature is associated with abdominal obesity, insulin resistance and lipid profile changes. Methods Anthropometric data were collected from 237 women (18–60 years old), residents of a shantytown in Maceió. Biochemical profiles of 60 individuals drawn from this population were determined. Results Total and low-density lipoprotein (LDL) cholesterol levels and insulin resistance rose with increasing waist:hip circumference ratio, particularly in women. Short, overweight individuals exhibited larger biochemical alterations than overweight individuals of average stature. Conclusion Short stature, when associated with overweight, is a risk factor for increased insulin resistance and alterations in lipid profile.

Excesso de peso e fatores associados em crianças da região nordeste do Brasil

OBJECTIVE: to estimate the prevalence and establish risk factors associated with anemia in children in the Brazilian State of Alagoas. METHODS: a cross-sectional study with a probabilistic sample of 666 children aged between 6 and 60 months. Anthropometric, environmental, demographic, socio-economic data were collected during home visits, along with information on health, the use of public services and the existence of diseases. The concentration of hemoglobin (Hb) was measured using a HemoCue® photometer, and a level of <11 g/dL was taken to indicate anemia. Pearsons test was used identify correlations and the X2 test to analyze associations between the category variables. The association of anemia with the predictor variables was confirmed by multiple logistic regression, with statistical significance set at p<0.05. RESULTS: the prevalence of anemia was 45.0%. Hb levels were positively and significantly associated with age (r=0.44; p<0.01). The highest prevalence was found in the 6-12 month age-group (75.2%). Multivariate analysis identified the following variables associated with anemia: age <36 months (p<0.001) and a household with five or more occupants (p=0.031). CONCLUSIONS: the degree of prevalence of anemia found indicates that this is a serious public health problem in the State of Alagoas. Larger families and those with children aged under three years should receive greater attention.

Prevalência de extremos antropométricos em crianças do estado de Alagoas

OBJECTIVE To investigate the prevalence of overweight and its association with socioeconomic, biological, and maternal factors in children under 5 years of age in the semiarid region of the state of Alagoas. METHODS This was a cross-sectional study with a representative sample. We evaluated child variables (excess weight, sex, birth weight, prematurity, duration of breastfeeding, and origin) and mother variables (excess weight, central obesity, income, education, and smoking during pregnancy). Excess weight in children was defined based on the weight-for-height ≥ 1 z score; in mothers, overweight and central obesity were identified by mass body index ≥ 30 kg/m2 and waist circumference ≥ 80 cm, respectively. We conducted logistic regression, adopting overweight as an outcome, considering as significant p < 0.05. RESULTS The sample comprised 963 children, with a mean age of 27.7 months (SD ±17.3). The prevalence of overweight children was 28.5%, directly associated with central obesity in the mother (odds ratio = 1.46; 95%CI 1.07-1.98) and duration of non-exclusive breastfeeding for a period of less than 6 months (odds ratio = 1.82, 95%CI 1.31-2.51). CONCLUSIONS This study showed a high prevalence of overweight children under 5 years of age associated with central obesity in the mother and non-exclusive breastfeeding for a period less than 6 months. These findings suggest that breastfeeding may protect children against overweight and point to the need for primary and secondary prevention of maternal central obesity.OBJECTIVE: To investigate the prevalence of overweight and its association with socioeconomic, biological, and maternal factors in children under 5 years of age in the semiarid region of the state of Alagoas. METHODS: This was a cross-sectional study with a representative sample. We evaluated child variables (excess weight, sex, birth weight, prematurity, duration of breastfeeding, and origin) and mother variables (excess weight, central obesity, income, education, and smoking during pregnancy). Excess weight in children was defined based on the weight-for-height > 1 z score; in mothers, overweight and central obesity were identified by mass body index > 30 kg/m2 and waist circumference > 80 cm, respectively. We conducted logistic regression, adopting overweight as an outcome, considering as significant p < 0.05. RESULTS: The sample comprised 963 children, with a mean age of 27.7 months (SD ±17.3). The prevalence of overweight children was 28.5%, directly associated with central obesity in the mother (odds ratio = 1.46; 95%CI 1.07-1.98) and duration of non-exclusive breastfeeding for a period of less than 6 months (odds ratio = 1.82, 95%CI 1.31-2.51). CONCLUSIONS: This study showed a high prevalence of overweight children under 5 years of age associated with central obesity in the mother and non-exclusive breastfeeding for a period less than 6 months. These findings suggest that breastfeeding may protect children against overweight and point to the need for primary and secondary prevention of maternal central obesity.

Should nutrition be considered as a supplementary measure in schistosomiasis control

O objetivo do artigo foi estimar a prevalencia de extremos antropometricos indicativos do estado nutricional de criancas. Realizou-se estudo transversal com amostra probabilistica de 1.386 criancas menores de cinco anos do estado de Alagoas. As prevalencias de deficits (z < -2; padrao da Organizacao Mundial de Saude-2006) para os indices peso-para-idade (baixo peso), peso-para-altura (magreza) e altura-para-idade (deficit estatural) foram, respectivamente, 2,9% (n=40), 1,2% (n=17) e 10,3% (n=144). O excesso de peso-para-altura (sobrepeso) acometeu 135 criancas (9,7%). Conclui-se que as prevalencias de baixo peso e magreza sao epidemiologicamente irrelevantes e que o deficit estatural e o sobrepeso prevalecem com identica magnitude.The objective of the study was to estimate the prevalence of extreme anthropometric measurements in children indicative of their nutritional status. A cross-sectional study was conducted in a random sample of 1,386 children under five in the state of Alagoas, northeastern Brazil. The prevalence of deficits (z <-2; WHO-2006 standard) for weight-for-age (underweight), weight-for-height (wasting) and height-for-age (stunting) were 2.9% (n = 40), 1.2% (n = 17), and 10.3% (n = 144), respectively. Excess of weight-for-height (overweight) was seen in 135 children (9.7%). In conclusion, the prevalences of underweight and wasting are epidemiologically irrelevant and stunting and overweight have a similar prevalence.