Jairo Calado Cavalcante

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.

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.

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

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.

Fluoride intake from drinking water and dentifrice by children living in a tropical area of Brazil

Objective: To assess fluoride (F-) intake from water and toothpaste by children aged 18 to 36 months and to monitor the F- concentrations in the drinking water system in a tropical city of Brazil. Methods: Children (n=58) aged 18-36 months, all lifetime residents of Penedo, state of Alagoas, Brazil, participated in this study. Water F- analyses were carried out in 7 different occasions at least a week apart. For 2 days all the water drunk by each child was accounted for. Fluoride intake from water for each child was estimated using the mean F- concentration of water in 7 different occasions. Fluoride intake from toothpaste was estimated by subtracting the recovered post-brushing F- from the original amount placed in the toothbrush. The F- intake from water and toothpaste was estimated by dividing the total amount of F- ingested by the weight of each child. Results: The mean F- concentration in the drinking water was 0.94 ppm (mean range 0.78-1.1 ppm), which is above the 0.7 ppm recommended for this area of Brazil. Mean total F- intake from water and toothpaste was 0.128 mg F-/Kg Body Weight/day. The daily means of F- intake from water and toothpaste were 0.021 and 0.107 mg F-/Kg Body Weight, respectively. Ninety six percent of children showed F- intake above 0.07 mg F-/Kg Body Weight/day. Conclusions: Children in Penedo are at risk for developing dental fluorosis due to high F- intake from fluoridated toothpastes. Water fluoridation showed low contribution to the total F- intake. However, high water F- concentrations in the water indicate the need of surveillance of the artificial water fluoridation system.

Influence of Maternal Height and Weight on Low Birth Weight: A Cross-Sectional Study in Poor Communities of Northeastern Brazil

Background Low birth weight (LBW) is associated with an increased risk of mortality, adverse metabolic conditions, and long-term chronic morbidities. The relationship between LWB and short maternal stature coupled with nutritional status was investigated in poor communities. Methods/Principal Findings A cross-sectional population-based study involving 2226 mother-child pairs was conducted during the period 2009-2010 in shantytowns of Maceió, Alagoas, Brazil. Associations between LBW and maternal sociodemographics, stature and nutritional status were investigated. The outcome variable was birth weight (< 2500g and ≥ 2500g). The independent variables were the age, income, educational background, stature and nutritional status (eutrophic, underweight, overweight and obese) of the mother. The frequency of LBW was 10%. Short-statured mothers (1st quartile of stature ≤ 152cm) showed a tendency of increased risk of LBW children compared to mothers in the 4th quartile of stature (>160.4cm) (OR: 1.42, 95% CI: 0.96 - 1.09, p = 0.078). Children from short-statured mothers weighed an average of 125g less than those from taller mothers (3.18±0.56kg vs. 3.30±0.58kg, respectively p = 0.002). Multivariate analyses showed that short stature, age < 20y (OR: 3.05, 95% CI:1.44 - 6.47) or were underweight (OR: 2.26, 95% CI:0.92 - 5.95) increased the risk of LBW, while overweight (OR: 0.38, 95% CI:0.16 - 0.95) and obesity (OR: 0.39, 95% CI:0.11 - 1.31) had lower risk for LBW. In taller mothers, lower income and underweight were associated with LBW (OR: 1.88, 95% CI: 1.07 - 3.29 and 2.85, 95% CI:1.09 - 7.47, respectively), and obese mothers showed a trend of increased risk of LBW (OR: 1.66, 95% CI:0.84 - 3.25). Conclusions/Significance Overweight was found to have a protective effect in short-statured mothers, indicating that a surplus of energy may diminish the risk of LBW. Short-statured younger mothers, but not taller ones, showed higher risk of LBW. The mother being underweight, regardless of stature, was associated with LBW.

Adolescents: contraceptive knowledge and use, a Brazilian study.

The purpose of this study was to identify the knowledge and use of contraceptive methods by female adolescent students. The study was cross-sectional and quantitative, using a semi-structured questionnaire that was administered to 12- to 19-year-old female students in Maceió, Brazil. A representative and randomized sample was calculated, taking into account the number of hospital admissions for curettage. This study was approved by the Human Research Ethics Committee, and Epi InfoTM software was used for data and result evaluation using the mean and chi-square statistical test. Our results show that the majority of students know of some contraceptive methods (95.5%), with the barrier/hormonal methods being the most mentioned (72.4%). Abortion and aborting drugs were inaccurately described as contraceptives, and 37.9% of the sexually active girls did not make use of any method. The barrier methods were the most used (35.85%). A significant association was found in the total sample (2,592) between pregnancy and the use of any contraceptive method. This association was not found, however, in the group having an active sexual life (559). The study points to a knowledge of contraceptive methods, especially by teenagers who have already been pregnant, but contraceptives were not adequately used. The low use of chemical methods of contraception brings the risk of pregnancy. Since abortion and aborting drugs were incorrectly cited as contraceptive methods, this implies a nonpreventive attitude towards pregnancy.

Nutrição e saúde das crianças das comunidades remanescentes dos quilombos no Estado de Alagoas, Brasil

OBJETIVO: Descrever as condicoes de nutricao e saude das criancas de 6 a 59 meses de 39 comunidades remanescentes dos quilombos no Estado de Alagoas. METODOS: Para este estudo transversal, coletaram-se dados antropometricos, demograficos, socioeconomicos e de saude. O escore Z 2 para o indice PE. Utilizou-se o padrao antropometrico de 2006 da Organizacao Mundial da Saude. A anemia foi diagnosticada por um nivel de hemoglobina (HemoCue) menor que 11 g/dL. RESULTADOS: Foram avaliadas 973 criancas (50,4% meninos). A maioria das familias (60,8%) pertencia a classe E (a mais pobre) e era assistida pelo Programa Bolsa Familia (76,0%). Os chefes de familia apresentavam escolaridade < 4 anos de estudo (75,9%) e 57,1% dos domicilios tinham mais do que 5 moradores. As prevalencias de deficits de PI, PE, EI (deficit estatural) e sobrepeso foram, respectivamente, 3,4, 2,0, 11,5 e 7,1%. A anemia foi identificada em 52,7% das criancas, nao diferindo entre aquelas portadoras de deficit estatural ou sobrepeso (P = 0,43). CONCLUSOES: O deficit estatural, indicativo de desnutricao cronica, foi o desvio antropometrico mais prevalente, seguido pelo sobrepeso, apesar do perfil de pobreza predominante. A anemia foi um grave problema, acometendo de forma intensa tanto criancas com deficit estatural como aquelas com sobrepeso. O conjunto desses achados indica que o direito humano a alimentacao adequada nao vem sendo garantido as criancas quilombolas alagoanas, devendo o poder publico adotar as medidas necessarias para reverter tal situacao.

Quality of life of individuals with sickle cell disease followed at referral centers in Alagoas, Brazil

Background Sickle cell disease is a genetic, hereditary and chronic disease that affects the health of its carriers and might impair their health-related quality of life. Objective The aim of the current study was to assess the health-related quality of life of individuals with sickle cell disease followed at referral centers in Alagoas, Brazil. Methods A total of 40 individuals with sickle cell disease aged 12 to 43 years old were evaluated by means of sociodemographic and clinical questionnaires, the Medical Outcomes Study 36-Item Short Form Health Survey and the Beck Depression Inventory. The latter was applied only to adults. Results Most participants were adults (62.5%) with a predominance of the SS genotype (85%) with pain being the commonest complication (95%). Mood disorder was found in 40% of the adults. The patients exhibited overall impairment of quality of life, which was more pronounced among the adults and under 15-year-old adolescents. Married adults exhibited less impairment of most quality of life domains compared to unmarried adults, and the adults with mood disorder exhibited greater impairment of all quality of life domains. Conclusions These results suggest that interventions that aim to improve vitality, pain, and mental health might contribute to maintaining high levels of quality of life in patients with sickle cell disease, especially among adults and under 15-year-old adolescents.

Prática do abortamento entre adolescentes: um estudo em dez escolas de Maceió (AL, Brasil)

Trata-se de um estudo de corte transversal, realizado com o objetivo de investigar as razoes que levaram adolescentes a provocarem o aborto, relacionando com idade e tipo de escola que frequentavam. A amostra foi calculada considerando o numero de internacoes para curetagem pos-abortamento. Usou-se como instrumento um questionario semiestruturado, anonimo, aplicado em dez escolas, sorteadas dentre todas da cidade de Maceio (Alagoas), pesquisando-se adolescentes dos 12 aos 19 anos, do sexo feminino. Os dados foram analisados pelo Programa Epi Info, usando-se odds ratio e risco relativo para verificar associacao entre variaveis e intervalo de confianca a 95%. Em uma amostra de 2.592 jovens, 559 (21,6%) tinham vida sexual ativa, 182 (7,0%) referiram ter engravidado e 149 (26,7%) abortado. Medo da reacao dos pais, idade, falta de apoio do companheiro e rejeicao da gravidez foram razoes para provocar o aborto, sendo medo a mais citada, em ambos os tipos de escola. O aborto foi mais citado nas escolas publicas, sendo significativo e protetor o risco para abortar antes dos 15 anos, e significativa a relacao entre abortar e estudar em escolas publicas. O medo da reacao dos pais como razao mais frequente sugere a necessidade de novos estudos sobre sexualidade e comunicacao entre pais e filhos.

Estado nutricional de crianças menores de 24 meses em Alagoas, Brasil

O objetivo deste estudo retrospectivo e transversal foi comparar a avaliação nutricional de crianças atendidas no ambulatório de puericultura do Hospital Universitário em Alagoas, Brasil, utilizando as curvas de crescimento de referência do National Center for Health Statistics (NCHS) de 1977 e o padrão da Organização Mundial da Saúde (OMS) de 2006. Foram analisados 252 prontuários de crianças menores de 24 meses e determinados comprimento para idade, peso para idade e peso para comprimento utilizando as duas curvas. A população era de baixo nível socioeconômico e recebia amamentação exclusiva ou predominante. Os escores Z para ambas as curvas indicaram que as crianças na amostra eram eutróficas, mas as curvas da OMS foram mais sensíveis para detectar desvios de crescimento nos primeiros 6 meses de vida.The aim of this retrospective, cross-sectional study was to compare the 1977 National Center for Health Statistics (NCHS) and the 2006 World Health Organization (WHO) growth standards to determine the nutritional status of children attending the pediatric outpatient clinic at a university hospital in Alagoas, Brazil. We reviewed 252 hospital charts of children younger than 24 months and determined the height-for-age, weight-for-age, and weight-for-height using the two standards. The sample was of low socioeconomic level and exclusively or predominantly breastfed children. TheZ-scores for both standards indicated that the children in this sample were healthy, but the WHO standard was more sensitive for the detection of growth limitations in the first 6 months of life.