Léris Salete Bonfanti Haeffner

Do early life factors influence body mass index in adolescents

The association between early life factors and body mass index (BMI) in adulthood has been demonstrated in developed countries. The aim of the present study was to assess the influence of early life factors (birth weight, gestational age, maternal smoking, and social class) on BMI in young adulthood with adjustment for adult socioeconomic position. A cohort study was carried out in 1978/79 with 6827 mother-child pairs from Ribeirão Preto city, located in the most developed economic area of the country. Biological, economic and social variables and newborn anthropometric measurements were obtained shortly after delivery. In 1996, 1189 males from this cohort, 34.3% of the original male population, were submitted to anthropometric measurements and were asked about their current schooling on the occasion of army recruitment. A multiple linear regression model was applied to determine variables associated with BMI. Mean BMI was 22.7 (95%CI = 22.5-23.0). After adjustment, BMI was 1.22 kg/m(2) higher among infants born with high birth weight ( > or = 4000 g), 1.21 kg/m(2) higher among individuals of low social class at birth and 0.69 kg/m(2) higher among individuals whose mothers smoked during pregnancy (P < 0.05). The association between social class at birth and BMI remained statistically significant (P < 0.05) even after adjustment for adult schooling. These findings suggest that early life social influences on BMI were more important and were not reversed by late socioeconomic position. Therefore, prevention of overweight and obesity should focus not only on changes in adult life styles but also on factors such as high birth weight.

Do intrauterine growth restriction and overweight at primary school age increase the risk of elevated body mass index in young adults

Obesity is one of the rising public health problems characterized as a risk factor for many chronic diseases in adulthood. Early life events such as intrauterine growth restriction, as well as life style, are associated with an increased prevalence of this disease. The present study was performed to determine if intrauterine growth restriction interacts with overweight at primary school age to affect body mass index (BMI) in young adults. From June 1, 1978 to May 31, 1979, 6827 singleton liveborns from Ribeirão Preto, São Paulo State, Brazil, corresponding to 98% of all births at the 8 maternity hospitals, were examined and their mothers were interviewed. Samples from the initial cohort were examined again at primary school age (8 to 11 years of age) and at the time of military service (18 years of age). There were 519 male individuals with complete measurements taken in the three surveys. Intrauterine growth-restricted individuals had a BMI 0.68 kg/m(2) lower than that of individuals who were not restricted (95%CI = -1.34 to -0.03) and overweight at primary school age showed a positive and strong effect on BMI at 18 years of age (coefficient 5.03, 95%CI = 4.27 to 5.79). However, the increase in BMI was much higher--6.90 kg/m(2)--when the conscript had been born with intrauterine growth restriction and presented overweight at primary school age (95%CI = 4.55 to 9.26). These findings indicate that the effect of intrauterine growth restriction on BMI at 18 years of age is modified by later weight gain during school age.

The oral motor capacity and feeding performance of preterm newborns at the time of transition to oral feeding

The objective of the present study was to determine the oral motor capacity and the feeding performance of preterm newborn infants when they were permitted to start oral feeding. This was an observational and prospective study conducted on 43 preterm newborns admitted to the Neonatal Intensive Care Unit of UFSM, RS, Brazil. Exclusion criteria were the presence of head and neck malformations, genetic disease, neonatal asphyxia, intracranial hemorrhage, and kernicterus. When the infants were permitted to start oral feeding, non-nutritive sucking was evaluated by a speech therapist regarding force (strong vs weak), rhythm (rapid vs slow), presence of adaptive oral reflexes (searching, sucking and swallowing) and coordination between sucking, swallowing and respiration. Feeding performance was evaluated on the basis of competence (defined by rate of milk intake, mL/min) and overall transfer (percent ingested volume/total volume ordered). The speech therapists evaluation showed that 33% of the newborns presented weak sucking, 23% slow rhythm, 30% absence of at least one adaptive oral reflex, and 14% with no coordination between sucking, swallowing and respiration. Mean feeding competence was greater in infants with strong sucking fast rhythm. The presence of sucking-swallowing-respiration coordination decreased the days for an overall transfer of 100%. Evaluation by a speech therapist proved to be a useful tool for the safe indication of the beginning of oral feeding for premature infants.

Os efeitos da estimulação sensório motora oral na sucção nutritiva na mamadeira de recém-nascidos pré-termo

PURPOSE: to check the nutritive sucking performance in preterm infants that underwent sensory-motororal stimulation. METHODS: a controlled clinical trial of intervention was performed in 20 preterm infants divided into experimental and control group. The infants received a speech therapist evaluation in two different times: at the beginning of the oral feeding (first speech therapist evaluation) and when they reached full oral feeding (second evaluation). Statistical data analyses used STATA 10 package and they were analyzed for treatment group differences with Fishers exact Test and Students unpaired t-test (p<0.05). RESULTS: infants in the experimental group, in the second evaluation, differed statistically in the pressure of strong sucking (p=0.003), presence of the three adaptive reflexes (p=0.001), coordination among sucking, swallowing and breathing (p=0.003), the total time for sucking (p=0.01) and of number of sucking/time (p<0.01). The total number of sucks showed a statistically significant difference (p<0.05) among the evaluations of the control group. No differences were observed among the groups as for sucking rhythm, and prescribed and ingested milk volume. CONCLUSION: in this study, sensory-motor-oral stimulation contributed for a better sucking performance, during bottle feeding, in preterm infants.

Aleitamento materno e sua influência nas habilidades orais de crianças

OBJECTIVE The objective of this study was to investigate the influence of oral habits and breastfeeding on the oral skills of children. METHODS Cross-sectional study evaluated the oral skills of 125 nine-month-old-children born at term, belonging to Macro-Midwest region of Rio Grande do Sul between August 2010 and March 2011. Variables included evaluating oral skills and information on breastfeeding and weaning. The results were analyzed using simple and multiple logistic regression. RESULTS Breastfeeding positively influenced the acquisition of oral skills sucking at nine months of age (OR 3.1, 95%CI 1.2;8.3) and using a pacifier had a negative effect (OR 0.1, 95%CI 0.03;0.6). CONCLUSIONS It was found that breastfeeding contributed to mature orofacial as it improved the ability of oral suction. Pacifier use was shown to affect the functioning of the stomatognathic system. This should be made clear to parents and the use of pacifiers during infancy should be avoided.OBJETIVO: Avaliar a influencia de habitos orais e do aleitamento materno sobre as habilidades orais de criancas. METODOS: Estudo transversal que avaliou as habilidades orais de 125 criancas nascidas a termo, aos nove meses de idade, pertencentes a macrorregiao centro-oeste do estado do Rio Grande do Sul, no periodo de agosto de 2010 a marco de 2011. As variaveis estudadas incluiram avaliacao das habilidades orais e informacoes sobre o aleitamento materno e a introducao da alimentacao complementar. Analise de regressao logistica simples e multipla foi utilizada na analise dos resultados. RESULTADOS: O aleitamento materno influenciou positivamente a aquisicao das habilidades orais de succao das criancas aos nove meses de idade (OR 3,1; IC95% 1,2;8,3) e o habito de usar a chupeta influenciou negativamente tais habilidades (OR 0,1; IC95% 0,03;0,6). CONCLUSOES: O aleitamento materno contribuiu para o amadurecimento orofacial, pois melhorou a habilidade oral de succao. O uso da chupeta mostrou alterar o funcionamento do sistema estomatognatico. Os pais devem ser esclarecidos e recomendados a evitar o uso de chupetas durante a infância.OBJETIVO: Evaluar la influencia de habitos orales y de la lactanciamaterna sobre las habilidades orales de los ninos METODOS: Estudio transversal que evaluo las habilidades orales de 125 ninos nacidos a termino, a los nueve meses de edad, pertenecientes a la macro region centro oeste del Estado de Rio Grande do Sul, Brasil, en el periodo de agosto de 2010 a marzo de 2011. Las variables estudiadas incluyeron evaluacion de las habilidades orales e informaciones sobre la lactancia materna y la introduccion de la alimentacion complementaria. Los resultados se analizaron utilizando regresion logistica simple y multiple. RESULTADOS: La lactancia materna influencio positivamente en la adquisicion de habilidades orales de succion de los ninos a los nueve meses de edad (OR=3,1; IC95% 1,2;8,3), mientras que el habito de usar el chupete influencio negativamente tales habilidades (OR=0,1; IC95% 0,03;0,6). CONCLUSIONES: La lactancia materna contribuyo para la maduracion orofacial, ya que mejoro la habilidad oral de succion. El uso del chupete mostro alterar el funcionamiento del sistema estomatognatico. Los padres deben ser informados y recomendados para que eviten el uso de chupetes durante la infancia.

Influence of breastfeeding on children's oral skills

OBJECTIVE The objective of this study was to investigate the influence of oral habits and breastfeeding on the oral skills of children. METHODS Cross-sectional study evaluated the oral skills of 125 nine-month-old-children born at term, belonging to Macro-Midwest region of Rio Grande do Sul between August 2010 and March 2011. Variables included evaluating oral skills and information on breastfeeding and weaning. The results were analyzed using simple and multiple logistic regression. RESULTS Breastfeeding positively influenced the acquisition of oral skills sucking at nine months of age (OR 3.1, 95%CI 1.2;8.3) and using a pacifier had a negative effect (OR 0.1, 95%CI 0.03;0.6). CONCLUSIONS It was found that breastfeeding contributed to mature orofacial as it improved the ability of oral suction. Pacifier use was shown to affect the functioning of the stomatognathic system. This should be made clear to parents and the use of pacifiers during infancy should be avoided.OBJETIVO: Avaliar a influencia de habitos orais e do aleitamento materno sobre as habilidades orais de criancas. METODOS: Estudo transversal que avaliou as habilidades orais de 125 criancas nascidas a termo, aos nove meses de idade, pertencentes a macrorregiao centro-oeste do estado do Rio Grande do Sul, no periodo de agosto de 2010 a marco de 2011. As variaveis estudadas incluiram avaliacao das habilidades orais e informacoes sobre o aleitamento materno e a introducao da alimentacao complementar. Analise de regressao logistica simples e multipla foi utilizada na analise dos resultados. RESULTADOS: O aleitamento materno influenciou positivamente a aquisicao das habilidades orais de succao das criancas aos nove meses de idade (OR 3,1; IC95% 1,2;8,3) e o habito de usar a chupeta influenciou negativamente tais habilidades (OR 0,1; IC95% 0,03;0,6). CONCLUSOES: O aleitamento materno contribuiu para o amadurecimento orofacial, pois melhorou a habilidade oral de succao. O uso da chupeta mostrou alterar o funcionamento do sistema estomatognatico. Os pais devem ser esclarecidos e recomendados a evitar o uso de chupetas durante a infância.OBJETIVO: Evaluar la influencia de habitos orales y de la lactanciamaterna sobre las habilidades orales de los ninos METODOS: Estudio transversal que evaluo las habilidades orales de 125 ninos nacidos a termino, a los nueve meses de edad, pertenecientes a la macro region centro oeste del Estado de Rio Grande do Sul, Brasil, en el periodo de agosto de 2010 a marzo de 2011. Las variables estudiadas incluyeron evaluacion de las habilidades orales e informaciones sobre la lactancia materna y la introduccion de la alimentacion complementaria. Los resultados se analizaron utilizando regresion logistica simple y multiple. RESULTADOS: La lactancia materna influencio positivamente en la adquisicion de habilidades orales de succion de los ninos a los nueve meses de edad (OR=3,1; IC95% 1,2;8,3), mientras que el habito de usar el chupete influencio negativamente tales habilidades (OR=0,1; IC95% 0,03;0,6). CONCLUSIONES: La lactancia materna contribuyo para la maduracion orofacial, ya que mejoro la habilidad oral de succion. El uso del chupete mostro alterar el funcionamiento del sistema estomatognatico. Los padres deben ser informados y recomendados para que eviten el uso de chupetes durante la infancia.

Tempo máximo fonatório de /e/ e /ė/ não-vozeado e sua relação com índice de massa corporal e sexo em crianças

Purpose: to characterize and associate childrens maximum phonation time of voiced /e/ and voiceless /e/ (/ė/), body mass index and gender. Methods: field and quantitative analytical observational cross-sectional study attended by 102 children aged between eight and 12 years (mean 9.66 years), being 53 (51.96%) girls and 49 (48.04%) boys. The subjects have gone through hearing screening, anthropometric assessment and collection of the maximum phonation times of /e/, /ė/. Data were analyzed using non-parametric Mann-Whitney and Spearmans rank correlation coefficient tests, with 5% significance level. Results: there was no difference of maximum phonation times of /e/, /ė/, or the relationship between them as a function of body mass index and age, but male children showed maximum phonation time significantly of /e/ higher than girls. No correlation was found between maximum phonation time and body mass index. Conclusion: there was no difference between maximum phonation time of /ė/, /e/ and ė/e ratio, according to age and body mass index, and body mass index and maximum phonation time were not correlated, showing homogeneity between measures within the group without influence of body mass index on the maximum phonation time. As for gender, boys presented maximum phonation time of /e/ higher than girls and only children aged eight years had maximum phonation time as expected.

Características miofuncionais de obesos respiradores orais e nasais

PURPOSE: To investigate the myofunctional characteristics of nasal and oral breathing in obese individuals. METHODS: Participants were 24 obese individuals with ages between 8 and 15 years, who participated in the Obesity Group of the Ambulatory of Pediatrics of an University Hospital, and were selected by convenience. The myofunctional characteristics were assessed using the Orofacial Myofunctional Assessment with Scales (Avaliacao Miofuncional Orofacial com Escalas - AMIOFE) protocol. RESULTS: Oral breathing was present in 62.5%, and nasal breathing in 37.5% of the population studied. In the oral breathing group, 40% of the subjects presented lips tension during occlusion and 80% showed a narrow palate, while almost all nasal breathers had normal palate and lips posture (p<0.05). Interposition of the tongue in the dental arches occurred in 47% of oral breathers and none of the nasal breathers. Oral breathers showed the tendency not to repeat the swallowing of the same bolus. No difference was found between groups regarding face appearance, jaw posture, cheeks, and chewing function. CONCLUSION: Oral breathing in obese children and adolescents was accompanied by myofunctional alterations of the stomatognathic system, represented by narrow palate, interposition of the tongue in the dental arches, occlusion of the lips with tension, and swallowing disorders.

Capacidade vital forçada e tempos máximos de fonação em relação à circunferência abdominal e ao estado nutricional de crianças

ABSTRACTPurpose: to evaluate and correlate forced vital capacity and maximum phonation time in relation to abdo-minal circumference and nutritional status of children. Methods: cross-sectional study of 82 children aged between eight and ten years, divided by the nutritional status (eutrophic, overweight and obese) and the percentile of abdominal circumference (≤ 25, 25 the 75, ≥ 75). There was forced vital capacity by spirometry and maximum phonation time the /e/, /a/ and /e/ voiceless (/ė/). Results: the forced vital capacity was higher in children with higher abdominal circumference (p = 0.003) and percentiles of abdominal circumference 25-75 had longer sustain the vowels (p <0.05). No statis-tically significant difference in forced vital capacity and TMF /e,a,ė/ in relation to nutritional status. There was strong correlation between /a/ maximum phonation time and maximum phonation time /e/ (0.84). Conclusion: the nutritional status of children did not influence the volume of expired air and measures of maximum phonation time, but it is perceived that a higher abdominal circumference, which is located fat, increases lung function.

PREVALÊNCIA DE OBESIDADE NA INFÂNCIA EM DIFERENTES AGRUPAMENTOS SOCIAIS E A IMPORTÂNCIA DE ESTRATÉGIAS PEDAGÓGICAS

A trajetoria do desenvolvimento da crianca e caracterizada por mudancas de comportamento no decorrer da vida. Atraves de uma visao dinâmica, essas mudancas ocorrem direcionadas por restricoes individuais; por experiencias vivenciadas pelo individuo restricoes do contexto; e pela especificidade e complexidade das atividades vivenciadas restricoes da tarefa. Nessa perspectiva, a preocupacao em saber qual a natureza, inata ou adquirida, que determina a maneira como a crianca cresce e se desenvolve, passa a ser ate mesmo pouco relevante. A maioria dos teoricos contemporâneos busca investigar as interacoes entre os diversos fatores que influenciam o desenvolvimento 1,2,3,4 ; pois, se a hereditariedade determina o potencial humano, e o meio que determina ate onde o ser humano pode chegar 5 . Essas interacoes (hereditarias e ambientais) acabam influenciando nas principais mudancas da crianca, ocasionando o desenvolvimento da mesma em ritmos e intensidades diferentes. No entanto, essas transformacoes parecem estar atreladas, principalmente, ao desenvolvimento fisico, social e motor na infância. No aspecto fisico, e nas transformacoes de crescimento como o peso e a estatura, que se pode tornar RESUMO