Luciane Peter Grillo

Mild Stunting Is Associated with Higher Susceptibility to the Effects of High Fat Diets: Studies in a Shantytown Population in São Paulo, Brazil

Previous studies by our group and others have suggested that nutritional stunting may increase the risk of obesity. To investigate mechanisms that could explain a link between stunting and obesity, a 22-mo follow-up study was conducted in two groups of shantytowns school girls (7-11 y old) in São Paulo, Brazil. One group (n = 15) had mild stunting (defined using a cutoff of -1.4 Z-scores of height-for-age) but normal weight-for-height; the control group (n = 15) had normal weight and height. Similar energy intake, dietary macronutrient composition and energy expenditure were observed in the two groups. Both groups showed comparable levels of IGF-1 that were below the normal range. A significant and positive association between baseline IGF-1 and the change in height-for-age during follow-up was found in all subjects combined (P = 0.044). A significant association was found between the baseline percentage of dietary energy supplied by fat and the gain in weight-for-height during follow-up in girls with mild stunting (P = 0.048), but not in the nonstunted control girls (P = 0.245); however, the slopes of these relationships were not significantly different. This study raises the question of whether a diet high in fat may increase the susceptibility to excess body fat gain in children who are mildly stunted. Further studies are need to explore this issue and to examine the possible etiological role of low levels of IGF-1.

Obesidade e fatores de risco para o desenvolvimento de doenças crônicas não transmissíveis entre usuários de unidade de alimentação e nutrição

O objetivo deste estudo foi avaliar o estado nutricional e fatores de risco para doencas cronicas nao transmissiveis entre 1.252 funcionarios de uma industria em Santa Catarina, Brasil. Foram estudadas as variaveis: estado nutricional, circunferencia da cintura, pressao arterial, glicemia, idade e escolaridade. Observou-se sobrepeso e obesidade em 45% e 10% da amostra, respectivamente, com associacao significativa entre o estado nutricional e sexo, mas nao entre estado nutricional e escolaridade, ajustados por idade. Verificaram-se valores de circunferencia da cintura elevados em 33% dos funcionarios, com diferenca significativa entre sexos. Observou-se pressao arterial sistolica (PAS) e pressao arterial diastolica (PAD) elevadas em 18% e 11% dos funcionarios, respectivamente, com associacao significativa entre sexos apos ajuste por idade. Diagnosticou-se diabetes mellitus tipo II em 2% da amostra e glicemia alterada em 4%. Apos ajuste por idade, as unicas variaveis associadas a circunferencia da cintura foram a PAS e a PAD. Estes resultados permitiram que atividades preventivas e educacionais fossem desenvolvidas pela empresa, de modo a melhorar a qualidade de vida e a produtividade dos funcionarios.

Long-Lasting Effects of Undernutrition

Undernutrition is one of the most important public health problems, affecting more than 900 million individuals around the World. It is responsible for the highest mortality rate in children and has long-lasting physiologic effects, including an increased susceptibility to fat accumulation mostly in the central region of the body, lower fat oxidation, lower resting and postprandial energy expenditure, insulin resistance in adulthood, hypertension, dyslipidaemia and a reduced capacity for manual work, among other impairments. Marked changes in the function of the autonomic nervous system have been described in undernourished experimental animals. Some of these effects seem to be epigenetic, passing on to the next generation. Undernutrition in children has been linked to poor mental development and school achievement as well as behavioural abnormalities. However, there is still a debate in the literature regarding whether some of these effects are permanent or reversible. Stunted children who had experienced catch-up growth had verbal vocabulary and quantitative test scores that did not differ from children who were not stunted. Children treated before 6 years of age in day-hospitals and who recovered in weight and height have normal body compositions, bone mineral densities and insulin production and sensitivity.

Lower resting metabolic rate and higher velocity of weight gain in a prospective study of stunted vs nonstunted girls living in the shantytowns of São Paulo, Brazil.

Objective:Previous studies have shown that stunting increases the risk of obesity in developing countries, particularly among girls and women, but the underlying reasons are not known. This study aimed to investigate the relationship between stunting, weight gain, and resting metabolic rate.Design and subjects:A prospective study was conducted over 36 months with girls from shantytowns in São Paulo, Brazil. A total of 15 stunted girls (S) were compared with 15 nonstunted (N) ones of similar weight for height ratio.Interventions:Resting metabolic rate was measured using indirect calorimetry, and the socioeconomic status was determined by interviews in the household. In addition, body composition was measured by skinfold thickness, while the growth rate was calculated dividing the change in weight and the change in height by the follow-up period.Results:The results of the present study, when combined, revealed that the S group had a lower resting metabolic rate throughout the follow-up period with the differences being significant at 24 and 36 months of follow-up, associated with an increase in the rate of weight gain and a decrease in lean mass, when compared to the N group.Conclusions:These changes are known to be risk factors for obesity and may help to explain the particularly higher prevalence of obesity in women in urban areas of developing countries.

Influência das condições socioeconômicas nas alterações nutricionais e na taxa de metabolismo de repouso em crianças escolares moradoras em favelas no município de São Paulo

PURPOSE A cross-sectional study was carried out to characterize the alterations in the resting metabolic rate (RMR), and socioeconomic conditions of 15 stunted (DP= height/age < 95% and 110% (3) weight/height >90%) and 15 nonstunted (EU= height/age > 95% and 110% (3) weight/height >90%) school girls living in shantytowns of São Paulo. METHODS Resting metabolic rate was measured using indirect calorimetry. Socioeconomic data was collected during home visits by administration of a questionnaire. RESULTS The mildly stunted group had a higher RMR when expressed as Kcal/kg body weight (EU= 40,5 Kcal/kg/day; DP=44,4 Kcal/kg/day; p<0.05) and lean body mass (EU= 49, 2 Kcal/kg/day; DP=52,5 Kcal/kg/day; p<0.05). Stunting was associated with maternal illiteracy (EU= 13,3%; DP=57,1%; p<0.05), income per capita (EU=US

Estado de ferro e retinol sérico entre crianças e adolescentes atendidos por equipe da Estratégia de Saúde da Família de Itajaí, Santa Catarina

107,14; DP=US

Prevalência de anemia e níveis séricos de hemoglobina em adolescentes segundo estágio de maturidade sexual

54,40; p< 0.05), number of parasites per child (EU=0; DP=1; p<0.05), birth order (EU=2; DP=4; p< 0.05), and number of siblings (EU=4; DP=6; p<0.01). Stunting was best predicted by income per capita and maternal illiteracy by using multiple logistic regression. CONCLUSIONS Although the two groups had normal weight/height, the group with mild stunting showed socioeconomic and metabolic alterations, typical of a malnourished condition.Universidade Federal de Sao Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Fisiologia

Síndrome metabólica e seus componentes em portadores do HIV

The objective of this article is to determine prevalence of iron and vitamin A deficiencies among children and adolescents attended by a Family Health Strategy team in Itajaí, Santa Catarina State, and to assess relations between iron status and serum retinol. A nutritional census of the families was carried out. Socioeconomic and demographic data were collected. Hemoglobin concentration, hematocrite, serum iron and retinal were determined. Thirty-one out of the 156 enrolled families participated in the study. Only 39.1% of the children and 62.0% of the adolescents had their blood samples collected. Mean per capita income was 1.68+/-1.00 minimum wages. None of the parents was illiterate and most families (80.6%) owned their homes. All homes had public sewage and water supply, and 87.1% were made of brickwork. Iron deficiency was diagnosed in 16.7% of the children and 19.3% of the adolescents. Only one child had vitamin A deficiency. Significant correlations were found between serum iron and retinol among children, and among adolescents between serum retinol and hemoglobin concentration and hematocrite. We found mild prevalences of iron and vitamin A deficiencies, possibly due to the socioeconomic and demographic characteristics.Este trabalho visa determinar prevalencias de deficiencia de ferro e vitamina A em criancas e adolescentes atendidos por equipe de Saude da Familia de Itajai (SC) e avaliar relacoes entre o estado de ferro e o retinol serico. Realizou-se um censo nutricional das familias cadastradas. Coletaram-se dados socioeconomicos e demograficos. Avaliou-se a concentracao de hemoglobina, hematocrito, ferro e retinol sericos. Participaram do estudo 31 das 156 familias cadastradas. Apenas 39,1% das criancas e 62,0% dos adolescentes coletaram amostras sanguineas. A renda media per capita foi 1,68±1,00 salarios minimos. Nenhum dos pais ou maes era analfabeto. Residiam em domicilio proprio 80,6% das familias. Todos os domicilios apresentavam esgoto e abastecimento de agua por rede publica e 87,1% eram de alvenaria. Diagnosticou-se deficiencia de ferro em 16,7% das criancas e 19,3% dos adolescentes, e deficiencia de vitamina A em apenas uma crianca. Observaram-se correlacoes significativas para o ferro e retinol sericos entre criancas e entre adolescentes para a concentracao de hemoglobina, hematocrito e retinol serico. Encontraram-se prevalencias leves de deficiencia de ferro e vitamina A, possivelmente devido as caracteristicas socioeconomicas e demograficas.

Metabolic syndrome and its components in HIV-infected individuals.

Accelerated growth spurt during adolescence leads to increased nutritional requirements, including iron, therefore posing a nutritional risk to adolescents. The present study aimed to assess the prevalence of anemia and hemoglobin serum levels according to the sexual maturation stage in a representative sample comprised of 272 adolescents enrolled in public schools in Balneario Camboriu, SC. Self-assessment of sexual maturation was carried out according to criteria defined by Tanner (1962). Hemoglobin serum levels were measured through the HemoCue® system and the diagnosis of iron deficiency was based on the cut off points proposed by the World Health Organization (2001). Differences were considered significant at the level of p<0.05. We found a prevalence of 31.2% of anemia without significant differences between genders. Hemoglobin serum levels were significantly higher in boys (p=0.044) than in girls. We did not find significant differences between mean hemoglobin levels of girls who had reached menarche and the ones who had not. There was no statistical association between the presence of anemia and sexual maturation stages of adolescents (c2=1.17; p=0.56). An increase in mean hemoglobin serum levels was observed along with sexual maturation in boys, but not in girls. The results of the present study showed a moderate prevalence of anemia, but did not point out any relation between anemia and sexual maturation in the population studied.

Riscos nutricionais de escolares pertencentes a famílias de baixa renda do litoral catarinense

OBJECTIVE: To assess the prevalence of metabolic syndrome and its components in HIV infected individuals assisted in a specialized health center in a municipality in the state of Santa Catarina, Brazil. METHODS: Cross-sectional study comprising 249 individuals (130 men and 119 women), aged 18 to 73 years. Metabolic syndrome was defined according to the National Cholesterol Education Program, as recommended by the Brazilian Society of Cardiology. RESULTS: Among the individuals who participated in the study, 20.9% had metabolic syndrome - 18.5% of the men and 23.5% of the women, with no statistical association between genders. Twenty seven percent of the individuals had two components of the syndrome. Components most frequently found were those related to lipid profile (low HDL cholesterol and high triglycerides), followed by elevated waist-circumference, altered blood pressure and altered fasting blood glucose. There was a significant association between gender and elevated waist-circumference. CONCLUSION: The prevalence of metabolic syndrome found in this study possibly reflects the quality of the health services delivered. We highlight the importance of investigating the presence of metabolic syndrome among HIV-infected populations, thus contributing for their survival.