Paula Dal Bó Campagnolo

Alguns fatores associados a excesso de peso, baixa estatura e déficit de peso em menores de 5 anos

OBJECTIVE To explore whether socioeconomic and sanitary conditions, maternal and child factors are associated with overweight, stunting, and wasting in children under five year old in the city of São Leopoldo, southern Brazil. METHODS Cross-sectional study of 3,957 children aged 1 month to 5 years conducted in all primary care services of the city during the National Childrens Vaccination Day in 2002. Maternal and child factors were assessed by a questionnaire. Childrens height and weight were measured. Cluster analysis was used to group the areas served by the primary care services according to socioeconomic and sanitary conditions of the census tracts assessed by the 2001 National Census. RESULTS Wasting was observed in 2.6% of children, stunting in 9.1% and overweight in 9.8%. The multivariable logistic regression model suggests that overweight was associated with higher socioeconomic status and better sanitation of the area (OR = 1.47; 95%CI 1.09-1.96), single child (OR = 1.44; 95%CI 1.00-2.07) and birth weight >or= 2,500 g (OR = 2.21; 95%CI 1.27-3.83). Wasting was associated with low birth weight (OR = 3.46; 95%CI 2.06-5.80) and mothers age < 20 years (OR = 1.99; 95%CI 1.09-3.62). Stunting was associated with low socioeconomic status and poor sanitation of the area (OR = 2.36; 95%CI 1.51-3.69), three or more siblings (OR = 3.12; 95%CI 2.18-4.47), low birth weight < 2,500 g (OR = 3.49; 95%CI 2.53-4.80), child age < 36 months (OR = 1.77; 95%CI 1.37-2.29) and mothers age < 20 years (OR = 1.60; 95%CI 1.09-2.35). CONCLUSIONS Overweight and stunting were the major anthropometric problems and therefore should be a priority for public policies.

Consumption of ultra-processed food products and its effects on children's lipid profiles: A longitudinal study

BACKGROUND AND AIMS Cardiovascular disease development is related to known risk factors (such as diet and blood lipids) that begin in childhood. Among dietary factors, the consumption of ultra-processing products has received attention. This study investigated whether childrens consumption of processed and ultra-processing products at preschool age predicted an increase in lipid concentrations from preschool to school age. METHODS AND RESULTS Cohort study conducted with 345 children of low socioeconomic status from São Leopoldo, Brazil, aged 3-4 years and 7-8 years. Blood tests were done to measure lipid profile. Dietary data were collected through 24-h recalls and the childrens processed and ultra-processing product intake was assessed. Linear regression analysis was used to assess the relationship between processed and ultra-processed product intake at 3-4 years on changes in lipid concentrations from preschool to school age. The percentage of daily energy provided by processed and ultra-processed products was 42.6 ± 8.5 at preschool age and 49.2 ± 9.5 at school age, on average. In terms of energy intake, the main products consumed were breads, savoury snacks, cookies, candy and other sweets in both age groups. Ultra-processed product consumption at preschool age was a predictor of a higher increase in total cholesterol (β = 0.430; P = 0.046) and LDL cholesterol (β = 0.369; P = 0.047) from preschool to school age. CONCLUSION Our data suggest that early ultra-processed product consumption played a role in altering lipoprotein profiles in children from a low-income community in Brazil. These results are important to understanding the role of food processing and the early dietary determinants of cardiovascular disease.

Avaliação de duas classificações para excesso de peso em adolescentes brasileiros

Estudo transversal com 418 adolescentes entre dez e 19 anos, de escola particular da cidade de Sao Paulo, em 1998. O objetivo foi avaliar os valores criticos propostos para diagnostico de excesso de peso de adolescentes brasileiros. O percentual de gordura corporal foi medido pela absorcao de duplo feixe de energia. Utilizou-se como ponto de corte para excesso de adiposidade 25% para meninos e 30% para meninas. O indice de massa corporal foi classificado de acordo com Cole et al e Conde & Monteiro. O referencial brasileiro apresentou maior sensibilidade entre as meninas de menor (44,2% vs. 32,6%) e maior faixa etaria (18,9% vs. 17%), assim como entre os meninos de maior faixa etaria (83,3% vs 50%). A proposta de Conde & Monteiro apresentou maiores valores preditivos positivos e negativos e predisse com maior sensibilidade o excesso de adiposidade na populacao estudada.

Maternal Dietary Counseling in the First Year of Life Is Associated with a Higher Healthy Eating Index in Childhood

Food preferences are established in early childhood and track later in life. Therefore, it is important to promote healthy feeding practices as early as possible. A randomized field trial was conducted with 500 mother-child pairs from a low-income area of São Leopoldo, State of Rio Grande do Sul, Brazil, to evaluate the impact of a nutritional intervention in the first year of life on the dietary quality of 3- to 4-y-old children. Mother-child pairs were randomized either to intervention and control groups and dietary counseling was provided for mothers in the intervention group during 10 home visits in the course of the first year of life. These visits were carried out by fieldworkers who counseled the mothers about the Ten Steps for Healthy Feeding from Birth to Two Years of Age, based on the WHO guidelines. Dietary intake was assessed at 3-4 y of age for 345 children using two 24-h food recalls. Overall diet quality was determined by the Healthy Eating Index. The prevalence of poor diet in the intervention group was lower compared with the control group [relative risk (RR) = 0.30; 95% CI = 0.13-0.71). The number of children who achieved the 75th percentile for the vegetable and fruit component score was higher in the intervention than in control group (RR = 1.95; 95% CI = 1.31-2.89 and RR = 1.49; 95% CI = 1.07-2.07, respectively). Such data provide evidence that dietary counseling for mothers during the first year of life improves the overall dietary quality of children in a low-income population.

Long-term effectiveness of maternal dietary counseling in a low-income population: a randomized field trial.

OBJECTIVE: To assess the impact of dietary counseling given to mothers during the first year of infants’ lives on food consumption, nutritional status, and lipid profile of the children up to 7 to 8 years old. METHODS: The randomized trial was conducted with 500 mothers who gave birth to full-term infants with birth weight ≥2500 g between October 2001 and June 2002 in São Leopoldo, Brazil. Mothers were randomly assigned to intervention (n = 200) and control groups (n = 300) and those in the intervention group received counseling on breastfeeding and complementary feeding by 12 fieldworkers on 10 home visits during the first year of children’s lives. Blinded fieldworkers assessed dietary and anthropometric data at 12 to 16 months, 3 to 4 years, and 7 to 8 years and lipid profiles at 3 to 4 years and 7 to 8 years old. The lipid profile was the primary outcome. RESULTS: Of the 500 recruited children, 397 underwent the 12- to 16-month, 354 the 3- to 4-year, and 315 the 7- to 8-year assessment. The energy-dense foods intake was significantly lower in the intervention group at 12 to 16 months and 3 to 4 years old. At 3 to 4 years, serum lipid levels did not differ between groups. At 7 to 8 years, high-density lipoprotein levels were 0.11 mmol/L higher (0.00 to 0.20), and triglycerides concentration was 0.13 mmol/L lower (−0.25 to −0.01) in intervention children but only among the girls. Overweight/obesity rates did not differ between groups. CONCLUSIONS: Dietary counseling for mothers during infancy decreased the energy-dense foods consumption and improved lipid profile.

Maternal Dietary Counseling Reduces Consumption of Energy-Dense Foods among Infants: A Randomized Controlled Trial

OBJECTIVE To evaluate the impact of a dietary counseling in reducing the intake of energy-dense foods by infants. DESIGN A randomized controlled trial. SETTING AND PARTICIPANTS São Leopoldo, Brazil. Mothers and infants of a low-income-group population were randomized into intervention (n = 163) and received dietary counseling during 10 home visits, or control (n = 234) groups. MAIN OUTCOMES MEASURES Child consumption of sugar-dense (SD) and lipid-dense (LD) foods at 12 to 16 months. ANALYSIS The effect of the intervention was expressed by relative risks and 95% confidence intervals. Poisson regression analysis was used to determine the association between exclusive breastfeeding and the energy-dense foods intake. RESULTS A smaller proportion of infants from the intervention group consumed candy, soft drinks, honey, cookies, chocolate, and salty snacks. In the intervention group, there was a reduction of 40% and 50% in the proportion of infants who consumed LD and SD foods, respectively. Being breastfed up to 6 months reduced the risk for consumption of LD and SD foods by 58% and 67%, respectively. CONCLUSIONS AND IMPLICATIONS Dietary counseling to mothers may be effective in reducing the consumption of energy-dense foods among infants, and it is helpful in improving early dietary habits.

Frequência de utilização do serviço público de puericultura e fatores associados

OBJECTIVE: Assess the maternal socio-demographic factors associated with the frequency of use of child care services by low income families. METHODS: Cross-sectional analysis of 393 children between 12 and 16 months old who participated in a randomized field trial during their first year of life in a program of nutritional intervention. The study began in the Brazilian Unified Health System (Sistema Unico de Saude, SUS) of the maternity hospital in the city of Sao Leopoldo, state of Rio Grande do Sul, Brazil. Children were examined regarding child care follow-up and vaccination schedule by checking the immunization chart. Data were analyzed using statistical tests Pearsons chi square and prevalence ratio (PR) with respective 95% confidence interval. RESULTS: The frequency of children who were not continuously taken to the child care service was 53.2%. Multivariate analysis suggests that the factors associated with the lack of continuous use of the service were: mothers educational level < 8 years (PR 1.32 95%CI 1.02-1.71), non-nuclear family structure (PR 1.32 95%CI 1.10-1.59) and not being an only child (PR 1.38 95%CI 1.10-1.72). The reasons for lack of follow-up, according to the mothers were: the fact that they thought it unnecessary for 66.2%, problems with the service for 21.7%, difficulties related to their jobs for 6.05%, and other reasons for 6.05%. CONCLUSION: The high frequency of children who were not taken to the child health care service for follow-up is associated with low maternal educational level and family structure, as well as the perception that follow-up visits are not necessary when the child does not have a disease.

Fatores associados ao hábito de assistir TV em excesso entre adolescentes

OBJETIVO: Avaliar a frequencia com que os adolescentes assistem televisao na regiao Sul do Brasil e quais fatores estao associados a esse comportamento. METODOS: Estudo transversal, com 722 adolescentes entre 10 e 19 anos. Foi calculado a media de horas diarias que os adolescentes assistiam televisao. Foi realizada analise de regressao logistica para analisar possivel associacao entre fatores sociodemografico, antropometricos, atividade fisica, sexo e idade, com o habito de assistir mais do que 4 horas diarias de televisao. RESULTADOS: Entre os adolescentes estudados, 41,1% assistiam mais do 4 horas de TV por dia. A prevalencia de adolescentes que assistiam > 4h de TV foi maior entre aqueles com menos de 16 anos. Ser filho de mae com escolaridade maior do que 8 anos (OR 1,9; IC 1,25-2,89) e possuir circunferencia da cintura maior do que o percentil 80 (OR 2,77; IC 1,33-5,77) foi positivamente associado ao habito de assistir televisao mais do que 4 horas diarias. CONCLUSOES: Maior escolaridade materna e circunferencia da cintura maior do que o percentil 80 estao associados ao comportamento de assistir TV em excesso entre os adolescentes. Esses achados devem ser utilizados para direcionar a elaboracao de programas de saude publica, especialmente por meio das escolas, enfocando adolescentes com faixa etaria entre 10 e 15 anos, assim como devem servir de alerta para os profissionais de saude e educadores.

Factors associated with risk of low folate intake among adolescents.

OBJECTIVE To evaluate factors associated with the risk of low folate intake among adolescents. METHODS We employed cluster sampling, using a random selection of 40 representative census sectors and households within those sectors, including all individuals between 10 and 19 years of age. The weight, height and skin folds of subjects were measured and socioeconomic data on their families were collected. A 24-hour dietary recall and frequency questionnaire were used to estimate the quantity and frequency of folate intake. Folate consumption was quantified using Nutwin software. Risk of low folate intake was defined as Folate consumption below the estimated average requirement. The statistical analysis employed hierarchical logistic regression. RESULTS A total of 722 adolescents were investigated and their mean folate intake was 145+/-117 microg. The frequency of subjects at risk of having a lower than recommended folate intake was 89%. Adolescents had a greater risk of inadequate folate intake if their body mass index was at or above the 85th percentile, their waist circumference was at or above the 80th percentile or they had a family history of cardiovascular disease. Adolescents who ate beans and dark green vegetables less than four times a week also exhibited an increased chance of having folate intake below recommended levels. CONCLUSIONS These adolescents present a high risk of low folate intake and this risk is linked with increasing age, waist circumference above the 80th percentile and low frequency of beans and dark green vegetables consumption.

Polymorphisms in LEPR, PPARG and APM1 genes: associations with energy intake and metabolic traits in young children.

OBJECTIVE To assess the association of single nucleotide polymorphisms (SNPs) in five genes - leptin, leptin receptor (LEPR), adiponectin (APM1), peroxisome proliferator-activated receptor gamma (PPARG) and uncoupling protein 1 - with anthropometric, metabolic, and dietary parameters in a Southern Brazilian cohort of 325 children followed up from birth to 4 years old. MATERIALS AND METHODS SNPs were analyzed using polymerase chain reaction-based procedures, and their association with phenotypes was evaluated by t-test, analysis of variance, and general linear models. RESULTS LEPR223Arg allele (rs1137101) was associated with higher daily energy intake at 4 years of age (P = 0.002; Pcorrected = 0.024). PPARG 12Ala-carriers (rs1801282) presented higher glucose levels than Pro/Pro homozygotes (P = 0.007; Pcorrected = 0.042). CONCLUSIONS Two of the six studied SNPs presented consistent associations, showing that it is already possible to detect the influences of genetic variants on susceptibility to overweight in 4-year-old children.