Sarah Aparecida Vieira

Exclusive Breastfeeding and Other Foods in the First Six Months of Life: Effects on Nutritional Status and Body Composition of Brazilian Children

Objective. To evaluate the effect of exclusive breastfeeding and consumption of other foods in the first six months of life in the nutritional status and body composition of children. Methods. A retrospective cohort study with 185 children aged from 4 to 7 years was monitored during the first months of life in a program of support to breastfeeding. We evaluated weight, height, waist circumference, and body composition by using DEXA. The nutritional status was assessed by the BMI/age index. The parameters of adiposity were classified by using as the cutoff point, the 85th percentile of the sample itself, according to gender and age. Confounding factors considered were variables related to maternal, pregnancy, birth, sociodemographic, health, lifestyle, and diet. Bivariate and multivariate analyses were performed, the latter by means of multiple logistic regression. Results. The median exclusive breastfeeding was 3 months. Of the children, 42.7% received cows milk and 35.7% received infant formula. Regarding nutritional status, 21.1% of the children showed changes. The variables of infant feeding were not independently associated with nutritional status and body composition of the children and there were no differences between the groups studied. Conclusion. Breastfeeding was not a protective factor to overweight and body fat in children.

Fatores associados à dislipidemia em crianças de 4 a 7 anos de idade

Objetivo: Avaliar o perfil lipidico e fatores associados a dislipidemia em criancas. Metodos: Estudo transversal que avaliou criancas de 4 a 7 anos acompanhadas nos primeiros meses de vida por um Programa de Extensao da Universidade Federal de Vicosa, Minas Gerais. Foram consideradas as dosagens de colesterol total, lipoproteina de alta densidade, lipoproteina de baixa densidade e triglicerideos. Foram estudadas variaveis possivelmente associadas ao perfil lipidico, sendo elas variaveis maternas, sociodemograficas e aquelas associadas a crianca. Foram realizadas analises bivariada e multivariadas, sendo as ultimas por meio de regressao logistica multipla. Resultados: A amostra foi constituida por 185 criancas, de ambos os sexos. Observou-se que 46,5% (n=86) apresentaram valores aumentados de colesterol total, 9,2% (n=17) de lipoproteina de baixa densidade e 4,9% (n=9) de triglicerideos. Com relacao a lipoproteina de alta densidade, 35,1% (n=65) apresentaram valores abaixo do desejavel. Demonstrou associacao independente com o perfil lipidico das criancas a renda per capita, escolaridade materna e idade materna (associando-se a lipoproteina de baixa densidade) e o excesso de peso, que se associou a maiores prevalencias de alteracoes em triglicerideos. Conclusao: Foram observadas altas prevalencias de dislipidemias. Condicoes sociodemograficas e estado nutricional demonstraram influenciar, tambem em criancas, a ocorrencia de dislipidemias, as quais sao citadas como fatores de risco para as doencas cardiovasculares. Revela-se a importância de se estudar esses fatores desde a infância, realizando-se estudos com outras faixas etarias que verifiquem a prevalencia e fatores associados, de forma a promover o cuidado com a saude desse grupo populacional.

Fatores associados às velocidades de ganho de peso e de comprimento nos primeiros seis meses de vida

The study aimed to verify factors associated with weight (WGR) and length (LGR) gain rates of infants during their first 4 to 6 months of life. A cross-sectional study with secondary data analysis, that collected information on medical charts of 371 infants followed during their first six months of life by the Lactation Support Program. The WGR and length LGR gain of infants from birth to 4-6 months old were calculated. Factors associated with WGR and LGR were examined by multiple linear regression analysis. We found that female infants and those that were not exclusively or predominantly breastfed had lower WGR at 4-6 months. Infants whose mothers were not living with a partner, infants of working mothers, and mothers that had less than six prenatal visits during their pregnancy had a lower LGR. Infants with a greater birth length also had a lower LGR at 4-6 months. The results of this study highlight the diversity of factors the may be associated with the length and weight gain rate during the first months of life, such as breastfeeding, prenatal care and socioeconomic variables. The early identification of factors related to infants growth can direct actions promote a proper development on that stage.

A pressão arterial está associada a indicadores de adiposidade corporal em crianças de quatro a sete anos

INTRODUCTION AND OBJECTIVE Studies in adults have shown an association between increased adiposity and hypertension, but few studies have analyzed this association in childhood. The aim of this study was to investigate the association between blood pressure (BP) and body adiposity indicators in children, controlling for the variables of birth conditions, sociodemographics, lifestyle and diet. METHODS In this cross-sectional study of 399 children aged 4 to 7 years, the dependent variable was BP, measured according to the protocol established by the 7th Brazilian Guidelines on Hypertension. The explanatory variables of the study were waist-to-height ratio (WHtR) and body mass index (BMI). Multiple linear regression was used to assess the independent association between adiposity and BP indicators adjusted for the variables of birth conditions, sociodemographics, lifestyle and diet. Statistical significance was set as α=5%. RESULTS BMI for age and WHtR correlated positively with systolic (SBP) and diastolic blood pressure (DBP). After multivariate analysis, higher values of BMI (model 1) and WHtR (model 2) were associated with increased SBP and DBP. CONCLUSION Increased body adiposity, as assessed by BMI and WHtR, was associated with increased SBP and DBP among the children studied. Thus, we suggest the use of BMI and WHtR in the nutritional assessment of children to detect changes in BP and other cardiometabolic risk factors in this population.

O HISTÓRICO FAMILIAR ESTÁ ASSOCIADO À PRESENÇA DE DISLIPIDEMIA EM CRIANÇAS PRÉ-ESCOLARES

ABSTRACT Objective: To evaluate the association between family history and the presence of dyslipidemia in children. Methods: A cross-sectional study with 257 children aged 4 to 7 years old from Viçosa, Minas Gerais, Southeast Brazil. Nutritional status and lipid profile (total cholesterol, cholesterol fractions, and triglyceride) assessments and an active search for a family history of dyslipidemia in parents were carried out. Pearson’s chi-square test was used to identify associations, and Student’s t-test was used to compare means. A Poisson regression analysis was performed to assess the independent association between family history and the presence of dyslipidemia in children. A significance level of 5% was adopted. Results: Children of parents with dyslipidemia had higher serum concentrations of total cholesterol and triglycerides. In a regression analysis after adjustments, the presence of dyslipidemia in the father or in the mother (OR: 2.43; 95%CI 1.12-5.27), as well as the presence of dyslipidemia in both the father and the mother (OR: 5.62; 95%CI 2.27-13.92) were associated with hypertriglyceridemia in children. Children of parents with dyslipidemia had a higher prevalence of elevated low-density lipoproteins (LDL-c) (OR: 1.52; 95%CI 1.18-1.97). Conclusions: An investigation of the family history of dyslipidemia should be made as part of the protocol to verify the presence of hypertriglyceridemia and dyslipidemia in children.OBJECTIVE To evaluate the association between family history and the presence of dyslipidemia in children. METHODS A cross-sectional study with 257 children aged 4 to 7 years old from Vicosa, Minas Gerais, Southeast Brazil. Nutritional status and lipid profile (total cholesterol, cholesterol fractions, and triglyceride) assessments and an active search for a family history of dyslipidemia in parents were carried out. Pearsons chi-square test was used to identify associations, and Students t-test was used to compare means. A Poisson regression analysis was performed to assess the independent association between family history and the presence of dyslipidemia in children. A significance level of 5% was adopted. RESULTS Children of parents with dyslipidemia had higher serum concentrations of total cholesterol and triglycerides. In a regression analysis after adjustments, the presence of dyslipidemia in the father or in the mother (OR: 2.43; 95%CI 1.12-5.27), as well as the presence of dyslipidemia in both the father and the mother (OR: 5.62; 95%CI 2.27-13.92) were associated with hypertriglyceridemia in children. Children of parents with dyslipidemia had a higher prevalence of elevated low-density lipoproteins (LDL-c) (OR: 1.52; 95%CI 1.18-1.97). CONCLUSIONS An investigation of the family history of dyslipidemia should be made as part of the protocol to verify the presence of hypertriglyceridemia and dyslipidemia in children.

ÍNDICE RELAÇÃO CINTURA-ESTATURA PARA PREDIÇÃO DO EXCESSO DE PESO EM CRIANÇAS

ABSTRACT Objective: To identify a low-cost abdominal adiposity index that has a higher accuracy in predicting excess weight in children aged four to seven years old. Methods: A cross-sectional study with a sample of 257 children aged 4 to 7 years old. Indicators of abdominal adiposity assessed were: waist circumference (WC), waist-to-height ratio (WHR) and central fat percentage (measured by dual energy X-ray absorptiometry - DEXA). Overweight children were classified using body mass index by age (BMI/age). In the analysis, the prevalence ratio (PR) using Poisson regression with a robust variance was estimated, and a receiver operating characteristic (ROC) curve was built, with a statistical significance of p<0.05. Results: The prevalence of overweight children was 24.9% and a higher median of all abdominal adiposity indicators was observed in the overweight group. Children with increased values of WC (PR=4.1; 95%CI 2.86-5.86), WHR (PR=5.76; 95%CI 4.14-8.02) and a central fat percentage (PR=2.48; 95%CI 1.65-3.73) had a higher prevalence of being overweight. Using the ROC curve analysis, the WHR index showed a higher area under the curve, when compared to the WC and to the central fat percentage estimated by DEXA for predicting the classification of being overweight. Conclusions: Given the results, WHR is suggested for the screening of overweight children.

Factors associated with the iron nutritional status of Brazilian children aged 4 to 7 years

Objective To evaluate factors associated with the iron nutritional status of Brazilian children aged 4 to 7 years in the city of Viçosa, Minas Gerais state, Brazil. Methods This is a cross-sectional study of 357 children aged 4-7 years who had been followed-up up for during their first six months of life by the Breastfeeding Support Program. Socioeconomic and demographic characteristics, feeding practices, nutritional status (height-for-age and body mass index-for-age), and serum ferritin and hemoglobin concentrations were evaluated. Multiple linear regression analysis was carried out to evaluate factors independently associated with iron nutritional status (hemoglobin and ferritin), considering α=0.05 as the significance level. Results The prevalence of anemia and iron deficiency was (34) 9.52% and (11) 11.00%, respectively. The factors independently associated with anemia were younger child age, low maternal education, low height-for-age Z-scores, and children of single and separated mothers or widows. Iron deficiency was associated with child younger age and consumption of chocolates and chocolate flavored milk.

Prevalência e fatores associados à anemia ferropriva e hipovitaminose A em crianças menores de um ano

Objective To assess the iron deficiency anemia and vitamin A deficiency prevalence and associated factors in children under one year. Methods Cross-sectional study with a sample of 93 children. Children with hemoglobin <11 g/dL were considered anemic. The cutoff point used for the classification of low levels of vitamin A was < 0.70 mMol/L and to characterize disability < 0.35 mmol/L. Statistical analyzes were carried out using Stata 10.0 software. Variables were presented in simple frequency and the association among the factors and deficiencies of iron and vitamin A was performed by the Pearson chi- square test. Mean hemoglobin and vitamin A were compared using the Student t test for parametric variables and Mann-Whitney test for nonparametric. Results The prevalence of anemia and vitamin A deficiency was 29.03% and 19.10%, respectively. It was found also low vitamin A values in 90.32% of children. The presence of iron deficiency anemia was associated to low maternal age and education. Low values of vitamin Awere significant in non-white mothers. The prevalence of inadequate iron intake and vitamin A was 23.66% and 22.58%, respectively. Conclusion This study evidences the high prevalence of these diseases, highlighting the importance of adopting preventive measures.

Aspectos metodológicos na construção de projetos de pesquisa em Nutrição Clínica

This text aims to foster the reflection and criticism in the process of developing research projects in clinical nutrition. We present aspects regarding the evidence, validity, and reliability of results of studies in this field. Appropriate study planning is critical, from defining the design and type of experiment, going through the ethical aspects, population choice, and calculation of sample size, to the assessment of the feasibility of the risks involved in study execution. Once the information is collected, the next stages correspond to the description of the results, statistical analyses, verification of the consistency of these results, and ultimately their correct interpretation.