Silvia Diez Castilho

Tendência secular da idade da menarca avaliada em relação ao índice de massa corporal

OBJECTIVE: To evaluate the secular trend of menarche according to body mass index (BMI). SUBJECTS AND METHODS: Six hundred and eighty five girls (7-18 years) assessed in 2001 were compared with 750 evaluated in 2010. They were grouped by BMI Z-score: (thin + normal) and (overweight + obese). Menarche was reported by status quo and age at menarche estimated by a logit model. We used the Qui-square test, Mann-Whitney test, and Logistic Regression, at a 5% significance level. RESULTS: Menarche advanced 3.24 months. There was an increase in obesity, and a decrease of the prevalence of normal girls. Menarche was anticipated by 1.44 month in the thin + normal group and by 5.76 months in the overweight + obese group. There was no interaction between the effects determined by the evaluated period and nutritional diagnosis. CONCLUSIONS: Although both the period and BMI influence the menarche, one cannot attribute this advance only to changes in the nutritional profile of the sample. Other factors that were not tested may also contribute to this finding.

The history of infant nutrition.

OBJECTIVE To retrace the history of infant nutrition with the objective of better understanding breastfeeding. SOURCES OF DATA Bibliographic searches were run on MEDLINE, LILACS, SciELO, and the Internet. Encyclopedias, scientific textbooks and books for the general public, in addition to literature, art and history, were also used. Texts on child care from several different periods were consulted, in addition to the history of medicine and recent scientific articles on infant nutrition. SUMMARY OF THE FINDINGS During the preindustrial period, customs varied little and the likelihood of survival was linked to breastfeeding or its substitution by a wetnurses milk. Where this was not possible, infants were given animal milk, pre-chewed foods or paps that were poor in nutrients and contaminated, which caused high mortality rates. There was nothing that could successfully substitute breastfeeding and the survival of the species was dependent on breastfeeding. Once the industrial revolution had started, women who had been accustomed to breastfeeding went to work in factories, stimulating the search for alternative infant nutrition. Consumption of animal milk and formulae (diluted, flour-based, powdered milk) and premature introduction of complementary foods compromised childrens health. The feminist movement and the contraceptive pill caused a fall in birth rates. Manufacturers in search of profits developed modified formulae and invested in advertising. Society reacted with breastfeeding support movements. CONCLUSIONS Nowadays, the advantages of breastmilk are recognized and exclusive breastfeeding is recommended up to 6 months, to be supplemented with other foods from this age on and continued until at least 2 years of age. Infant nutrition, whether natural or artificial, has always been determined and conditioned by the social value attributed to breastfeeding.

Alimentos utilizados ao longo da história para nutrir lactentes

OBJECTIVE: To retrace the history of infant nutrition with the objective of better understanding breastfeeding. SOURCES: Bibliographic searches were run on MEDLINE, LILACS, SciELO, and the Internet. Encyclopedias, scientific textbooks and books for the general public, in addition to literature, art and history, were also used. Texts on child care from several different periods were consulted, in addition to the history of medicine and recent scientific articles on infant nutrition. SUMMARY OF THE FINDINGS: During the preindustrial period, customs varied little and the likelihood of survival was linked to breastfeeding or its substitution by a wetnurses milk. Where this was not possible, infants were given animal milk, pre-chewed foods or paps that were poor in nutrients and contaminated, which caused high mortality rates. There was nothing that could successfully substitute breastfeeding and the survival of the species was dependent on breastfeeding. Once the industrial revolution had started, women who had been accustomed to breastfeeding went to work in factories, stimulating the search for alternative infant nutrition. Consumption of animal milk and formulae (diluted, flour-based, powdered milk) and premature introduction of complementary foods compromised childrens health. The feminist movement and the contraceptive pill caused a fall in birth rates. Manufacturers in search of profits developed modified formulae and invested in advertising. Society reacted with breastfeeding support movements. CONCLUSIONS: Nowadays, the advantages of breastmilk are recognized and exclusive breastfeeding is recommended up to 6 months, to be supplemented with other foods from this age on and continued until at least 2 years of age. Infant nutrition, whether natural or artificial, has always been determined and conditioned by the social value attributed to breastfeeding.

Dobras cutâneas e bioimpedância elétrica perna-perna na avaliação da composição corporal de crianças

OBJECTIVE: The objective of this study was to compare the components of body composition obtained by leg-to-leg bioimpedance and skinfold thickness measurements in children. METHODS: Triceps and subscapular skinfold thicknesses and TANITA TBF-300A leg-to-leg bioimpedance were used to determine the body composition of 1 286 schoolchildren (703 girls and 583 boys) aged 7 to 9 years. The Pearsons correlation coefficient (r) and Bland-Altman plot were used to analyze the agreement between the two methods. RESULTS: The two methods correlated strongly and significantly for girls´ and boys´ percentage of body fat (0.77 and 0.89, respectively), fat mass (0.93 and 0.94 respectively) and lean mass (0.92 and 0.89 respectively). The Bland-Altman plot also showed good agreement between the methods, since only a few points corresponding to the differences between the measurements obtained by the two methods were outside the confidence interval. CONCLUSION: These results show that both methods, triceps and subscapular skinfold thicknesses and leg-to-leg bioimpedance, can be used to asses the body composition of schoolchildren in population-based studies. Yet, the wide variability observed in some measurements suggests that either method should always be associated with other indicators to assess body composition.

Age at menarche in schoolgirls with and without excess weight

OBJECTIVE To evaluate the age at menarche of girls, with or without weight excess, attending private and public schools in a city in Southeastern Brazil. METHODS This was a cross-sectional study comparing the age at menarche of 750 girls from private schools with 921 students from public schools, aged between 7 and 18 years. The menarche was reported by the status quo method and age at menarche was estimated by logarithmic transformation. The girls were grouped according to body mass index (BMI) cut-off points: (thin + normal) and (overweight + obesity). In order to ensure that they belonged to different strata, 328 parents of these schools answered a questionnaire to rate the students socioeconomic level. RESULTS Menarche was reported by 883 girls. Although they belonged to different classes (p<0.001), there was no difference in the nutritional diagnosis (p=0.104) between them. There was also no difference in age at menarche between the girls studying in private (12.1 years, 95% CI: 12.0-12.2) and public schools (12.2 years, 95% CI:12.1-12.3; p=0.383). When evaluated by nutritional status, there was difference only in the age at menarche between girls from private schools with excess weight and without excess weight (11.6 and 12.3 years; p<0.001). The girls with excess weight attending private schools also had earlier an menarche than those attending public schools (respectively, 11.6 and 12.1 years; p=0.016). CONCLUSIONS Although the students from private schools belonged to a higher socioeconomic status, there is currently no longer a large gap between them and girls from public schools regarding nutritional and socioeconomic factors that may influence the age at menarche.

Evolução histórica dos utensílios empregados para alimentar lactentes não amamentados

The objective of this article is to describe the utensils used throughout history to feed non breastfed infants. The method used was article review, reference search on the MEDLINE, LILACS and SciELO databases from 1966 to 2007 and documental analysis based on data from the internet, encyclopedias, art and history books, and museums. Utensils manufactured in a variety of materials and shapes, depending on availability, purchasing power and culture have been used since early history to feed babies who for different reasons were not breastfed. Many objects coexisted at the same time and place, others at distant sites and times. New alternatives have been accepted without evidence to prove or point toward the benefits of the change. Some of these alternatives were adopted again, even if infant mortality was high at the time in which they were used at first. In the beginning of the 20th century, bottles became conic-cylindrical. Technology brought about progress as to improve hygiene and enable contamination control. Glass gave way to plastic, and rubber nipples to silicone ones, but the bottle as we know it today is still the same of a 100 years ago.

Importância do viés de memória na obtenção da idade da menarca pelo método recordatório em adolescentes brasileiras

OBJECTIVE To compare the age at menarche obtained by recall method according to the time elapsed since the event, in order to verify the importance of the recall bias. SUBJECTS AND METHODS Were evaluated 1,671 girls (7-18 years) at schools in Campinas-SP regarding the occurrence of menarche by the status quo method (menarche: yes or no) and the recall method (date of menarche, for those who mentioned it). The age at menarche obtained by the status quo method was calculated by logit, which considers the whole group, and the age obtained by the recall method was calculated as the average of the mentioned age at menarche. In this group, the age at menarche was obtained by the difference between the date of the event and the date of birth. Girls who reported menarche (883, 52.8%) were divided into four groups according to the time elapsed since the event. To analyze the results, we used ANOVA and logistic regression for the analysis, with a significance level of 0.05. RESULTS The age at menarche calculated by logit was 12.14 y/o (95% CI 12.08 to 12.20). Mean ages obtained by recall were: for those who experienced menarche within the previous year 12.26 y/o (±1.14), between > 1-2 years before, 12.29 y (±1.22); between > 2-3 years before, 12.23 y/o (±1.27); and more than 3 years before, 11.55y/o (±1.24), p < 0.001. CONCLUSION The age at menarche obtained by the recall method was similar for girls who menstruated within the previous 3 years (and approaches the age calculated by logit); when more than 3 years have passed, the recall bias was significant.Objective: To compare the age at menarche obtained by recall method according to the time elapsed since the event, in order to verify the importance of the recall bias. Subjects and methods: Were evaluated 1,671 girls (7-18 years) at schools in Campinas-SP regarding the occurrence of menarche by the status quo method (menarche: yes or no) and the recall method (date of menarche, for those who mentioned it). The age at menarche obtained by the status quo method was calculated by logit, which considers the whole group, and the age obtained by the recall method was calculated as the average of the mentioned age at menarche. In this group, the age at menarche was obtained by the difference between the date of the event and the date of birth. Girls who reported menarche (883, 52.8%) were divided into four groups according to the time elapsed since the event. To analyze the results, we used ANOVA and logistic regression for the analysis, with a significance level of 0.05. Results: The age at menarche calculated by logit was 12.14 y/o (95% CI 12.08 to 12.20). Mean ages obtained by recall were: for those who experienced menarche within the previous year 12.26 y/o (±1.14), between > 1-2 years before, 12.29 y (±1.22); between > 2-3 years before, 12.23 y/o (±1.27); and more than 3 years before, 11.55y/o (±1.24), p < 0.001. Conclusion: The age at menarche obtained by the recall method was similar for girls who menstruated within the previous 3 years (and approaches the age calculated by logit); when more than 3 years have passed, the recall bias was significant.

Skinfold thicknesses and leg-to-leg bioimpedance for the assessment of body composition in children

OBJECTIVE: The objective of this study was to compare the components of body composition obtained by leg-to-leg bioimpedance and skinfold thickness measurements in children. METHODS: Triceps and subscapular skinfold thicknesses and TANITA TBF-300A leg-to-leg bioimpedance were used to determine the body composition of 1 286 schoolchildren (703 girls and 583 boys) aged 7 to 9 years. The Pearsons correlation coefficient (r) and Bland-Altman plot were used to analyze the agreement between the two methods. RESULTS: The two methods correlated strongly and significantly for girls´ and boys´ percentage of body fat (0.77 and 0.89, respectively), fat mass (0.93 and 0.94 respectively) and lean mass (0.92 and 0.89 respectively). The Bland-Altman plot also showed good agreement between the methods, since only a few points corresponding to the differences between the measurements obtained by the two methods were outside the confidence interval. CONCLUSION: These results show that both methods, triceps and subscapular skinfold thicknesses and leg-to-leg bioimpedance, can be used to asses the body composition of schoolchildren in population-based studies. Yet, the wide variability observed in some measurements suggests that either method should always be associated with other indicators to assess body composition.

Trends of body composition among adolescents according to maturation stage and body mass index

Abstract Background: Excessive increases in percentage body fat (%BF) according to sex may pose greater risks of chronic diseases. Objective: To evaluate trends of body composition according to sexual maturation stage and body mass index (BMI) of adolescents. Method: Data about weight, height, lean mass, fat mass, %BF, BMI and sexual maturation of 1345 private school students (685 girls) aged from 7 to 18 years were collected in 2001 and compared with data of 1450 students (750 girls) collected in 2010 in Campinas, Brazil. χ2-test, ANOVA and logistic regression were used for statistical analyses (p<0.05). Results: Obesity prevalence increased, and number of boys and girls with normal BMI (p=0.0183 and p=0.0041) decreased. Differences in the median values of the study variables according to time point and nutritional diagnosis were not significant, except for lean mass (p=0.0484) and height (p=0.0275) in B2 (Breast stage) and %BF (p=0.0324) in G5 (Genitalia stage). Conclusion: Body composition did not change significantly, although overweight increased.

Prevalence of weight excess according to age group in students from Campinas, SP, Brazil

OBJECTIVE: To evaluate the prevalence of weight excess in children and adolescents attending public and private schools of Campinas, Southeast Brazil, according to age group. METHODS: Cross-sectional study that enrolled 3,130 students from 2010 to 2012. The weight and the height were measured and the body mass index (BMI) was calculated. The students were classified by BMI Z-score/age curves of the World Health Organization (WHO)-2007 (thinness, normal weight, overweight and obesity) and by age group (7-10, 11-14 and 15-18 years). Multinomial logistic regression analysis was applied to verify variables associated to overweight and obesity. RESULTS: Among the 3,130 students, 53.7% attended public schools and 53.4% were girls. The prevalence of weight excess (overweight or obesity) was higher in private schools (37.3%) than in public ones (32.9%) and among males (37.5%), compared to females (32.7%; p<0.05). The chance of having weight excess in children aged 7-10 years was more than twice of those over 15 years old (OR 2.4; 95%CI 2.0-3.0) and it was 60% higher for the group with 11-14 years old (OR 1.6; 95%CI 1.3-2.0). The chance of being obese was three times higher in 7-10 years old children than in the adolescents with 15-18 years old (OR 4.4; 95%CI 3.3-6.4) and 130% higher than the group with 11-14 years old (OR 2.3; 95%CI 1.6-3.2). CONCLUSIONS: The prevalence of weight excess in Campinas keeps increasing at an alarming rate, especially in the younger age group.Objective: To evaluate the prevalence of weight excess in children and adolescents attending public and private schools of Campinas, Southeast Brazil, accord...