Adolescent parenthood associated with adverse socio-economic outcomes at age 30 years in women and men of the Pelotas, Brazil: 1982 Birth Cohort Study.

OBJECTIVE: To investigate the potential long-term effects of adolescent parenthood on completed education and income. DESIGN: Population-based birth cohort study. SETTING: All live births in 1982, whose mothers lived in the urban area of Pelotas, southern Brazil. SAMPLE: A total of 3701 participants: 1914 women and 1787 men at age 30 years. METHODS: Questionnaires were completed by the mothers in the early phases of this study, and by the cohort members in adolescence and adulthood. Linear regression models and G-computation were used in the analyses. MAIN OUTCOME MEASURES: Educational attainment and income at age 30 years. RESULTS: In women, adolescent parenthood was associated with lower attained education compared with women without adolescent maternity: by -2.8 years [95% confidence interval (CI) -3.2 to -2.3] if their first birth was at age 16-19, and by -4.4 years (-5.5 to -3.3) at age 11-15. These effects were greater among women who had three or more children. Women with adolescent parenthood also had 49 or 33% lower income at age 30 if their first child was born when aged 16-19 or 11-15, respectively. In men, the adverse effect of adolescent parenthood on education appeared to be mediated by a higher number of children and there was no effect of adolescent paternity on income at age 30 years. CONCLUSION: These findings suggest lasting socio-economic disadvantages of adolescent parenthood, with larger effects being apparent in women than in men. TWEETABLE ABSTRACT: Adolescent parenthood has an adverse effect on educational attainment later in life, and on household income among women.

Obesity-induced hypoadiponectinaemia: the opposite influences of central and peripheral fat compartments.

Background and Aims: The substantial reduction in adiponectin concentration among obese individuals seems to depend on fat distribution and is a marker of metabolic and adipose tissue dysfunction. We aimed to: (i) address whether abdominal fat from different compartments (visceral, deep subcutaneous abdominal and superficial subcutaneous abdominal) and gluteofemoral fat are independently associated with blood adiponectin concentration; and (ii) investigate whether abdominal (proxied by waist circumference) and gluteofemoral fat (proxied by hip circumference) accumulation causally determine blood adiponectin concentration. Methods: To investigate the independent association of abdominal and gluteofemoral fat with adiponectin concentration, we used multivariable regression and data from 30-year-old adults from the 1982 Pelotas Birth Cohort (n = 2,743). To assess the causal role of abdominal and gluteofemoral fat accumulation on adiponectin concentration, we used Mendelian randomization and data from two consortia of genome-wide association studies-the GIANT (n > 210 000) and ADIPOGen consortia (n = 29 347). Results: In the multivariable regression analysis, all abdominal fat depots were negatively associated with adiponectin concentration, specially visceral abdominal fat [men: ß = -0.24 standard unit of log adiponectin per standard unit increase in abdominal fat; 95% confidence interval (CI) = -0.31, -0.18; P = 8*10-13; women: ß = -0.31; 95% CI = -0.36, -0.25; P = 7*10-27), whereas gluteofemoral fat was positively associated with adiponectin concentration (men: ß = 0.13 standard unit of log adiponectin per standard unit increase in gluteofemoral fat; 95% CI = 0.03, 0.22; P = 0.008; women: ß = 0.24; 95% CI = 0.17, 0.31; P = 7*10-11). In the Mendelian randomization analysis, genetically-predicted waist circumference was inversely related to blood adiponectin concentration (ß = -0.27 standard unit of log adiponectin per standard unit increase in waist circumference; 95% CI = -0.36, -0.19; P = 2*10-11), whereas genetically-predicted hip circumference was positively associated with blood adiponectin concentration (ß = 0.17 standard unit of log adiponectin per standard unit increase in hip circumference; 95% CI = 0.11, 0.24; P = 1*10-7). Conclusions: These results support the hypotheses that there is a complex interplay between body fat distribution and circulating adiponectin concentration, and that whereas obesity-induced hypoadiponectinaemia seems to be primarily attributed to abdominal fat accumulation, gluteofemoral fat accumulation is likely to exert a protective effect.

Interactions between lifestyle and MTHFR polymorphisms on homocysteine concentrations in young adults belonging to the 1982 Pelotas Birth Cohort.

BACKGROUND/OBJECTIVES: Homocysteine (Hcy) is a key intermediate in methionine metabolism. A high plasma concentration of Hcy is an independent risk factor for cardiovascular diseases among other determinants. In this study, we aimed to investigate the interactions between methylenetetrahydrofolate reductase enzyme gene (MTHFR) polymorphisms and lifestyle variables (smoking, alcohol intake and physical activity) on Hcy concentrations in a young Brazilian population. SUBJECTS/METHODS: The study population comprised 3803 individuals from the Pelotas Birth Cohort, aged 22-23 years. Allelic discrimination assays and chemiluminescence immunoassays were performed for genotyping and serum Hcy measurements, respectively. Linear regression models were used to explore the effect of gene-lifestyle interactions on Hcy concentrations. RESULTS: Men carrying the MTHFR 677TT genotype, who were also smokers and drinkers (⩾15 g of alcohol per day), had the highest concentration of Hcy (P-value for the interaction <0.001 for smoking and 0.002 for alcohol intake). In contrast, high folate concentrations attenuated the effects of the MTHFR C677T genotype on serum Hcy concentrations (P-value for interaction <0.001). Also, among males, blood folate concentration was the only lifestyle variable able to modify the influence of MTHFR A1298C genotypes on Hcy concentrations (P-value for the interaction <0.001). There was no strong evidence of an interaction between the MTHFR genotypes and the lifestyle variables in women. CONCLUSIONS: In summary, our study demonstrates a sex difference in Hcy concentrations among Brazilian young adults regarding MTHFR C677T-lifestyle interactions that are worsened under conditions of low blood folate. Identification of potentially modifiable factors related to an increase in homocysteine in young adults, especially in those who are genetically susceptible, is important to prevent negative health consequences in the future.

Childhood stunting and the metabolic syndrome components in young adults from a Brazilian birth cohort study.

BACKGROUND/OBJECTIVES: The aim of this study was to investigate the association between stunting in the second year of life and metabolic syndrome components in early adulthood among subjects who have been prospectively followed-up since birth, in a city in Southern Brazil. SUBJECTS/METHODS: In 1984, we attempted to follow-up the entire cohort; the subjects were examined and their mothers interviewed. Stunting was defined by a length-for-age Z-score 2 s.d. or more below the mean, in accordance with the World Health Organization reference. Between 2004 and 2005, we again tried to follow the entire cohort; during this period the subjects were evaluated for the following metabolic syndrome components: high-density lipoprotein (HDL) cholesterol, triglycerides, random blood glucose, waist circumference and systolic and diastolic blood pressure. Family income at the time of the baby's birth, asset index, mother's education, mother's smoking during pregnancy and duration of breastfeeding were considered possible confounders. Linear regression was used in the unadjusted and adjusted analyses. RESULTS: Among men, stunting was inversely associated with triglycerides (ß=-11.90, confidence interval (CI)=-22.33 to -1.48) and waist circumference (ß=-4.29, CI=-5.62 to -2.97), whereas for women stunting was negatively related to HDL-cholesterol (ß=-4.50, CI=-6.47 to -2.52), triglycerides (ß=-9.61, CI=-17.66 to -1.56) and waist circumference (ß=-1.14, CI=-4.22 to -1.02). However, after controlling for confounding variables, these associations vanished. CONCLUSIONS: The findings suggest that stunting in childhood is not associated with metabolic syndrome components in young adults.

Maternal depression and anxiety predicts the pattern of offspring symptoms during their transition to adulthood.

BACKGROUND: Episodes of depression and anxiety (D&A) during the transition from late adolescence to adulthood, particularly when persistent, are predictive of long-term disorders and associated public health burden. Understanding risk factors at this time is important to guide intervention. The current objective was to investigate the associations between maternal symptoms of D&A with offspring symptoms during their transition to adulthood. METHOD: Data from a large population-based birth cohort study, in South Brazil, were used. Prospective associations between maternal D&A and offspring risk of these symptoms during the transition to adulthood (18/19, 24 and 30 years) were estimated. RESULTS: Maternal D&A in adolescence was associated with offspring symptoms across the transition to adulthood, associations were consistently stronger for females than for males. Daughters whose mothers reported D&A were 4.6 times (95% confidence interval 2.71-7.84) as likely to report D&A at all three time-points, than daughters of symptom-free mothers. CONCLUSIONS: Maternal D&A is associated with persistent D&A during the daughter's transition to adulthood. Intervention strategies should consider the mother's mental health.

Associations of birth weight, linear growth and relative weight gain throughout life with abdominal fat depots in adulthood: the 1982 Pelotas (Brazil) birth cohort study.

BACKGROUND: Several studies have reported on associations of size at birth and early growth with general and central obesity; however, few have examined the potential effects of birth weight and postnatal growth on separate abdominal fat compartments. We investigated the effects of size at birth, linear growth and relative weight gain from birth to adulthood on visceral (VFT) and subcutaneous abdominal (SAFT) fat thicknesses at age 30 years. METHODS: A total of 2663 participants from the 1982 Pelotas (Brazil) birth cohort study had complete information on ultrasound measures of abdominal fat at age 30 years, and anthropometric measurements for at least five visits (0/2/4/23/30 years). We estimated weight and height Z-score changes, conditional relative weight gain and conditional height at several ages. RESULTS: In both men and women, VFT and SAFT showed positive associations with conditional relative weight gain during all age periods beyond 2 years and birth, respectively (all P⩽0.01). Women born with intrauterine growth restriction (IUGR) had greater VFT than other women (difference=0.15 s.d., 95% CI: 0.01-0.29), and they showed a stronger positive influence of infant weight gain 0-2 years on VFT (IUGR: ß=0.17 s.d., 95% CI: 0.05-0.29; non-IUGR: ß=0.01 s.d., 95% CI: -0.04 to 0.06; Pinteraction=0.02). Stunting at 2 years was associated with lower SAFT but not VFT, and it modified the influence of weight gain 2-4 years on SAFT in both sexes (both Pinteraction<0.05). CONCLUSIONS: Our findings reinforce the advantages of being born with an appropriate birth weight, and the hazards of rapid postnatal gains in weight relative to linear growth, particularly after the critical window of the first 1000 days.

Body size dissatisfaction among young adults from the 1982 Pelotas birth cohort.

BACKGROUND/OBJECTIVES: To identify the prevalence and factors associated with body dissatisfaction. SUBJECTS/METHODS: Birth cohort study investigating 4100 subjects (2187 men and 1913 women) aged between 22 and 23 years who answered questionnaires, including the body satisfaction Stunkard Scale were included in the study; they were weighed and measured. Multinomial logistic regression was used in the crude and adjusted analyses. RESULTS: The prevalence of body dissatisfaction was 64% (95% CI, 62.7-65.6); 42% (95% CI, 40.6-43.6) of the subjects reported feeling larger than the desired body size, and 22% (95% CI, 20.7-23.3) reported feeling smaller than desired. Underweight subjects, subjects with less schooling, poor and sedentary male subjects with low psychological well-being and female subjects who were already mothers were more likely to express body dissatisfaction, perceiving their body as smaller than the desirable body size. The prevalence of body dissatisfaction was also high among overweight subjects, subjects with a high socioeconomic status and married female subjects, who perceived their body size as too large. Minor psychiatric disorders were associated with body dissatisfaction in all subjects, regardless of perceiving themselves as larger or smaller than the desired body size. Most women perceived themselves as larger, but similar proportions of men perceived themselves as too small or too large. CONCLUSIONS: Body dissatisfaction was observed among men and women with normal weight, but it was more evident in the obese individuals. Regardless of the nutritional status, both men and women should be appropriately counseled because body size perception can lead to unhealthy behaviors in relation to diet and physical activity.

Parental childhood growth and offspring birthweight: pooled analyses from four birth cohorts in low and middle income countries.

OBJECTIVE: Associations between parental and offspring size at birth are well established, but the relative importance of parental growth at different ages as predictors of offspring birthweight is less certain. Here we model parental birthweight and postnatal conditional growth in specific age periods as predictors of offspring birthweight. METHODS: We analyzed data from 3,392 adults participating in four prospective birth cohorts and 5,506 of their offspring. RESULTS: There was no significant heterogeneity by study site or offspring sex. 1SD increase in maternal birthweight was associated with offspring birthweight increases of 102 g, 1SD in maternal length growth 0-2 year with 46 g, and 1SD in maternal height growth Mid-childhood (MC)-adulthood with 27 g. Maternal relative weight measures were associated with 24 g offspring birth weight increases (2 year- MC) and 49 g for MC-adulthood period but not with earlier relative weight 0-2 year. For fathers, birthweight, and linear/length growth from 0-2 year were associated with increases of 57 and 56 g in offspring birthweight, respectively but not thereafter. CONCLUSIONS: Maternal and paternal birthweight and growth from birth to 2 year each predict offspring birthweight. Maternal growth from MC-adulthood, relative weight from 2-MC and MC-adulthood also predict offspring birthweight. These findings suggest that shared genes and/or adequate nutrition during early life for both parents may confer benefits to the next generation, and highlight the importance of maternal height and weight prior to conception. The stronger matrilineal than patrilineal relationships with offspring birth weight are consistent with the hypothesis that improving the early growth conditions of young females can improve birth outcomes in the next generation.

Haplotype TGTG from SNP 45T/G and 276G/T of the adiponectin gene contributes to risk of polycystic ovary syndrome.

BACKGROUND: Haplotypes of adiponectin gene single nucleotide polymorphisms (SNP) might be related to metabolic disorders. AIM: To assess whether the prevalence of SNP 45T/G and 276G/T of the adiponectin gene and their haplotypes differ between polycystic ovary syndrome (PCOS) and non-hirsute cycling controls and to investigate the relationship between these haplotypes and risk factors for cardiovascular disease. SUBJECTS AND METHODS: In this case-control study, 80 women with PCOS and 1500 non-hirsute controls with regular cycles underwent clinical and laboratory measurements. Genotype distribution was analyzed by conventional PCR-restriction fragment length polymorphism. RESULTS: Compared to controls, PCOS women had greater body mass index (BMI) (31.0±7.9 kg/m² vs 23.4±4.6 kg/m²; p<0.001), waist circumference (92.2±18.8 cm vs 74.5±10.2 cm; p<0.001), and systolic and diastolic blood pressure (124.6±19.9 vs 111.5±13.0 mmHg and 79.2±12.5 vs 71.8±10.6 mmHg; p<0.025), as well as a worse lipid profile (p<0.007), even after adjustment for age and BMI. Genotype distribution was similar in PCOS and controls (45T/G: p=0.399; 276G/T: p=0.135). Six haplotypes were inferred and their frequencies differed significantly between the groups (p=0.001). The TGTG haplotype was more frequent in PCOS than controls (41.3 vs 18.9%). In PCOS, the GG genotype for SNP 276 (p=0.031) and the TGTG haplotype (p=0.023) were associated with higher systolic blood pressure vs other genotypes and haplotypes. Body composition, glucose, insulin, and lipid profile were similar across genotypes and haplotypes in both groups. CONCLUSIONS: Haplotype TGTG from adiponectin gene variants 45T/G and 276G/T is related to susceptibility to PCOS, and might be associated with increased blood pressure in PCOS.

Caesarean sections and risk of wheezing in childhood and adolescence: data from two birth cohort studies in Brazil.

BACKGROUND: There is evidence from two meta-analyses that children born through caesarean section (C-section) may have an increased risk of developing asthma compared with those born through vaginal delivery. Objective To evaluate the association between mode of delivery and wheezing (current and persistent) in childhood and adolescence, in two birth cohort studies in Brazil. METHODS: The outcome variable was based on the International Study of Allergy and Asthma questionnaire, which collects information about wheezing within the 12 months before the interview. Persistent wheezing was defined when it was present in more than one follow-up at different ages, in the 1993 cohort. The questions were asked to mothers when children were aged 4 years (1993 and 2004 cohorts) and directly to cohort participants at 11 and 15 years (1993 cohort). Mode of delivery was collected by the research team of each cohort when children were born. RESULTS: Response rates in the last follow-up visit of the 1993 and 2004 cohorts were 85% and 92%, respectively. The prevalence of current wheezing increased from 20% to 28% at 4 years from 1993 to 2004; at 11 and 15 years, the prevalence was around 14% and 12%, in the 1993 cohort. The proportion of C-sections increased from 30.5% to 45% between 1993 and 2004. In each cohort, the prevalence of current wheezing was similar among children born through vaginal and C-section. The risk for persistent wheezing in the 1993 cohort was higher among girls born through C-section than boys. CONCLUSION: Despite the increase in the proportion of C-section in two cohorts in Southern Brazil, we found no evidence of an association between mode of delivery and the subsequent risk of wheezing. Among girls, although there was no statistical significance, the risk was higher for those born by C-section, especially regarding persistent wheezing.

Life-course determinants of need for dental prostheses at age 24.

This study aimed to assess the prevalence of use and need for dental prostheses (UNDP) by individuals at age 24 and their life-course determinants. A representative sample (n = 720) of all 5914 births occurring in Pelotas in 1982 were prospectively investigated, and the UNDP were assessed in 2006. Exploratory variables included demographic and socio-economic, oral health, and dental service utilization patterns during the life-course. The prevalence of UNDP was 2.1% and 29.7%, respectively. Multivariable Poisson regression analysis showed that low socio-economic status through the life-course [Prevalence Ratio (PR) = 1.56 (95% CI: 1.08-2.26)], lower maternal schooling in childhood [PR 2.79 (1.34-5.79)], no oral hygiene instruction by a dentist at age 15 [PR 1.64 (1.11-2.41)], and caries presence at age 15 (high DMFT tertile) [PR 2.90 (1.98-4.24)] were associated with prosthetic treatment needs. These results support the hypothesis that life-course socio-economic, behavioral, and clinical determinants are associated with the need for dental prostheses.

Epidemiology of early and late growth in height, leg and trunk length: findings from a birth cohort of Brazilian males.

BACKGROUND/OBJECTIVE: To investigate socioeconomic, gestational and early life exposures as potential determinants of total height, leg and trunk length. SUBJECTS/METHODS: Male subjects from the 1982 Pelotas Birth Cohort Study were examined in 1986 at home, and in 2000 when registering at the local army base. The follow-up rate was 79%. Standing and sitting heights were measured on both occasions. Leg length was calculated as the difference between standing and sitting heights. Outcome measures were height, leg and trunk length at 4 and 18 years and growth in this period. Complete data were obtained for 2012 participants, representing 71% of all eligible male subjects. RESULTS: Mean (s.d.) height, trunk length and leg length at 18 years were 173.4 (6.8), 96.0 (3.5) and 77.5 cm (4.5), respectively. The mean (s.d.) change in height from 1986 to 2000 was 75.4 cm (5.2) and for leg and trunk length 35.4 (3.9) and 40.0 cm (2.9), respectively. Of 11 independent variables analyzed, only maternal height and birthweight were associated with all three variables of growth. Gestational age showed no associations with growth or attained size. CONCLUSIONS: Early growth plays a pivotal role in determining attained height and its components. Both biological and socioeconomic variables strongly influence determinants of height, though socioeconomic factors appear to be more important in early growth. Leg and trunk length contribute almost equally to differences in overall height, regardless of the independent variable influencing the difference. Public health strategies designed to improve chronic disease profiles should focus on the early growth period.

Toothache prevalence and associated factors: a population based study in southern Brazil.

OBJECTIVES: The aim of this study was to estimate toothache prevalence and associated factors among adult residents in Pelotas, a southern Brazilian city. METHODS: A cross-sectional population-based study was carried out in individuals aged > or = 20 years (n = 3353). A multi-stage sampling scheme was adopted, and data collection was performed at participants' homes through standardized pre-tested questionnaires. Toothache in the past 6 months was regarded as the outcome. Socioeconomic and demographic data as well as health-related behavioural data were collected. All analyses were undertaken with a Poisson regression model, following a hierarchical conceptual model. RESULTS: The response rate was 93.5% and toothache prevalence was 17.7% (95% CI 16.0-19.3). Multivariable analyses revealed that toothache was more likely to be reported by those with low educational attainment and low family income. Younger subjects, women and black people were also more likely to report toothache. Current smokers and problem drinkers were at increased risk of experiencing toothache in the past 6 months. CONCLUSIONS: The toothache prevalence reported in the present study is not negligible and should initiate the formulation of preventive policies and support the planning of local oral health services.

Breastfeeding and overweight in childhood: evidence from the Pelotas 1993 birth cohort study.

OBJECTIVES: The effect of breastfeeding duration on the prevalence of overweight and on mean weight for height z-score (WHZ) was evaluated in Brazilian children. DESIGN: Prospective population-based birth cohort study. SUBJECTS: In total, 1,273 children aged 4 years, corresponding to a follow-up rate of 87.2%. MEASUREMENTS: Three explanatory variables were studied: duration of any breastfeeding, duration of exclusive or predominant breastfeeding, and ever breastfeeding. Weight and height were measured using a digital electronic scale and a portable stadiometer. Overweight was defined as WHZ >2 using the National Center for Health Statistics reference curve. RESULTS: Overweight prevalence at the age of 4 years was 10.2% (95% CI 8.4; 11.8). The lowest prevalence (6.5%) was observed among children breastfed for >11 months. Among those breastfed for less than 3 months, the prevalence of overweight was approximately 9.5%. Mean WHZ ranged from 0.38 among children breastfed for less than 1 month to 0.62 among those breastfed for 9-11.9 months. No linear trends were detected in the association between breastfeeding and anthropometric indicators. None of the three breastfeeding variables was significantly associated with the prevalence of overweight or mean WHZ in multivariable analyses. No interactions were detected between breastfeeding and the variables sex, birth weight, socioeconomic status, skin color and pregestational in body mass index. CONCLUSION: Our results do not support the hypothesis that breastfeeding promotion would reduce overweight or obesity in this population. Existing evidence on many other benefits of breastfeeding for the mother and the child supports its continued promotion, protection and support.

A shift in the epidemiology of low body mass index in Brazilian adults.

OBJECTIVE: To study the prevalence and current predictors of low body mass index (BMI) in a population undergoing a rapid nutritional transition. DESIGN: Population-based cross-sectional study. SETTINGS: Individuals living in the urban area of Pelotas, a medium-sized southern Brazilian city, were interviewed at home. SUBJECTS: A multiple-stage sampling strategy was used. Out of 3372 eligible subjects, 3047 were interviewed. The study was restricted to adults (> or = 20 y). MAIN OUTCOME MEASURE: Low BMI was defined as <18.5 kg/m2. RESULTS: The prevalence of low BMI was 2.7% (95% confidence interval: 2.1; 3.3), higher in women than men (3.8 vs 1.3%; P < 0.001). In the whole sample (men and women combined), living without a partner and current smoking were positively associated with low BMI. Among women, low BMI presented a U-shaped relationship with age and was positively associated with educational level. The prevalence of low BMI in young women was 6.3%, and in highly educated young women was 8.9%. CONCLUSIONS: Consistently with previous Brazilian studies, a decline in the overall prevalence of low BMI is clear. However, differently from these studies, the predictors of low BMI in women are similar to those observed within developed countries (including low age and high education), possibly indicating an increase in eating disorders.

Waist circumference as a determinant of hypertension and diabetes in Brazilian women: a population-based study.

OBJECTIVE: To evaluate the role of central adiposity, as evaluated by the measurement of waist circumference (WC), as an independent risk factor for hypertension and type 2 diabetes mellitus in the setting of a developing country. DESIGN: Population-based, cross-sectional study. SETTING: A medium-sized town in southern Brazil. PARTICIPANTS: One thousand and ninety-five non-pregnant women, 20 to 69 years old, recruited by cluster random sampling between 1999 and 2000. Their mean WC was 85.3 cm (standard deviation 13.9 cm) and 23.3% (n=255) were obese (body mass index >30 kg m(-2)). The prevalence of hypertension and diabetes was 25.6% (n=280) and 6.2% (n=68), respectively. RESULTS: The risks of hypertension and diabetes were directly related to WC measurement. Women with WC>80 cm had increased risk of hypertension (odds ratio (OR)=6.2, P<0.001). The association remained significant (OR=1.04 per cm increase in WC, P=0.02) after adjusting for confounders. The effect of WC on diabetes was modified by age. The effect was stronger in women younger than 40 years old (OR=12.7, P=0.016) than in those over 40 years old (OR=2.8, P=0.013). In the multivariate analysis, the odds ratio was 5.7 (P=0.12) in those under 40 years old and 2.8 (P=0.008) in older women. CONCLUSIONS: Waist circumference is an independent determinant for hypertension and diabetes in women in this population. The stronger association between WC and diabetes in younger women suggests that the validity of this indicator to assess abdominal adiposity is age-specific. Further studies should validate the usefulness of WC measurement in different age groups.

Nutrition counseling increases weight gain among Brazilian children.

To assess the impact on child growth of the nutrition-counseling component of the Integrated Management of Childhood Illnesses (IMCI) strategy, a randomized trial was implemented. All 28 government health centers in a Southern Brazil city were paired according to baseline nutritional indicators. One center from each pair was randomly selected and its doctors received 20-h training in nutrition counseling. Thirty-three doctors were included and 12-13 patients < 18 mo of age from each doctor were recruited. The study included testing the knowledge of doctors, observing consultations and visiting the children at home 8, 45 and 180 d after the initial consultation. Maternal knowledge, practices and adherence to nutritional recommendations were assessed, and anthropometric measurements were taken. Day-long dietary intake was evaluated on a subsample of children. Doctors in the intervention group had better knowledge of child nutrition and improved assessment and counseling practices. Maternal recall of recommendations was higher in the intervention than in the control group, as was satisfaction with the consultation. Reported use of recommended foods was also increased. Daily fat intake was higher in the intervention than in the control group; mean daily intakes of energy and zinc also tended to improve. Children 12 mo of age or older had improved weight gain and a positive but nonsignificant improvement in length. Nutrition-counseling training improved doctors' performances, maternal practices and the diets and weight gain of children. The randomized design with blind outcome evaluation strongly supports a causal link. These results should be replicated in other settings.

[Diabetes mellitus at the primary health care level in Southern Brazil: structure, course of action and outcome]. / Atenção primária em diabetes no Sul do Brasil: estrutura, processo e resultado.

OBJECTIVE: To describe and evaluate the structure, course of action, and the outcome of diabetic patient care delivered at primary health care level in Pelotas, Southern Brazil. METHODS: Through a cross-sectional study all of 32 health centers in the region were assessed, along with the 61 doctors who were managing diabetic patients. A sample of 378 diabetic patients who attended these health centers was also included. Patients were interviewed at home and their glucose capillary blood level, blood pressure and body mass index were assessed and compared with standard parameters. Course of action and structure components were compared against the basic recommendations for the care of diabetic patients. RESULTS: Most centers didn't meet the basic recommendations. Blood pressure measurement was the most reported action in the physical examination in the first visit. As part of the management plan set in the first visit, almost 85% of the doctors reported to prescribe a special diet and 72% referred recommending physical exercise. For laboratory monitoring, all doctors reported asking for fasting blood glucose and 60% of them reported checking their patients' glycated hemoglobin. The rate of disease control ranged from 6 to 11%, according to the Latin American Diabetes Association and the Ministry of Health parameters, respectively. CONCLUSIONS: Although currently undersupplied, the primary health sector is potentially able to improve in its three components (structure, course of actions and outcome) by training medical doctors and their compliance with established guidelines.

Breast-feeding has a limited long-term effect on anthropometry and body composition of Brazilian mothers.

The effect of lactation on maternal nutrition is controversial. Some studies have shown that breast-feeding reduces maternal weight, whereas some have not. All studies have been restricted to the first 2 y after delivery. We investigated the effect of lactation on maternal nutrition 5 y after delivery. All mothers giving birth in the city of Pelotas, Brazil, in 1993 were interviewed and weighed soon after delivery; information was also obtained on prepregnancy weight. In 1994, information on breast-feeding duration and pattern was collected for a 20% subsample. They were seen again in 1998, and those eligible (nonsmokers, no subsequent pregnancy, last birth weight > or = 2500 g) underwent measurements for weight, height, waist, hip and arm circumferences, triceps and subscapular skinfolds. The following indices were calculated in 312 women: body mass index, waist/hip ratio, arm fat area, the percentage of body fat assessed through skinfolds, and weight and body mass index change since before conception. The percentage of body fat was also measured through bioimpedance for half of the sample. After adjustment for confounding, all outcomes generally showed a similar pattern, i.e., mothers who breast-fed for 6-11.9 mo had lower measurements than those with shorter or longer durations. However, only the association with bioimpedance was significant (P < 0.03), and that for arm fat area tended to be significant (P = 0.06). Exclusive or predominant breastfeeding at 4 mo was associated with lower waist circumference (P = 0.05) and the percentage of body fat measured through skinfolds (P = 0.04). This study suggests that the relationship between breast-feeding and long-term changes in maternal weight is complex and, in this population, not particularly strong.

[Estimating the prevalence of height for age deficits based on the prevalence of weight for age deficits among Brazilian children]. / Estimativa da prevalência de déficit de altura/idade a partir da prevalência de déficit de peso/idade em crianças brasileiras.

INTRODUCTION: Anthropometry is frequently used for evaluating nutritional status of individuals and populations. In recent years, community surveys have been conducted by health professionals in various regions of Brazil with the objective of complementing the data obtained through nutritional surveillance programs. One important difficulty in conducting these assessments has been measuring height during visits to the homes of survey participants. METHODS: Thirty-eight anthropometric surveys of Brazilian children aged up to 5 years using the National Center for Health Statistics (NCHS) reference were identified. The percentage of children with a Z-score below standard deviations was used to define deficits of weight for age and height for age. RESULTS: Correlation between prevalences of height for age and weight for age deficits were examined. Due to the low prevalence of deficits in weight for height in all surveys, there was a strong correlation between weight for age and height for age at the population level. Approximately 90% of the height for age (H/A) variation was accounted for by that of weight for age (W/A). CONCLUSIONS: Using the equation, (Prevalence H/A) = 0.74 + 2.34 (Prevalence W/A) -0.03 (Prevalence W/A)2 it is possible to estimate the prevalence of height deficits on the basis of prevalence of weight deficits. These results suggest that anthropometric surveys as conducted in Brazil, in the context of health services, can be simplified by measuring weight only, instead of both weight and height.