RESUMEN
OBJECTIVE: To investigate birth-to-childhood tracking of linear growth and weight gain across the distribution of length/height and weight for age z-scores and according to household wealth. METHODS: Data from 614 children from the MINA-Brazil Study with repeated anthropometric measurements at birth and up to age five years were used. Z-scores were calculated for length/height (HAZ) and weight (WAZ) according to international standards. Birth-to-childhood tracking was separately estimated using quantile regression models for HAZ and WAZ, extracting coefficients and 95% confidence intervals (95%CI) at the 25th, 50th, and 75th quantiles. In a subgroup analysis, we estimated tracking between birth and age two years, and between ages two and five years. To investigate disparities in tracking, interaction terms between household wealth indexes (at birth and age five years) and newborn size z-scores were included in the models. RESULTS: Tracking coefficients were significant and had similar magnitude across the distribution of anthropometric indices at age five years (HAZ, 50th quantile: 0.23, 95%CI: 0.11 to 0.35; WAZ, 50th quantile: 0.31, 95%CI: 0.19 to 0.43). Greater tracking was observed between ages two and five years, with coefficients above 0.82. Significantly higher tracking of linear growth was observed among children from wealthier households, both at birth, at the lower bounds of HAZ distribution (25th quantile: 0.30, 95%CI: 0.13 to 0.56), and during childhood, in the entire HAZ distribution at five years. For weight gain, stronger tracking was observed at the upper bounds of WAZ distribution at age five years among children from wealthier households at birth (75th quantile: 0.59, 95%CI: 0.35 to 0.83) and during childhood (75th quantile: 0.54, 95%CI: 0.15 to 0.93). CONCLUSION: There was significant tracking of HAZ and WAZ since birth, with indication of substantial stability of nutritional status between ages two and five years. Differential tracking according to household wealth should be considered for planning early interventions for preventing malnutrition.
Asunto(s)
Desnutrición , Aumento de Peso , Recién Nacido , Humanos , Preescolar , Brasil , Antropometría , Estado NutricionalRESUMEN
OBJECTIVES: To determine predictors of 25-hydroxyvitamin D3 (25(OH)D3) concentrations (25th, 50th, and 75th percentiles) in the third trimester of pregnancy. SUBJECTS/METHODS: Data on sociodemographic, obstetric, lifestyle and pregnancy characteristics, including serum 25(OH)D3 and retinol, were collected among 448 pregnant women who participated in the Maternal and Child Health and Nutrition in Acre, Brazil (MINA-Brazil Study) in Cruzeiro do Sul, Brazilian Amazon (latitude 7°S). Simultaneous-quantile regression was fitted to prospectively assess predictors at the 25th, 50th and 75th percentiles of 25(OH)D3 concentrations. RESULTS: In the third trimester, 25(OH)D3 <50 nmol/L was observed in 26% of pregnant women. Exposure to the Amazonian dry season during follow-up and vitamin D status ≥75 nmol/L in the second trimester of pregnancy were positively associated with 25(OH)D3 concentrations in the third trimester. Pregnant women who were the main providers of family income presented lower 25(OH)D3 concentrations (50th and 75th percentiles: -15 nmol/L, 95%CI -24; -3, p = 0.02, and -22 nmol/L, 95%CI -36; -7, p = 0.004, respectively), as well as those with sustained vitamin A insufficiency (25th and 50th percentiles: -27 nmol/L, 95%CI -40; -15, p < 0.001, and -17 nmol/L, 95%CI -33; -1, p = 0.04, respectively). Sun protection practices had a smaller negative impact on 25(OH)D3, restricted to participants whose concentrations were at the 25th percentile of the distribution. CONCLUSIONS: Seasonality and vitamin A status were important predictors of 25(OH)D3 concentrations in the third trimester. Adequate exposure to sunlight and dietary sources of vitamin A within safe intake levels may help ensuring a good nutritional status of vitamin D during pregnancy.
Asunto(s)
Vitamina A , Deficiencia de Vitamina D , 25-Hidroxivitamina D 2 , Brasil/epidemiología , Calcifediol , Niño , Suplementos Dietéticos , Femenino , Humanos , Embarazo , Estaciones del Año , Vitamina D/análogos & derivados , VitaminasRESUMEN
ABSTRACT OBJECTIVE: To investigate birth-to-childhood tracking of linear growth and weight gain across the distribution of length/height and weight for age z-scores and according to household wealth. METHODS: Data from 614 children from the MINA-Brazil Study with repeated anthropometric measurements at birth and up to age five years were used. Z-scores were calculated for length/height (HAZ) and weight (WAZ) according to international standards. Birth-to-childhood tracking was separately estimated using quantile regression models for HAZ and WAZ, extracting coefficients and 95% confidence intervals (95%CI) at the 25th, 50th, and 75th quantiles. In a subgroup analysis, we estimated tracking between birth and age two years, and between ages two and five years. To investigate disparities in tracking, interaction terms between household wealth indexes (at birth and age five years) and newborn size z-scores were included in the models. RESULTS: Tracking coefficients were significant and had similar magnitude across the distribution of anthropometric indices at age five years (HAZ, 50th quantile: 0.23, 95%CI: 0.11 to 0.35; WAZ, 50th quantile: 0.31, 95%CI: 0.19 to 0.43). Greater tracking was observed between ages two and five years, with coefficients above 0.82. Significantly higher tracking of linear growth was observed among children from wealthier households, both at birth, at the lower bounds of HAZ distribution (25th quantile: 0.30, 95%CI: 0.13 to 0.56), and during childhood, in the entire HAZ distribution at five years. For weight gain, stronger tracking was observed at the upper bounds of WAZ distribution at age five years among children from wealthier households at birth (75th quantile: 0.59, 95%CI: 0.35 to 0.83) and during childhood (75th quantile: 0.54, 95%CI: 0.15 to 0.93). CONCLUSION: There was significant tracking of HAZ and WAZ since birth, with indication of substantial stability of nutritional status between ages two and five years. Differential tracking according to household wealth should be considered for planning early interventions for preventing malnutrition.
RESUMO OBJETIVO: Investigar a autocorrelação do crescimento linear e ganho de peso do nascimento até a infância considerando a distribuição de escores z de comprimento/estatura e peso por idade e de acordo com a riqueza domiciliar. MÉTODOS: Foram utilizados dados de 614 crianças do Estudo MINA-Brasil com medições antropométricas realizadas do nascimento até os cinco anos de idade. Escores z foram calculados para comprimento/estatura (HAZ) e peso (WAZ) seguindo padrões internacionais. A autocorrelação ou estabilidade da adequação do estado nutricional do nascimento à infância foi estimada por meio de modelos de regressão quantílica para HAZ e WAZ, separadamente, extraindo-se coeficientes e intervalos de confiança de 95% (IC95%) nos quantis 25, 50 e 75. Em uma análise de subgrupo, estimou-se a autocorrelação entre o nascimento até os dois anos de idade, e entre dois e cinco anos de idade. Para investigar disparidades na autocorrelação, termos de interação entre índices de riqueza familiar (ao nascer e aos cinco anos de idade) e escores z de tamanho do recém-nascido foram incluídos nos modelos. RESULTADOS: Os coeficientes de autocorrelação foram significantes e tiveram magnitude semelhante ao longo da distribuição dos índices antropométricos aos cinco anos de idade (HAZ, quantil 50: 0,23, IC95%: 0,11 a 0,35; WAZ, quantil 50: 0,31, IC95%: 0,19 a 0,43). Maior estabilidade do estado nutricional foi observada entre dois e cinco anos, com coeficientes acima de 0,82. Autocorrelação significantemente maior do crescimento linear foi observada entre as crianças de domicílios mais ricos, tanto ao nascer, nos limites inferiores da distribuição HAZ (quantil 25: 0,30, IC95%: 0,13 a 0,56) e durante a infância, em toda a distribuição HAZ aos cinco anos. Para o ganho de peso, observou-se uma autocorrelação mais forte nos limites superiores da distribuição do WAZ aos cinco anos de idade entre as crianças de domicílios mais ricos ao nascer (quantil 75: 0,59, IC95%: 0,35 a 0,83) e durante a infância (quantil 75: 0,54, IC95%: 0,15 a 0,93). CONCLUSÃO: Houve autocorrelação significante de HAZ e WAZ desde o nascimento, com indicação de substancial estabilidade do estado nutricional entre os dois e cinco anos de idade. A autocorrelação diferencial de acordo com a riqueza domiciliar deve ser considerada para o planejamento de intervenções precoces para prevenir a má nutrição.
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Factores Socioeconómicos , Aumento de Peso , Niño , Estado Nutricional , Cohorte de Nacimiento , CrecimientoRESUMEN
Introdução: A inadequação do estado nutricional de vitamina D, segundo concentrações de 25-hidroxivitamina D (25(OH)D), vem sendo colocada como uma questão global de saúde pública, sendo as gestantes um grupo de alto risco. A condição relaciona-se a diversas intercorrências, incluindo a resistência à insulina (RI). Objetivos: Caracterizar preditores das concentrações de 25(OH)D e investigar prospectivamente a associação da insuficiência persistente de vitamina D sobre RI no terceiro trimestre gestacional, em Cruzeiro do Sul, Acre. Métodos: Análise longitudinal junto ao Estudo MINA-Brasil entre gestantes com duas medidas de 25(OH)D na gestação. Coletaram-se informações socioeconômicas, demográficas, história obstétrica e estilo de vida. Para caracterizar preditores, coeficientes e intervalos de confiança de 95% (IC95%) foram estimados por regressão quantílica simultânea com estimador boostrap de erro padrão nos percentis 25 (49 nmol/L), 50 (79 nmol/L) e 75 (110 nmol/L) da distribuição de 25(OH)D. Investigou-se a associação da insuficiência persistente de vitamina D (<75 nmol/L no 2º e 3º trimestres) com RI (homeostatic model assessment for insulin resistance, HOMA-IR >2,71) por meio de regressão logística. Adicionalmente, com inclusão de um termo de interação, realizou-se análise de moderação segundo ganho de peso gestacional (GPG) excessivo. Resultados: Entre as participantes (n=448; 25 [DP: 6] anos; 28 [DP: 1,6] semanas gestacionais), observou-se prevalência de 28% de insuficiência persistente de vitamina D. Preditores das concentrações de 25(OH)D no terceiro trimestre incluíram exposição à estação seca e melhor estado nutricional de vitamina D no segundo trimestre, com impactos positivos ao longo de toda a distribuição de 25(OH)D. Menores concentrações de 25(OH)D foram observadas entre gestantes chefes de família (percentis 50 e 75: -15 nmol/L, IC95% -24; -3 e -22 nmol/L, IC95% - 36; -7, respectivamente) e com insuficiência persistente em vitamina A (percentis 25 e 50: -27 nmol/L, IC95% -40; -15 e -17 nmol/L, IC95% -33; -1, respectivamente). Práticas de proteção solar tiveram impacto menor, restrito ao percentil 25 das concentrações de 25(OH)D. Entre as participantes (n=444), 28% apresentaram RI. A insuficiência persistente de vitamina D associou-se ao HOMA-IR (0,39, IC95% 0,03; 0,74), com odds ratio de 1,90 (IC 95% 1,03; 3,53) para a ocorrência de RI. Observou-se interação significante entre insuficiência persistente de vitamina D e GPG excessivo. Entre participantes sem GPG excessivo, insuficiência persistente de vitamina D incorreu em maior probabilidade para RI (0,36, IC95% 0,24; 0,48) em comparação àquelas suficientes em vitamina D (0,12, IC95% 0,04; 0,20). Não houve efeito significantemente diferente do estado de vitamina D sobre RI entre gestantes com GPG excessivo. Conclusão: A sazonalidade e o estado de vitamina A foram importantes preditores das concentrações de 25(OH)D. A insuficiência persistente de vitamina D mostrou-se deletéria à RI, sendo moderada por cenário de GPG excessivo. Exposição adequada à luz solar e fontes alimentares de vitamina A, entre cuidados pré-natais de melhor qualidade e com manejo adequado do GPG, contribuiriam a um bom estado nutricional de vitamina D, e consequentemente ao menor risco para RI.
Introduction: Inadequate nutritional status of vitamin D, according to concentrations of 25-hydroxyvitamin D (25(OH)D), has been raised as a global public health issue, with pregnant women being a high-risk group. The condition is related to several complications, including insulin resistance (IR). Aims: To characterize predictors of 25(OH)D concentrations and to prospectively investigate the association of persistent vitamin D insufficiency with IR in the third trimester of pregnancy, in Cruzeiro do Sul, Acre. Methods: Longitudinal analysis within the MINA-Brazil Study among pregnant women with two measurements of 25(OH)D during pregnancy. Socioeconomic, demographic, obstetric history and lifestyle data were collected. To characterize predictors, coefficients and 95% confidence intervals (95%CI) were estimated by simultaneous quantile regression with a bootstrap for standard errors, at the 25th (49 nmol/L), 50th (79 nmol/L) and 75th (110 nmol) percentiles of 25(OH)D distribution. The association of persistent vitamin D insufficiency (<75 nmol/L in the 2nd and 3rd trimesters) with IR (homeostatic model assessment for insulin resistance, HOMA-IR >2.71) was investigated by logistic regression. Additionally, with the inclusion of an interaction term, a moderation analysis was performed according to excessive gestational weight gain (GWG). Results: Among participants (n=448; 25 [SD: 6] years; 28 [SD: 1.6] gestational weeks), 28% presented persistent vitamin D insufficiency. Predictors of 25(OH)D concentrations in the third trimester included exposure to the Amazonian dry season and improved nutritional status of vitamin D in the second trimester, with positive impacts throughout the 25(OH)D distribution. Lower concentrations of 25(OH)D were observed among pregnant women who were head of household (50th percentile: -15 nmol/L, 95%CI -24; -3 and 75th percentile: -22 nmol/L, 95%CI - 36; -7) and with persistent vitamin A insufficiency (25th percentile: -27 nmol/L, 95%CI -40; -15 and 50th percentile: -17 nmol/L, 95%CI -33; -1). Sun protection practices had a smaller impact, restricted to the 25th percentile of 25(OH)D concentrations. Among participants (n=444), 28% had IR. Persistent vitamin D insufficiency was associated with HOMA-IR (0.39, 95%CI 0.03; 0.74), with an odds ratio of 1.90 (95%CI 1.03; 3.53) for the occurrence of IR. There was a significant interaction between persistent vitamin D insufficiency and excessive GWG. Among participants without excessive GWG, a higher probability for IR was detected for pregnant women with persistent vitamin D insufficiency (0.36, 95%CI 0.24; 0.18), compared to those who were sufficient in vitamin D (0.12, 95%CI 0.04; 0.20). There was no significantly different effect of vitamin D status on IR among pregnant women with excessive GWG. Conclusion: Seasonality and vitamin A status were important predictors of 25(OH)D concentrations. Persistent vitamin D insufficiency proved to be harmful to IR, with moderation by an excessive GWG scenario. Adequate exposure to sunlight and dietary sources of vitamin A, among better quality antenatal care and adequate management of GWG, can contribute to an optimal nutritional status of vitamin D, and consequently to a lower risk for IR.