Influence of weight gain rate on early life nutritional status and body composition of children.

OBJECTIVE: To evaluate the influence of the weight gain rate at 4-6 months on nutritional status and body composition in children between 4 and 7 years of age. METHODS: Retrospective cohort study, sample of 257 children. Data collection was performed in two stages, with the first relating to retrospective data of weight gain from birth to the first 4-6 months of life in the patient records. Measurements of weight, height, waist circumference, and body composition in children between ages 4 and 7 years were obtained. Nutritional status was assessed by the BMI/age. Control variables, such as pregnancy, breastfeeding, lifestyle, and sociodemographics, were studied. Descriptive analysis and multiple linear regression were performed. RESULTS: In the nutritional status assessment, the prevalence of overweight observed was 24.9%. After adjusting for control variables, it was found that the increase of the WGR at 4-6 months of age explained the occurrence of higher BMI/age, percentage of total body fat, body fat percentage in the android region, and waist circumference in children between 4 and 7 years of age. CONCLUSION: The increase of the WGR in the first months of life can lead to the occurrence of higher values of parameters of nutritional status and body composition in later life.

[Metabolic syndrome risk assessment in children: use of a single score]. / Risco de síndrome metabólica em crianças: uso de um escore único.

OBJECTIVE: To calculate a score of metabolic syndrome (MetS) in children and set a cutoff point of this score for the prediction of MetS risk. METHODS: The study included a random sample of 348 children aged 8 and 9 years of Viçosa, Southeast Brazil. Factor analysis by principal components (PCA) was used to determine, among various risk factors, those with higher degrees of intercorrelation. The chosen variables were: waist circumference (PC), homeostatic model assessment of insulin resistance (HOMA), high density lipoprotein (HDL), triglycerides (TAG) and mean arterial pressure (MAP). Z-scores were created for each one of these parameters and the sum of these z-scores constituted the MetS score. The receiver operating characteristic (ROC) curve was used to identify the cutoff of MetS score, using as gold standard the presence or absence of MetS determined according to criteria age-modified. RESULTS: The prevalence of MetS in the sample was 8.9% by adopting specific criteria for age, and 24% when considering the cutoff of MetS score. The selected cutoff point of 1.86 was accurate to predict the MetS risk in this sample due to its high sensitivity (96.7%), specificity (82.7%) and AUC of 0.96. CONCLUSIONS: This original Brazilian study presents the MetS score as a suitable alternative for the study of Metabolic Syndrome in children, given the lack of consensus for the definition of this syndrome in childhood.

[Calcium intake, serum vitamin D and obesity in children: is there an association?]. / Ingestão de cálcio, níveis séricos de vitamina D e obesidade infantil: existe associação?

OBJECTIVE: To evaluate the association between calcium intake and serum vitamin D levels and childhood obesity by an integrative review. DATA SOURCE: The research was conducted in the databases PubMed/medLine, Science Direct and SciELO with 2001 to 2014 publications. We used the combined terms in English: "children" and "calcium" or "children" and "vitamin D" associated with the descriptors: "obesity", "adiposity" or "body fat" for all bases. Cross-sectional and cohort studies, as well as clinical trials, were included. Review articles or those that that have not addressed the association of interest were excluded. DATA SYNTHESIS: Eight articles were part of this review, five of which were related to calcium and three to vitamin D. Most studies had a longitudinal design. The analyzed studies found an association between calcium intake and obesity, especially when age and sex were considered. Inverse relationship between serum vitamin D and measures of adiposity in children has been observed and this association was influenced by the sex of the patient and by the seasons of the year. CONCLUSIONS: The studies reviewed showed an association between calcium and vitamin D with childhood obesity. Considering the possible protective effect of these micronutrients in relation to childhood obesity, preventive public health actions should be designed, with emphasis on nutritional education.

[Dietary patterns of children and socioeconomical, behavioral and maternal determinants]. / Padrões alimentares de crianças e determinantes socioeconômicos, comportamentais e maternos.

OBJECTIVE: To identify dietary patterns of children and to verify their association with socio-economical, behavioral and maternal determinants. METHODS: A cross-sectional study with a random sample of 328 children aged 8 and 9 years. Dietary intake was assessed by food records in three nonconsecutive days and measured in grams of food groups and nutrients. Factor analysis and subsequent orthogonal rotation (varimax) were used to determine dietary patterns. Ordinal logistic regression was used to assess associations between dietary patterns and the studied determinants. RESULTS: Five dietary patterns were observed: "Traditional", "Sweetened beverages and snacks", "Monotonous", "Healthy" and "Ovo-lacto". A higher maternal level of education was directly associated with "Sweetened beverages and snacks" and "Ovo-lacto" standards. Low income children who were submitted to greater food restriction by parents/guardians followed the more "Traditional" standard, represented by the consumption of rice, beans, vegetables, cooked roots and tubers, and red meat. The "Monotonous" pattern, represented by a high consumption of milk and chocolate milk, was most followed by children from the middle class. Children living in rural areas consumed more foods from the "Ovo-lacto" pattern, when compared to those from the urban area. CONCLUSIONS: Dietary patterns of children were associated with family socioeconomic status, maternal level of education, practice of food restriction by parents/guardians and location of residence in urban or rural area. Better socioeconomic conditions contributed to a more nutritionally inadequate dietary pattern.

[Prevalence of vitamin D deficiency and associated factors in women and newborns in the immediate postpartum period]. / Prevalência de deficiência de vitamina D e fatores associados em mulheres e seus recém-nascidos no período pós-parto.

OBJECTIVE: To assess the prevalence of vitamin D deficiency and its associated factors in women and their newborns in the postpartum period. METHODS: This cross-sectional study evaluated vitamin D deficiency/insufficiency in 226 women and their newborns in Viçosa (Minas Gerais, BR) between December 2011 and November 2012. Cord blood and venous maternal blood were collected to evaluate the following biochemical parameters: vitamin D, alkaline phosphatase, calcium, phosphorus and parathyroid hormone. Poisson regression analysis, with a confidence interval of 95% was applied to assess vitamin D deficiency and its associated factors. Multiple linear regression analysis was performed to identify factors associated with 25(OH)D deficiency in the newborns and women from the study. The criteria for variable inclusion in the multiple linear regression model was the association with the dependent variable in the simple linear regression analysis, considering p<0.20. Significance level was α<5%. RESULTS: From 226 women included, 200 (88.5%) were 20 to 44 years old; the median age was 28 years. Deficient/insufficient levels of vitamin D were found in 192 (85%) women and in 182 (80.5%) neonates. The maternal 25(OH)D and alkaline phosphatase levels were independently associated with vitamin D deficiency in infants. CONCLUSIONS: This study identified a high prevalence of vitamin D deficiency and insufficiency in women and newborns and the association between maternal nutritional status of vitamin D and their infants' vitamin D status.

[Waist circumference, waist/height ratio, and neck circumference as parameters of central obesity assessment in children]. / Perímetro da cintura, relação cintura/estatura e perímetro do pescoço como parâmetros na avaliação da obesidade central em crianças.

OBJECTIVE: To analyze studies that assessed the anthropometric parameters waist circumference (WC), waist-to-height ratio (WHR) and neck circumference (NC) as indicators of central obesity in children. DATA SOURCES: We searched PubMed and SciELO databases using the combined descriptors: "Waist circumference", "Waist-to-height ratio", "Neck circumference", "Children" and "Abdominal fat" in Portuguese, English and Spanish. Inclusion criteria were original articles with information about the WC, WHR and NC in the assessment of central obesity in children. We excluded review articles, short communications, letters and editorials. DATA SYNTHESIS: 1,525 abstracts were obtained in the search, and 68 articles were selected for analysis. Of these, 49 articles were included in the review. The WC was the parameter more used in studies, followed by the WHR. Regarding NC, there are few studies in children. The predictive ability of WC and WHR to indicate central adiposity in children was controversial. The cutoff points suggested for the parameters varied among studies, and some differences may be related to ethnicity and lack of standardization of anatomical site used for measurement. CONCLUSIONS: More studies are needed to evaluate these parameters for determination of central obesity children. Scientific literature about NC is especially scarce, mainly in the pediatric population. There is a need to standardize site measures and establish comparable cutoff points between different populations.

Prediction of body fat in a dolescents: comparison of two electric bioimpedance devices with dual-energy X-ray absorptiometry.

INTRODUCTION: An accurate estimate of body composition is important in assessing and monitoring the nutritional status of adolescents. OBJECTIVES: To compare the accuracy of 2 electrical bioimpedance devices with that of dual-energy X-ray absorptiometry (DXA) to predict body fat in Brazilian adolescents. METHODS: We evaluated 500 adolescents aged between 10 and 19 years, stratified by sex and divided into overweight and non-overweight groups. The percentage of body fat (%BF) was estimated using 2 types of electrical bioimpedance devices: BIA1 (horizontal tetrapolar bioimpedance equipment) and BIA2 (vertical 8-electrode bioimpedance equipment), as well as by DXA. A Bland- Altman plot was used to calculate the total errors and standard errors of estimate. RESULTS: Considering BMI for age, 19.4% were overweight and 47.4% as assessed by %BF of DXA were overweight. The %BF estimated by BIA2 correlated well (p < 0.05) with the %BF predicted by DXA, and only the total errors for BIA2 in the overweight group were acceptable (≤2.5%). The standard errors of estimate was <3.5%, with the lowest values observed for BIA2. Both BIA1 and BIA2 underestimated the %BF in overweight adolescents, while overestimating the %BF in male adolescents of normal weight. CONCLUSIONS: The BIA2 was found to be more effective in the evaluation of body fat. Regardless of the method used, the results should be carefully interpreted when assessing the body composition of adolescents.

Introducción: Una estimación precisa de la composición corporal es importante para evaluar y monitorear el estado nutricional de los adolescentes. Objetivos: Comparar la exactitud de 2 dispositivos de bioimpedancia eléctrica con la absortometria de rayos X de doble energía (AXD) para predecir la grasa corporal en adolescentes brasileños. Métodos: Se evaluaron 500 adolescentes entre 10 y 19 años, estratificados por sexo y divididos en grupos con sobrepeso y sin sobrepeso. El porcentaje de grasa corporal (%GC) se estimó utilizando 2 tipos de bioimpedancia eléctrica: BIA1 (equipo de bioimpedancia tetrapolar horizontal) y BIA2 (vertical equipo de bioimpedancia 8 electrodos), así como por AXD. Un gráfico de Bland-Altman se utilizó para calcular los errores totales y errores estándar de estimación. Resultados: Teniendo en cuenta el IMC para la edad, el 19,4% tenían sobrepeso y el 47,4% según la evaluación de %GC de DXA tenían sobrepeso. El %GC estimado por BIA2 buena correlación (p.

[Timing of clamping and factors associated with iron stores in full-term newborns]. / Tempo de clampeamento e fatores associados à reserva de ferro de neonatos a termo.

OBJECTIVE: To analyze the impact of timing of clamping and obstetric, biological and socioeconomic factors on the iron stores of full-term newborns. METHODS: Cross-sectional study between October 2011 and July 2012 in which hematological parameters were evaluated for newborns in Viçosa, MG, Southeastern Brazil. It involved collecting 7 mL of umbilical cord blood from 144 full-term not underweight newborns. The parameters investigated were complete blood count, serum iron, ferritin and C-reactive protein. The time of umbilical cord clamping was measured using a digital timer without interfering in the procedures of childbirth. The birth data were collected from Live Birth Certificates and other information was obtained from the mother through a questionnaire applied in the first month postpartum. Analysis of multiple linear regression was then used to estimate the influence of biological, obstetrics and socioeconomic factors on the ferritin levels at birth. RESULTS: The median ferritin was 130.3 µg/L (n = 129, minimum = 16.4; maximum = 420.5 µg/L), the mean serum iron was 137.9 µg/dL (n = 144, SD = 39.29) and mean hemoglobin was 14.7 g/dL (n = 144, SD = 1.47). The median time of cord clamping was 36 seconds, ranging between 7 and 100. The bivariate analysis detected an association between ferritin levels and color of the child, timing clamping of 60 seconds, type of delivery, the presence of gestational diabetes and per capita family income. In multivariate analysis, the variables per capita income, number of antenatal visits and length at birth accounted for 22.0% of variation in ferritin levels. CONCLUSIONS: Iron stores at birth were influenced by biological, obstetric and social characteristics. Tackling anemia should involve creating policies aimed at reducing social inequalities, improving the quality of antenatal care, as well as implementing a criterion of delayed clamping of the umbilical cord within the guidelines of labor.

[Insulin resistance and components of metabolic syndrome, analysis by gender and stage of adolescence]. / Resistência à insulina e componentes da síndrome metabólica, análise por sexo e por fase da adolescência.

OBJECTIVE: To analyze the influence of metabolic syndrome components in insulin resistance, by gender and adolescence phase. SUBJECTS AND METHODS: We evaluated biochemical, clinical, lifestyle and body composition data of 800 adolescents from 10 to 19 years old, from both genders, from Viçosa, MG/Brasil, and there was the division by stage: early (10 to 13 years), intermediate (14 to 16 years) and late (17 to 19 years). RESULTS: 10.3 and 3.4% had, respectively, insulin resistance and metabolic syndrome. In the initial phase there was a higher prevalence of dyslipidemia and intermediate hyperuricemia and excess body fat. Females had a higher prevalence of dyslipidemia, excess body fat and insulin resistance and higher male prevalence of low HDL, hyperuricemia and blood pressure changes. Those from the initial phase had higher levels of total cholesterol, LDL, HDL, triglycerides, fasting glucose and waist/hip ratio, stayed less time sitting and had more meals (p < 0.05) in relation to other phases. The final model, adjusted for gender, was different for each phase of adolescence. CONCLUSIONS: Insulin resistance is associated with inadequate body composition, in biochemical levels and lifestyle, being the factors associated different in each phase of adolescence.

[Problems of adherence to the program of prevention of iron deficiency anemia and supplementation with iron salts in the city of Viçosa, Minas Gerais, Brazil]. / A problemática da adesão na prevenção da anemia ferropriva e suplementação com sais de ferro no município de Viçosa (MG).

The scope of this article is to analyze the understanding of mothers and persons responsible for infants taking ferrous sulfate supplement about anemia and its consequences, assessed by the level of adherence to supplementation. A prospective, qualitative and quantitative population study was conducted with non-anemic children not taking supplements to receive prophylactic supplementation with ferrous sulfate for six months. After six months, there was adherence to supplementation. Among the 133 children initially eligible for the study, 97 returned for the second evaluation. Of these, 4 had anemia during the follow-up and began treatment and 3 others were brought in by individuals who were unable to provide information on use of the supplement. High adherence was showed by 56.7% of children and low adherence by 43.3%, while 23.3% had interrupted supplementation due to the lack of guidance and support of the health service. Mothers and persons responsible of the two groups (high and low adherence) manifested little knowledge about anemia, its prevention and health consequences for the child. More information regarding iron deficiency anemia, routine follow-up by professionals and evaluation of the perception of individuals involved with iron supplementation is necessary.

Epidemiological characteristics and deaths of premature infants in a referral hospital for high-risk pregnancies. / Características epidemiológicas e óbitos de prematuros atendidos em hospital de referência para gestante de alto risco.

OBJECTIVE: To analyze the process of care provided to premature infants in a neonatal intensive care unit and the factors associated with their mortality. METHODS: Cross-sectional retrospective study of premature infants in an intensive care unit between 2008 and 2010. The characteristics of the mothers and premature infants were described, and a bivariate analysis was performed on the following characteristics: the study period and the "death" outcome (hospital, neonatal and early) using Pearson's chi-square test, Fisher's exact test or a chi-square test for linear trends. Bivariate and multivariable logistic regression analyses were performed using a stepwise backward logistic regression method between the variables with p<0.20 and the "death" outcome. A p value <0.05 was considered to be significant. RESULTS: In total, 293 preterm infants were studied. Increased access to complementary tests (transfontanellar ultrasound and Doppler echocardiogram) and breastfeeding rates were indicators of improving care. Mortality was concentrated in the neonatal period, especially in the early neonatal period, and was associated with extreme prematurity, small size for gestational age and an Apgar score <7 at 5 minutes after birth. The late-onset sepsis was also associated with a greater chance of neonatal death, and antenatal corticosteroids were protective against neonatal and early deaths. CONCLUSIONS: Although these results are comparable to previous findings regarding mortality among premature infants in Brazil, the study emphasizes the need to implement strategies that promote breastfeeding and reduce neonatal mortality and its early component.

[Implementation and impact of the National Iron Supplementation Program in the city of Viçosa, State of Minas Gerais]. / Implantação e impacto do Programa Nacional de Suplementação de Ferro no município de Viçosa - MG.

The scope of this work was to evaluate the implementation of the National Iron Supplementation Program (NISP) in Viçosa in the State of Minas Gerais and its impact on 6- to 18-month-old non-anemic infants assisted by the Family Health Teams. Interviews were conducted with the professionals and with the children's mothers/guardians. The non-anemic children who didn't receive the earlier supplementation (n=133) were given ferrous sulphate syrup for six months. Hemoglobin dosage, anthropometric evaluation and a socioeconomic survey were conducted before and after the six-month period. Children who ingested 75% or more of the prescribed dosage were classified as high adhesion, while the others were classified as low adhesion, according to the mothers' testimonials. With respect to the implementation in the city, the distribution system was not always available to the priority group and there was a lack of training and motivation on the part of most Community Health Agents. The lack of promotion of NISP among the priority group was detected, apart from a mothers' awareness drive. Regarding diet supplementation, children showed low adhesion and the dosage wasn't effective in preventing anemia. Therefore, important operational barriers to implementation were observed.

[Bolsa Família Program and child nutritional status: strategic challenges]. / Programa Bolsa Família e estado nutricional infantil: desafios estratégicos.

The main nutritional deficiencies during childhood, namely anemia and malnutrition, are predominantly related to socio-economic factors. Thus, as the Bolsa Família Program (BFP) is the main policy to combat poverty, it is expected that it will have an impact on child nutrition. The aim was to analyze the differences in the nutritional situation of children registered with the BFP of a municipality located in Zona da Mata of Minas Gerais state. 446 children aged between 6 and 84 months were evaluated, of which 262 were non-beneficiaries and 184 were beneficiaries. Nutritional evaluation included analysis of weight and height parameters through weight/age, weight/height, height/age and Body Mass Index/age indexes and hemoglobin levels, using the Hemocue. The prevalence of anemia, short stature and obesity were 22.6, 6.3 and 5.2%, respectively, and there were no statistical differences between beneficiaries and non-beneficiaries. The beneficiary group initially had worse socio-economic conditions, but with the BFP it managed to financially match the non-beneficiary group. It is possible that the similarity between the two groups, also in the nutritional status, can be attributed to the program benefits, due to the financial funding as well as to the nutritional monitoring required as a condition of the program.

Social and biological determinants of iron deficiency anemia.

This cross-sectional study aimed to identify the social and biological determinants of anemia in children enrolled in the Brazilian Income Transfer Program (PBF). The study evaluated 446 children (69.1% of the total enrolled) ranging from 6 to 84 months of age, of whom 262 were receiving the income transfer (60.2% of the beneficiaries) and 184 were not (87.6% of the non-beneficiaries). Testing for anemia was performed with the Hemocue portable hemoglobinometer, and the cutoff points were set at 11.0 and 11.5 g/dL, according to age bracket. The data were analyzed using Poisson hierarchical regression with robust variance for multivariate analysis. There was no difference in the anemia prevalence rates between the beneficiary and non-beneficiary groups. Risk factors for anemia were low paternal schooling, cesarean birth, consumption of untreated water, stunting, and age less than 24 months. Prevalence of anemia in the group of non-beneficiary children under two years of age was significantly higher than in the beneficiary group in the same age bracket, suggesting the importance of the PBF income transfer for preventing anemia in children.

Diferenças no ponto de corte de hemoglobina para diagnóstico de anemia em função da raça/cor / Differences in the hemoglobin cut-off point for the diagnosis of anemia as a function of race/color

Os níveis de hemoglobina variam em função de idade, sexo, diferentes fases da gestação, hábito de fumar e altitude. No início dos anos 90, pesquisadores começaram a observar diferença inexplicável nos níveis de hemoglobina entre brancos e negros nas mais diversas faixas etárias. A partir de então, estudos começaram a ser publicados a fim de identificar quais possíveis fatores seriam responsáveis por tais diferenças. Objetivou-se, a partir de uma revisão de literatura, expor aspectos relevantes que possam auxiliar no conhecimento sobre por que negros possuem menores níveis de hemoglobina em relação aos brancos. A base de dados utilizada para tal revisão foi Medline, Lilacs e Pubmed. Estudos têm evidenciado que os níveis de hemoglobina em negros são menores, variando entre 0,5 e 1g/dL em relação à raça branca. Essa diferençapermanece, mesmo controlando possíveis fatores de confusão como ingestão e estado nutricional de ferro, nível socioeconômico, idade, comorbidades, entre outros. Os estudos, entretanto, não chegam a uma conclusão sobre o que realmente gera essa diferença entre as raças. Assim, propor pontos de corte específicos em função da raça, como alguns autores sugerem, pode ser precipitado e ter como consequênciaa não identificação de portadores de anemia, que é considerada sério problema de saúde pública no Brasil.

Hemoglobin levels vary according to age, gender, different phases of pregnancy, smoking habit, and altitude. In the early 90s, researchers began to notice unexplained differences in hemoglobin levels between whites and blacks in various age groups. Since then, studies began to be published to identify which factors would be responsible for such differences. From a review of the literature, we aimed at exposing relevant aspects that mayassist in the understanding of why blacks have lower levels of hemoglobin in relation to whites. The Medline, Lilacs, and Pubmed databases were used for this review. Studies have shown that the levels of hemoglobin in blacks are lower, ranging between 0.5 and 1 g/dL in relation to whites. This difference remains, even controlling for possible confounding factors such as intake and iron nutritional status, socioeconomic status, age, andcomorbidities among others. The studies, however, do not come to a conclusion about what raises this difference between races. Therefore, proposing specific cut-off points as a function of race, as some authors suggest, may be precipitated and result in not identifying people with anemia, which is considered a serious public health problem in Brazil.

[The influence of the social net of lactating mothers in the breastfeeding: the strategic role of the relatives and professionals of health]. / A influência da rede social da nutriz no aleitamento materno: o papel estratégico dos familiares e dos profissionais de saúde.

The objective was to raise and classify scientific works on the influence of the social net of lactating mothers in the context of the breastfeeding. A bibliographical review was done in the main databases (MEDLINE, LILACS, SciELO), using as keywords: breastfeeding, weaning and family (and their versions in English and Spanish). Books, thesis, dissertations, and publications in international and national institutions were consulted (WHO, UNICEF, Ministry of Health). It could be observed that the actors that compose the social net of the lactating mothers can interfere in the decision of breastfeeding, through different extents, such as the encouragement/support to the initiative; reviewing the knowledge and cultural values; family tradition; and the cultivation of the indifference/discourage and the pressure exercised on the lactating mothers in relation to the form of feeding the child. In this way, it can infer on the need of the implementation of new health practices regarding to the care of this group. It is worth to highlight, the importance of the professionals to be qualified for the sensitive listening on the meaning of the nursing under the glance of the lactating mothers . Finally, it stands out the importance role of the social net of the lactating mothers, especially the family, for a successful breastfeeding.

Fatores associados à dislipidemia em crianças de 4 a 7 anos de idade / Associated factors with dyslipidemia in children 4 to 7 years old

Objetivo: Avaliar o perfil lipídico e fatores associados à dislipidemia em crianças. Métodos: Estudo transversal que avaliou crianças de 4 a 7 anos acompanhadas nos primeiros meses de vida por um Programa de Extensão da Universidade Federal de Viçosa, Minas Gerais. Foram consideradas as dosagens de colesterol total, lipoproteína de alta densidade, lipoproteína de baixa densidade e triglicerídeos. Foram estudadas variáveis possivelmente associadas ao perfil lipídico, sendo elas variáveis maternas, sociodemográficas e aquelas associadas à criança. Foram realizadas análises bivariada e multivariadas, sendo as últimas por meio de regressão logística múltipla. Resultados: A amostra foi constituída por 185 crianças, de ambos os sexos. Observou-se que 46,5% (n=86) apresentaram valores aumentados de colesterol total, 9,2% (n=17) de lipoproteína de baixa densidade e 4,9% (n=9) de triglicerídeos. Com relação à lipoproteína de alta densidade, 35,1% (n=65) apresentaram valores abaixo do desejável. Demonstrou associação independente com o perfil lipídico das crianças a renda per capita, escolaridade materna e idade materna (associando-se à lipoproteína de baixa densidade) e o excesso de peso, que se associou a maiores prevalências de alterações em triglicerídeos. Conclusão: Foram observadas altas prevalências de dislipidemias. Condições sociodemográficas e estado nutricional demonstraram influenciar, também em crianças, a ocorrência de dislipidemias, as quais são citadas como fatores de risco para as doenças cardiovasculares. Revela-se a importância de se estudar esses fatores desde a infância, realizando-se estudos com outras faixas etárias que verifiquem a prevalência e fatores associados, de forma a promover o cuidado com a saúde desse grupo populacional. .

Objective: To evaluate the lipid profile and associated factors with dyslipidemia in children. Methods: A cross-sectional study that evaluated children 4-7 years old, followed the first months of life in a Program of the Universidade Federal de Viçosa, Minas Gerais. Performed biochemical measurements were total cholesterol, high density lipoprotein, low density lipoprotein and triglycerides. The variables possibly associated with lipid profile were maternal variables, sociodemographic and those associated with the child. Bivariate and multivariate analyses have been done, the latter by multiple logistic regressions. Results: The sample consisted of 185 children, both genders. It was observed that 46.5% (n=86) showed increased levels of total cholesterol, 9.2% (n=17) of low density lipoprotein and 4.9% (n=9) in triglycerides. With relation to the high density lipoprotein, 35.1% (n=65) had values less than desirable. Demonstrated an independent association with the lipid profile of children the per capita income, maternal education and maternal age (with low density lipoprotein) and overweight, which was associated with a higher prevalence of changes in triglycerides. Conclusion: High prevalence of dyslipidemia were observed. Sociodemographic conditions and nutritional status demonstrated influence, also in children, the occurrence of dyslipidemia, which are cited as risk factors for cardiovascular disease. Reveals the importance of studying these factors since childhood, performing studies with other age groups to check the prevalence and associated factors to promote the health care of this population group. .

Calcium intake, serum vitamin D and obesity in children: is there an association? / Ingestão de cálcio, níveis séricos de vitamina D e obesidade infantil: existe associação?

OBJECTIVE: To evaluate the association between calcium intake and serum vitamin D levels and childhood obesity by an integrative review. DATA SOURCE: The research was conducted in the databases PubMed/medLine, Science Direct and SciELO with 2001 to 2014 publications. We used the combined terms in English: ''children'' and ''calcium'' or ''children'' and ''vitamin D'' associated with the descriptors: ''obesity'', ''adiposity'' or ''body fat'' for all bases. Cross-sectional and cohort studies, as well as clinical trials, were included. Review articles or those that that have not addressed the association of interest were excluded. DATA SYNTHESIS: Eight articles were part of this review, five of which were related to calcium and three to vitamin D. Most studies had a longitudinal design. The analyzed studies found an association between calcium intake and obesity, especially when age and sex were considered. Inverse relationship between serum vitamin D and measures of adiposity in children has been observed and this association was influenced by the sex of the patient and by the seasons of the year. CONCLUSIONS: The studies reviewed showed an association between calcium and vitamin D with childhood obesity. Considering the possible protective effect of these micronutrients in relation to childhood obesity, preventive public health actions should be designed, with emphasis on nutritional education.

OBJETIVO: Avaliar a associação da ingestão de cálcio e níveis séricos de vitamina D e a obesidade infantil, por meio de uma revisão integrativa. FONTES DE DADOS: A pesquisa foi feita nas bases Pubmed/MedLine, Science Direct e SciELO com publicações de 2001 a 2014. Usaram-se os termos em inglês combinados: "children" e "calcium" ou "children" e "vitamina D" associados, cada um, aos descritores: "obesity", "adiposity" ou "body fat", para todas as bases. Foram incluídos estudos que relacionassem as palavraschave da pesquisa, com delineamento transversal, estudos de coorte e ensaios clínicos. Foram excluídos artigos de revisão ou artigos que não estudaram a associação de interesse. SÍNTESE DOS DADOS: Oito artigos fizeram parte dessa revisão, dos quais cinco eram referentes ao cálcio e três abordaram a vitamina D. A maioria dos estudos foi de delineamento longitudinal. Os estudos analisados encontraram associação entre ingestão cálcio e obesidade, especialmente quando consideradas características como idade e sexo. Tem-se observado relação inversa entre concentrações séricas de vitamina D e medidas de adiposidade em crianças. Essas são influenciadas pelo sexo e pelas estações do ano. CONCLUSÕES: Os estudos avaliados mostraram associação entre cálcio e vitamina D com a obesidade na infância. Assim, considerando o possível efeito protetor desses micronutrientes em relação à obesidade infantil, as ações preventivas de saúde pública podem ser pautadas com ênfase na educação nutricional.

Metabolic syndrome risk assessment in children: use of a single score / Risco de síndrome metabólica em crianças: uso de um escore único

OBJECTIVE: To calculate a score of metabolic syndrome (MetS) in children and set a cutoff point of this score for the prediction of MetS risk. METHODS: The study included a random sample of 348 children aged 8 and 9 years of Viçosa, Southeast Brazil. Factor analysis by principal components (PCA) was used to determine, among various risk factors, those with higher degrees of intercorrelation. The chosen variables were: waist circumference (PC), homeostatic model assessment of insulin resistance (HOMA), high density lipoprotein (HDL), triglycerides (TAG) and mean arterial pressure (MAP). Z-scores were created for each one of these parameters and the sum of these z-scores constituted the MetS score. The receiver operating characteristic (ROC) curve was used to identify the cutoff of MetS score, using as gold standard the presence or absence of MetS determined according to criteria age-modified. RESULTS: The prevalence of MetS in the sample was 8.9% by adopting specific criteria for age, and 24% when considering the cutoff of MetS score. The selected cutoff point of 1.86 was accurate to predict the MetS risk in this sample due to its high sensitivity (96.7%), specificity (82.7%) and AUC of 0.96. CONCLUSIONS: This original Brazilian study presents the MetS score as a suitable alternative for the study of Metabolic Syndrome in children, given the lack of consensus for the definition of this syndrome in childhood.

OBJETIVO: Calcular um escore de síndrome metabólica (SM) em crianças e definir um ponto de corte para a predição de risco de SM nesse grupo. MÉTODOS: Estudo com amostra aleatória de 348 crianças de oito e nove anos do município de Viçosa. Análise fatorial por componentes principais foi usada para verificar, entre vários fatores de risco, aqueles com maiores graus de intercorrelação: perímetro da cintura (PC), modelo homeostático de resistência à insulina (HOMA), lipoproteína de alta densidade (HDL), triacilgliceróis (TAG) e pressão arterial média (PAM). Escores-z foram criados para cada um desses parâmetros e o somatório desses constituiu o escore de SM. A curva receiver operating characteristic (ROC) foi usada para identificar o ponto de corte do escore, considerando-se como padrão-ouro a presença ou ausência de SM, segundo critérios modificados para a idade. RESULTADOS: A prevalência de SM na amostra foi de 8,9% adotando-se critérios específicos para a idade e de 24% quando considerado o ponto de corte do escore. Foi eleito o ponto de corte de 1,86, por ter elevadas sensibilidade (96,7%) e especificidade (82,7%), AUC de 0,96, e, assim, acurácia em predizer a presença de síndrome metabólica em crianças nessa faixa etária. CONCLUSÕES: Este inédito estudo brasileiro apresenta uma opção adequada para o estudo da SM em crianças, vista a ausência de definição consensual para a SM na infância.

Padrões alimentares de crianças e determinantes socioeconômicos, comportamentais e maternos / Dietary patterns of children and socioeconomical, behavioral and maternal determinants

Objetivo:Identificar os padrões alimentares de crianças e verificar sua associação com determinantes socioeconômicos, comportamentais e maternos.Métodos:Estudo transversal com amostra aleatória de 328 crianças de oito e nove anos. O consumo alimentar foi avaliado por registros alimentares de três dias não consecutivos e quantificado em gramas de grupos alimentares e de nutrientes. Análise fatorial e subsequente rotação ortogonal (varimax) foram usadas para determinar os padrões alimentares. Regressão logística ordinal foi usada para verificar associações entre padrões alimentares e os determinantes estudados.Resultados:Cinco padrões alimentares foram extraídos: “Tradicional”, “Bebidas adoçadas e lanches”, “Monótono”, “Saudável” e “Ovo-lacto”. A maior escolaridade materna se associou de forma direta aos padrões “Bebidas doces e lanches” e “Ovo-lacto”. Crianças de baixo nível econômico e que recebiam maior restrição alimentar pelos pais/responsáveis aderiram mais ao padrão “Tradicional”, representado pelo consumo de arroz, feijão, hortaliças, raízes e tubérculos cozidos e carne vermelha. O padrão “Monótono”, representado pelo elevado consumo de leite e achocolatado, foi mais consumido por crianças de classe econômica intermediária. Crianças que residiam em zona rural consumiam mais alimentos do padrão “Ovo-lacto” comparadas com as de zona urbana.Conclusões:Os padrões alimentares das crianças estiveram associados às condições econômicas da família, escolaridade materna, prática de restrição alimentar pelos pais/responsáveis e localização da residência em zona urbana ou rural. Melhores condições socioeconômicas contribuíram para um padrão alimentar nutricionalmente mais inadequado.

Objective:To identify dietary patterns of children and to verify their association with socio-economical, behavioral and maternal determinants.Methods:A cross-sectional study with a random sample of 328 children aged 8 and 9 years. Dietary intake was assessed by food records in three nonconsecutive days and measured in grams of food groups and nutrients. Factor analysis and subsequent orthogonal rotation (varimax) were used to determine dietary patterns. Ordinal logistic regression was used to assess associations between dietary patterns and the studied determinants.Results:Five dietary patterns were observed: “Traditional,” “Sweetened beverages and snacks,” “Monotonous,” “Healthy” and “Egg-dairy.” A higher maternal level of education was directly associated with “Sweetened beverages and snacks” and “Egg-dairy' standards. Low income children who were submitted to greater food restriction by parents/guardians followed the more “Traditional” standard, represented by the consumption of rice, beans, vegetables, cooked roots and tubers and red meat. The “Monotonous” pattern, represented by a high consumption of milk and chocolate powder, was most followed by children from the middle class. Children living in rural areas consumed more foods from the “Egg-dairy” pattern, when compared to those from the urban area.Conclusions:Dietary patterns of children were associated with family socioeconomic status, maternal level of education, practice of food restriction by parents/guardians and location of residence in urban or rural area. Better socioeconomic conditions contributed to a more nutritionally inadequate dietary pattern.