Phytosterol-enriched milk lowers LDL-cholesterol levels in Brazilian children and adolescents: Double-blind, cross-over trial.

BACKGROUND AND AIMS: Despite evidence of the lipid-lowering effect of plant sterols among adults with hypercholesterolemia, data regarding phytosterol use in children are limited. In this paper, we examined the effects of daily consumption of a phytosterol-enriched milk compound on the lipid profiles of Brazilian children and adolescents with dyslipidemia. METHODS AND RESULTS: This was a randomized, double blind, crossover clinical trial. Twenty eight dyslipidemics outpatients (aged 6-9 years) from an University Hospital were randomly allocated to control or intervention group. The intervention group received milk enriched with 1.2 g/day of plant sterol and the control group received the equivalent amount of skim milk during the period of 8 weeks. Changes from baseline in the mean lipid profile, including total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), and triglyceride (TG) concentrations. Serum lipid profiles, glucose levels, dietary and anthropometric data were determined at weeks 0, 4, 8, 16, and 20. Details regarding the safety and tolerance of phytosterol were obtained, using an open-ended questionnaire. Intention-to-treat analysis were performed, using the proc mixed procedure in SAS. After 8 weeks, the mean concentrations of TC and LDL-C were significantly reduced in the intervention group as compared to the control group with reductions of 5.9% (p = 0.09) and 10.2% (p = 0.002), respectively. In addition, TG concentrations were reduced by 19.7% (p = 0.09). No serious side effects were reported during the study. CONCLUSION: Our results confirm that plant sterols are an effective and safe treatment of infantile dyslipidemia. TRIAL REGISTRATION: RBR-3h7f9k.

Factors associated with the calibration of a food frequency questionnaire for the Bambuí Project, Brazil.

BACKGROUND: The present study aimed to calibrate a food frequency questionnaire (FFQ) using one 24-h recall (R24) associated with foodstuff replicas. METHODS: Calibration was performed by linear regression. Of a probability sample of 150 individuals (>18 years) of the town of Bambui, 98 completed the study. RESULTS: The mean age of the participants was 43.8 years and 63.3% were women. The calibration of the FFQ included sex for the estimation of iron, protein and zinc; and an interaction between sex and R24 was significant for vitamin A and cholesterol models. Age contributed to the vitamin C, polyunsaturated fatty acids, proteins and zinc models, and an interaction between age and R24 was significant for protein and zinc. CONCLUSIONS: Calibration coefficients and many interactions in linear regression models revealed important differences between dietary methods, indicating the complexity encountered when combining two methodologies for estimating food intake.

Rationale, design, and analysis of combined Brazilian household budget survey and food intake individual data.

BACKGROUND: Data on food intake at the individual level and its statistical distribution in population groups defined by age, gender, or geographic areas are important in planning public health and nutrition programs. However, individual-based surveys in representative population samples are expensive to perform. METHODS/DESIGN: In Brazil, an individual based survey is under consideration to be conducted alongside the household budget survey (HBS), which will be carried out in 2008-2009. This paper presents the methodological framework of dietary data collection and indicates the directions to combining both sources of data. The 2008-2009 Brazilian HBS sample will include 60,000 households. Of the selected HBS households, 30% will be randomly sampled to gather data on individual food intake. Therefore, individual dietary intake data is expected to be gathered for 70,000 individuals. Data collection procedures will comprise: completion of a diary with information regarding food purchases during a seven-day period; registration of all items consumed during two non-consecutive days for all 10 year-old or older members of the household. The sample will be large enough to capture the variation between individuals, and the two records will assure the estimation of the variation within individuals for food groups, energy and nutrients. Data on individual dietary intake and food family budget will be stratified by the five regions of the country and by rural or urban. A pilot study has been conducted in two states, and it indicated that combining individual and budgetary data in a survey is feasible. DISCUSSION: This kind of study will allow us to estimate correlations between individual intake and household purchases, overcoming the limitations of individual dietary surveys, and enhancing the HBS with information on eating out and intra-familiar distribution of food.

Trends in underweight, overweight and body mass index among elderly population of Brazil.

OBJECTIVE: To evaluate body mass index (BMI - kg/m2) trend of the elderly (superior 60 y) in the poorest (Northeast) and richest (Southeast) regions of Brazil. METHOD: Household surveys conducted in 1975, 1989 and 1997 measured weight and stature of a probabilistic sample of about 18,000 elderly people. Weighted prevalences were calculated and analysis took into account the sample design. RESULTS: In the entire period, the prevalence of overweight doubled reaching 37.4% for men and 50.6% for women in the most recent survey. Although there was an important reduction in the prevalence of underweight, these percentages were still high in the poorest region for both sexes in 1997 (13%). The increase in BMI in the period from 1975 to 1989 was significant for all subgroups, except for the men living in the rural area of the richest region, but this group was the only one that presented a significant increase in the BMI in the 1989--1997 period. CONCLUSIONS: Overweight has highly prevalent among the elderly. However there was no trend of increasing BMI in the last period, except for men living in the rural area of the richest region. Underweight is still an important nutritional problem in the poorest region.

Adjusting diet-outcome associations for random error: comparison of associations based on observed and estimated usual intakes.

BACKGROUND/OBJECTIVES: To compare linear regression coefficients adjusted for random errors with true coefficients. SUBJECTS/METHODS: Three hundred and two individuals from the city of Rio de Janeiro, Brazil answered 20 non-consecutive 24-hr. Means of 20 24-hr were used as an approximation of the usual dietary intakes. It was simulated outcomes with pre-defined linear regression coefficient (ß=1.0, referred as 'true coefficient') for usual coffee and soft-drink intakes as explanatory variables controlled for sex and age. Regression calibration was applied in each 1000 random combinations of j days of intake (j=2, 4 and 6), and adjusted coefficients were compared with true one. RESULTS: Mean-adjusted coefficients were 1.06 to 1.03 (coffee) and 1.17 to 1.11 (soft drink). The association was not detected (95% CI included zero) in 33 to 23% (coffee) and 37 to 23% (soft drink) when using two and six collection days, respectively, compared with 20% when using observed usual intake. Frequency of consumption as covariate in the regression calibration model increased the precision of the adjusted coefficients. CONCLUSIONS: Adjustment for random errors de-attenuates the association but its precision depends mainly on the number of collection days and sample size.

n-6 and n-3 Long-chain polyunsaturated fatty acids in the erythrocyte membrane of Brazilian preterm and term neonates and their mothers at delivery.

Placental transfer of the long-chain polyunsaturated fatty acids (LCPUFA) arachidonic (AA) and docosahexaenoic (DHA) acids is selectively high to maintain accretion to fetal tissues, especially the brain. The objectives of the present study were to investigate the essential fatty acid (EFA) and LCPUFA status at birth of preterm and term Brazilian infants and their mothers, from a population of characteristically low intake of n-3 LCPUFA, and to evaluate the association between fetal and maternal status, by the determination of the fatty acid composition of the erythrocyte membrane. Blood samples from umbilical cord of preterm (26-36 weeks of gestation; n = 30) and term (37-42 weeks of gestation; n = 30) infants and the corresponding maternal venous blood were collected at delivery. The LCPUFA composition of the erythrocyte membrane and DHA status were similar for mothers of preterm and term infants. Neonatal AA was higher (P < 0.01) whereas its precursor 18:2n-6 was lower (P < 0.01) than maternal levels, as expected. There was no difference in LCPUFA erythrocyte composition between preterm and term infants, except for DHA. Term infants presented a worse DHA status than preterm infants (P < 0.01) and than their mothers (P < 0.01) at delivery. There was a negative correlation of neonatal DHA with maternal AA and a positive correlation between neonatal AA and maternal AA and 18:2n-6 only at term. These results suggest that the persistent low DHA maternal status, together with the comparatively better AA and 18:2n-6 status, might have affected maternal-fetal transfer of DHA when gestation was completed up to term, and possibly contributed to the worse DHA status of term neonates compared with the preterm neonates.

Misreport of energy intake assessed with food records and 24-h recalls compared with total energy expenditure estimated with DLW.

BACKGROUND/OBJECTIVES: The accuracy of dietary assessment methods has rarely been validated using precise techniques. The objective of this work was to evaluate the validity of energy intake (EI) estimated with food records (FRs) and 24-h recalls (24hRs) against total energy expenditure (EE) estimated by the doubly labeled water (DLW) method. In addition, the magnitude of EI under-reporting was assessed along with its associated characteristics. SUBJECTS/METHODS: The studied group included 83 adults between 20 and 60 years of age who were recruited from a population-based sample. Within-person variation-adjusted means of EI estimated from two FRs and three 24hRs were compared with EE estimated using the DLW method multiple-point protocol. The Wilcoxon signed-rank test was used to assess the differences between EI and EE, whereas Bland-Altman and survival-agreement plots assessed the agreement between the estimates. RESULTS: The mean EE (2540 kcal) was greater than the mean reported EI for both dietary assessment methods (FR: 1774 kcal; 24hR: 1658 kcal, P<0.01). The frequency of under-reporting was lower (20%) for EI estimated with the 24hR than that estimated with the FR (32%). Men presented lower magnitude of under-reported EI than women did. For women, differences between EI and EE were lower with FR than with 24hR. Overall, FR and 24hR showed similar performance. The mean under-reported EI was ~30% for both methods. CONCLUSIONS: Irregular meal habits, smoking and low education were associated with the under-report of EI. Both FR and 24hR are subjected to bias suggesting the need of refining the procedures applied in dietary assessment methods.

The lack of selection bias in a snowball sampled case-control study on drug abuse.

BACKGROUND: Friend controls in matched case-control studies can be a potential source of bias based on the assumption that friends are more likely to share exposure factors. This study evaluates the role of selection bias in a case-control study that used the snowball sampling method based on friendship for the selection of cases and controls. METHODS: The cases selected fro the study were drug abusers located in the community. Exposure was defined by the presence of at least one psychiatric diagnosis. Psychiatric and drug abuse/dependence diagnoses were made according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria. Cases and controls were matched on sex, age and friendship. The measurement of selection bias was made through the comparison of the proportion of exposed controls selected by exposed cases (p1) with the proportion of exposed controls selected by unexposed cases (p2). If p1 = p2 then, selection bias should not occur. RESULTS: The observed distribution of the 185 matched pairs having at least one psychiatric disorder showed a p1 value of 0.52 and a p2 value of 0.51, indicating no selection bias in this study. CONCLUSIONS: Our findings support the idea that the use of friend controls can produce a valid basis for a case-control study.

Influence of ambient temperature on the sleep-wakefulness cycle in the golden hamster.

The sleep-wakefulness cycle (SWC) of euthermic golden hamsters (Mesocricetus auratus) after 5 weeks of warm (30 degrees C) and of cold (5 degrees C) acclimation, was recorded at ambient temperatures between 5 degrees and 35 degrees C. Significant influences both of acclimation and of recording temperature were detected. Amount of paradoxical sleep (P%) after warm acclimation was maximal at 30 degrees C decreasing markedly at lower and higher temperatures. Variations in P% were mainly consequent to alterations in the frequency of occurrence of paradoxical sleep (PS) episodes. After cold acclimation (CA) P% was maximal at 20 degrees C but no strong decreases occurred at lower temperatures. Influences of CA upon SWC were already detectable after 3 days of cold exposure. Significant individual differences as well as strong fluctuations in P% during CA occurred. Acute oscillations in abdominal temperature along the SWC were recorded. Reductions in abdominal temperature during PS episodes, in relation to ambient temperature and to the length of the episode tended to occur.

Waist circumference and waist-to-hip ratio as predictors of serum concentration of lipids in Brazilian men.

OBJECTIVE: It is unknown whether waist circumference can predict a lipid profile beyond that predicted by body fatness alone, after adjustment for important confounding variables such as smoking, alcohol intake, and physical activity. The purpose of this non-clinical, healthy-subject study was to test this hypothesis. METHODS: Data refer to 416 men, ages 20 to 58 y with a body mass index between 18.5 and 29.9 kg/m(2), who were blood donors living in a Brazilian city. Alcohol consumption, smoking, and physical activity were evaluated by interview; body fat was measured by electrical bioimpedance, and weight, height, and waist and hip circumferences were measured by trained anthropometrists. Multiple linear regression analysis was performed to quantify the association between measurements of fat distribution (waist circumference and waist-to-hip ratio) and the ratio of total cholesterol to high-density lipoprotein cholesterol and triacylglycerols independently of measurements of fatness and potentially confounding factors. RESULTS: Waist circumference was strongly correlated with percentage of body fat (r = 0.90), whereas waist-to-hip ratio was less correlated (r = 0.55). After adjustment for age, percentage of body fat, smoking, alcohol intake, and physical activity, waist circumference was not significantly related to the ratio of total cholesterol high-density lipoprotein cholesterol, whereas the waist-to-hip ratio was strongly associated among the youngest subjects (beta = 3.51, P = 0.005). CONCLUSION: Although several studies have analyzed the association between serum lipids with anthropometric markers, few, including the present one, support waist circumference as a good predictor of lipid profile.

Influence of parental height and sociodemographic factors on adolescent height in Brazil.

OBJECTIVE: To analyze the influence of parental stature and environmental factors on the stature of adolescents from a national survey sample. METHODS: A nationwide survey was carried out in 1989 among a stratified, two-stage, probability cluster sample of 14,455 Brazilian households to provide estimates of anthropometric deficits for urban and rural populations from the five regions of the country. Stature was measured for 5681 boys and girls age 14-18 years, 78.9% of their fathers, and 93.8% of their mothers. Associations between explanatory variables and adolescent height in centimeters were assessed by fitting multiple linear models to the data. RESULTS: The predicted effects of parental stature and environmental conditions together sum to a total of 17 cm when comparing a boy born to parents with stature below the median and living in the underdeveloped rural Northeast region (1.56 m) with one born to parents with stature above the median and living in the partially industrialized urban South region (1.73 m). For girls, this estimated difference was 12 cm. For boys, the overall influence of parents' stature was 10 cm (R(2)= 0.40) and the sociodemographic factors had an overall influence of 7 cm (R(2) = 0.29). For girls, these values were 7 cm (R(2)= 0.35) for the parental influence and 5 cm (R(2) = 0.11) for the sociodemographic factors. CONCLUSIONS: Mother's stature had the same influence on adolescent's stature as father's stature. Independent of parental stature, environmental factors have a strong influence on adolescent stature, particularly among boys.

Combined effect of short stature and socioeconomic status on body mass index and weight gain during reproductive age in Brazilian women.

Short stature, a marker for undernutrition early in life, has been associated with obesity in Brazilian women, but not in men. We tested the hypothesis that weight gain during the reproductive years could explain this gender difference. A national two-stage household survey of mothers with one or more children under five years of age was conducted in Brazil in 1996. The subjects were women aged 20 to 45 years (N = 2297), with last delivery seven months or more prior to the interview. The regions of the country were divided into rural, North/Northeast (urban underdeveloped) and South/Southeast/Midwest (urban developed). The dependent variables were current body mass index (BMI) measured, BMI prior to childbearing (reported), and BMI change. Socioeconomic variables included mother's years of education and family purchasing power score. A secondary analysis was restricted to primiparous women. The prevalence of current overweight and overweight prior to childbearing (BMI > or = 25 kg/m2) was higher among shorter women (<1.50 m) compared to normal stature women only in the urban developed region (P < 0.05). After adjustment for socioeconomic variables, age, parity, BMI prior to childbearing, and age at first birth, current BMI was 2.39 units higher (P = 0.008) for short stature women living in the urban developed area compared with short stature women living in the urban underdeveloped area. For both multiparous and primiparous women, BMI gain compared to the value prior to childbearing was significantly higher among short stature women living in the urban developed region (P <= 0.04). These results provide clear evidence that short stature was associated with a higher BMI and with an increased risk of weight gain/retention with pregnancy in the developed areas of Brazil, but not in the underdeveloped ones.

High prevalence of hypertension among Black and Mulatto women in a Brazilian survey.

STUDY OBJECTIVES: Brazil has a high admixture of Blacks and Whites, making it possible to compare the prevalence of hypertension among Blacks, Whites, and Mulattos. DESIGN: A population-based health and nutrition survey was carried out in 1996 in the city of Rio de Janeiro, Brazil. Blood pressure, weight, height, food frequency information, and skin color were obtained from a sample of 2,802 private household residents aged 20 years or older. MAIN OUTCOME MEASURE: Hypertension was defined as systolic blood pressure >140 mm Hg and/or diastolic pressure >90 mm Hg or the use of antihypertensive medication. RESULTS: The prevalence of hypertension among men was 12.0% among Whites, 13.8% among Mulattos, and 14.4% for Blacks. For women, these prevalences were 12.0%, 16.4%, and 20.2%, respectively. After adjustment for age, calcium and salt intake, physical activity level, body mass index, and waist-hip ratio, we observed (among women only) a trend toward increasing prevalence of hypertension with increasing skin darkness. The adjusted odds ratio of hypertension was 1.52 for Mulatto women compared to Whites and 2.27 for Blacks compared to Whites (P<.05). With further adjustment for income, the odds ratios were reduced to 1.30 (95% CI 0.86-1.95) and 1.75 (95% CI 1.04-2.94). CONCLUSIONS: Black women showed increased risk of hypertension independent of socioeconomic factors or overweight status.

[Waist:hips girth ratio as a predictor of arterial hypertension]. / Razão cintura/quadril como preditor de hipertensão arterial.

This study aims to define cut-off points for the waist:hips girth ratio (WHR), using arterial hypertension as the outcome. The data refer to 3,282 individuals over twenty years of age examined in a survey conducted in the municipality of Rio de Janeiro in 1995-1996, using a two-stage sample. Sixty census tracts were drawn initially; subsequently, 34 households were selected systematically from each tract. Stature, weight, waist and hips girths, and blood pressure were measured in the households. The criterion for hypertension was a systolic blood pressure of ( 140 mmHg or diastolic pressure of ( 90 mmHg, or use of medication to reduce blood pressure. The sensitivity and specificity of different cut-off points for WHR were calculated in the prediction of arterial hypertension according to sex, age, and presence of overweight, classified according to World Health Organization guidelines. The best cut-off points for WHR were 0.95 for men and 0.80 for women. Compared to the waist:stature ratio and waist circumference, the WHR proved more capable of predicting arterial hypertension and less correlated with body mass index.

[Physical activity in a probabilistic sample in the city of Rio de Janeiro]. / Atividade física em uma amostra probabilística da população do Município do Rio de Janeiro.

This study evaluated physical activity in a probabilistic sample of 4,331 individuals 12 years of age and older residing in the city of Rio de Janeiro, who participated in a household survey in 1996. Occupation and leisure activity were grouped according to categories of energy expenditure. The study also evaluated number of hours watching TV, using the computer, or playing video-games. Only 3.6% of males and 0.3% of females reported heavy occupational work. A full 59.8% of males and 77.8% of females reported never performing recreational physical activity, and there was an increase in this prevalence with age, especially for men. Women's leisure activities involved less energy expenditure and had a lower median duration than those of men. Mean daily TV/video/computer time was greater for women than for men. The greater the level of schooling, the higher the frequency of physical activity for both sexes. Analyzed jointly, these data show the low energy expenditure through physical activity by the population of the city of Rio de Janeiro. Women, the middle-aged, the elderly, and low-income individuals were at greatest risk of not performing recreational physical activity.

[Reliability of the WPPSI-R test in the evaluation of cognitive development in preschool children]. / Confiabilidade do Teste WPPSI-R na avaliação do desenvolvimento cognitivo de pré-escolares.

The WPPSI-R scale (Wechsler Preschool and Primary Scale of Intelligence - Revised) is a psychometric test chosen as the evaluation tool in a study on preschool-age cognitive development in a cohort of very low birth weight (VLBW) premature children from the Fernandes Figueira Institute (IFF), applied by four previously trained psychologists. The objective of this study was to verify inter-observer reliability in the test application. Two types of reliability study design were used: balanced incomplete blocks, to verify agreement in the application of the scale, and crossed design, to verify agreement in scoring of items. We studied 12 preschool children born at IFF (birthweight < 1,500g). The intraclass correlation coefficients (ICC) were: 0.82 (full-scale IQ), 0.89 (verbal IQ), and 0.91 (performance IQ), in the incomplete block design study, and 0.99, 0.98, and 0.99, respectively, in the crossed design study, indicating good reliability. Application of the WPPSI-R scale in the study of cognitive development of VLBW premature children at IFF proved adequate, as shown by these results.

[Nutritional status of children and occupational categories of the family in a rural community of Paraná, Brazil]. / Estado nutricional de crianças e relações de trabalho da família em uma comunidade rural do Paraná, Brasil.

The relationship between the occupational category of the family and the nutritional status of children was studied. Participants were 340 children up to 11 years of age, living in a small town of a rural area in Paraná, Brazil. The nutritional status of the children, as measured in 1983, was related to the principal occupational categories of the family in the period 1972- 1983. Occupation of the family was categorized as: migrant farmworkers (bóias-frias) throughout the entire period; renters or sharecroppers that were converted to migrant farmworkers; those who never worked as migrant farmworkers; and salaried urban workers that were converted to migrant farmworkers. Other variables included age and sex of the children, condition of birth (home or hospital), number of children up to 11 years of age in the family, birthweight and school enrollment of the children 5 years old or over. The prevalence of wasting was greatest among children belonging to salaried urban workers that were converted to migrant farmworkers. In contrast, this category showed the lowest prevalence of stunting. Compared with migrant farmworkers during the entire period, the odds ratio of wasting in this category was 2.7 with a 95% confidence interval of 1.3-5.7. Wasting and stunting were also independently associated with the number of children (p<0.05). The larger the family, the lower the risk of wasting, whereas for stunting, the larger the family, the higher the risk. These findings suggest an important role for the occupational category in the determination of the nutritional status in children and indicate that wasting and stunting may have differential risk factors.

[Factors associated with obesity among adolescents]. / Fatores associados à obesidade em adolescentes.

INTRODUCTION: Obesity during adolescence is considered a strong predictor of adult obesity. The present study assessed the overweight/obesity prevalence and associated factors in middle class adolescents of a school in the city of Niteroi, Rio de Janeiro, Brazil, and evaluated the correlation between body mass index with anthropometric measures of fatness. METHOD: The analysis covered 391 students aged from 15 to 17 years. Adolescents had their weight, height, skinfold thickness and upper arm circumference measured at school. A food frequency questionnaire (list of 79 items) and a questionnaire including food habits, parents anthropometric characteristics, physical activity and other factors associated with obesity were filled out by the adolescents at school. RESULTS: The proportion of overweight individuals among boys (Body Mass Index (BMI) greater than the 90th percentile of the Brazilian population) was 23.9%, whereas the prevalence among girls was 7.2%. The fact of being on a slimming diet was a relevant factor for the prediction of BMI and was 7 times more frequent among girls than among boys. Among boys, being on a diet, absence of breakfast, and family body appearance were positively associated with BMI. Among girls these variables were also significantly associated, whereas age at menarche was negatively associated with BMI. Hours of watching TV/video/video-game was associated with BMI only among boys. The correlation coefficient between BMI and measures of fatness varied from 0.7 to 0.9 for boys, and from 0.8 to 0.90 for girls. CONCLUSIONS: BMI appears to be a good indicator of obesity among adolescents and showed that girls demonstrated an exaggerated preoccupation with body image and stereotyped slim body patterns.

Geographical patterns of proportionate mortality for the most common causes of death in Brazil.

Mortality due to chronic diseases has been increasing in all regions of Brazil with corresponding decreases in mortality from infectious diseases. The geographical variation in proportionate mortality for chronic diseases for 17 Brazilian state capitals for the year 1985 and their association with socio-economic variables and infectious disease was studied. Calculations were made of correlation coefficients of proportionate mortality for adults of 30 years or above due to ischaemic heart disease, stroke and cancer of the lung, the breast and stomach with 3 socio-economic variables, race, and mortality due to infectious disease. Linear regression analysis included as independent variables the % of illiteracy, % of whites, % of houses with piped water, mean income, age group, sex, and % of deaths caused by infectious disease. The dependent variables were the % of deaths due to each one of the chronic diseases studied by age-sex group. Chronic diseases were an important cause of death in all regions of Brazil. Ischaemic heart diseases, stroke and malignant neoplasms accounted for more than 34% of the mortality in each of the 17 capitals studied. Proportionate cause-specific mortality varied markedly among state capitals. Ranges were 6.3-19.5% for ischaemic heart diseases, 8.3-25.4% for stroke, 2.3-10.4% for infections and 12.2-21.5% for malignant neoplasm. Infectious disease mortality had the highest (p < 0.001) correlation with all the four socio-economic variables studied and ischaemic heart disease showed the second highest correlation (p < 0.05). Higher socio-economic level was related to a lower % of infectious diseases and a higher % of ischaemic heart diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

Height, weight, weight change and risk of breast cancer in Rio de Janeiro, Brazil.

CONTEXT: The relationship between body size and breast cancer still remains controversial in considering menopausal status. OBJECTIVE: To evaluate the association of height, weight and weight changes with breast cancer in the city of Rio de Janeiro, Brazil. DESIGN: Case-control study. SETTING: National Cancer Institute (INCA), Rio de Janeiro, Brazil, and State University of Rio de Janeiro (UERJ). SAMPLE: 177 incident cases of invasive breast cancer admitted to the main hospital of INCA between May 1995 and February 1996, and 377 controls recruited from among female visitors to the same hospital. MAIN MEASUREMENTS: Height and weight were measured and information on maximum weight, weight at ages 18 and 30 years, and potential risk factors were ascertained by interview at the hospital. RESULTS: Height was not related to risk of breast cancer among both pre and postmenopausal women. Nevertheless, women in this study were shorter than in studies that have found a positive association. Premenopausal women in the upper quartile of recent body mass index (BMI) and maximum BMI showed a reduced risk of breast cancer (P for trend < or = 0.03). Weight loss between ages 18 and 30 years and from 18 years to present was also associated with breast cancer among premenopausal women. CONCLUSIONS: These findings may merely indicate the known association between leanness and breast cancer. Further studies should explore the role of weight loss on breast cancer risk.