Body mass index, adipokines and insulin resistance in asthmatic children and adolescents.

OBJECTIVE: This study aimed to describe the body mass index, insulin resistance, levels of adipokines and inflammatory markers in Brazilian asthmatic children and adolescents and to investigate their possible association with the severity and control of asthma. METHODS: Cross-sectional study (n = 92; age: 3-18 years). Assessed data: Body weight and height, used to calculate the body mass index (BMIZ) and height-for-age (HAZ). Laboratory measurements: Lipid profile; glycemia and insulin for homeostasis model assessment (HOMA); adipokines; tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP) and monocyte chemoattractant protein-1 (MCP-1); total immunoglobulin E (IgE) and specific IgE against aeroallergens. RESULTS: The median age was 9.6 years (3.0-16.6); most participants were male (n = 52, 56.5%), pre-pubertal (n = 54, 58.6%) and had atopic asthma (n = 85, 92.4%). Overweight/obesity (38%) showed an inverse correlation with age (adjusted odds ratio [OR] = 0.781; 95% confidence interval [CI] 0.66-0.92) and a direct correlation with the leptin concentration (adjusted OR = 1.13; 95% CI 1.04-1.22). Insulin concentration was independently associated with moderated persistent asthma (adjusted OR = 1.31; 95% CI 1.09-1.52). HOMA showed a direct correlation with the leptin (ß = 0.475; 95% CI 0.117-0.268) and total IgE (ß = 0.197; 95% CI 0.002-0.096) levels and an inverse correlation with the TNF-α levels (ß = -0.255; 95% CI;-0.366-0.055). CONCLUSIONS: Asthma was associated with insulin resistance and a systemic inflammatory response possibly mediated by adipokines, with leptin levels standing out among the participants with excess weight.

Enzyme replacement therapy with idursulfase for mucopolysaccharidosis type II (Hunter syndrome).

BACKGROUND: Mucopolysaccharidosis II, also known as Hunter syndrome, is a rare, X-linked disease caused by a deficiency of the lysosomal enzyme iduronate-2-sulfatase, which catalyses a step in the catabolism of glycosaminoglycans. The glycosaminoglycans accumulate within tissues affecting multiple organs and physiologic systems. The clinical manifestations include neurologic involvement, severe airways obstruction, skeletal deformities and cardiomyopathy. The disease has a variable age of onset and variable rate of progression. In those with severe disease, death usually occurs in the second decade of life, whereas those individuals with less severe disease may survive into adulthood. Enzyme replacement therapy with intravenous infusions of idursulfase has emerged as a new treatment for mucopolysaccharidosis type II. This is an update of a previously published version of this review. OBJECTIVES: To evaluate the effectiveness and safety of enzyme replacement therapy with idursulfase compared to other interventions, placebo or no intervention, for treating mucopolysaccharidosis type II. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Trials Register (date of last search 23 November 2015).We also searched Embase, PubMed and the Literature Latino-Americana e do Caribe em Ciências da Saúde (LILACS) (date of last search 28 November 2015). SELECTION CRITERIA: Randomised and quasi-randomised controlled trials of enzyme replacement therapy with idursulfase compared to no intervention, placebo or other options (e.g. behavioral strategies, transplantation). DATA COLLECTION AND ANALYSIS: Two authors independently screened the trials identified, appraised quality of papers and extracted data. MAIN RESULTS: One study (96 male participants) met the inclusion criteria, although the primary outcome of this review - z score for height and weight, was not assessed in the study. This trial was considered to be of overall good quality. Following 53 weeks of treatment, participants in the weekly idursulfase 0.5 mg/kg group demonstrated a significant improvement rate compared with placebo for the primary outcome: distance walked in six minutes on the basis of the sum of ranks of change from baseline, mean difference 37.00 (95% confidence interval 6.52 to 67.48). The every-other-week idursulfase 0.5 mg/kg group also showed an improvement, which was not significant compared with placebo, mean difference 23.00 (95% confidence interval -4.49 to 50.49). After 53 weeks, there was no statistical significance difference in per cent predicted forced vital capacity between the three groups and absolute forced vital capacity was significantly increased from baseline in the weekly dosing group compared to placebo, mean difference 0.16 (95% confidence interval CI 0.05 to 0.27). No difference was observed between the every-other-week idursulfase 0.5 mg/kg group and placebo.In addition, liver and spleen volumes and urine glycosaminoglycan excretion were significantly reduced from baseline by both idursulfase dosing regimens. Idursulfase was generally well tolerated, but infusion reactions did occur. Idursulfase antibodies were detected in 31.7% of participants at the end of the study and they were related to a smaller reduction in urine glycosaminoglycan levels. AUTHORS' CONCLUSIONS: The current evidence is limited. While the randomised clinical trial identified was considered to be of good quality, it failed to describe important outcomes. It has been demonstrated that enzyme replacement therapy with idursulfase is effective in relation to functional capacity (distance walked in six minutes and forced vital capacity), liver and spleen volumes and urine glycosaminoglycan excretion in people with mucopolysaccharidosis type II compared with placebo. There is no available evidence in the included study and in the literature on outcomes such as improvement in growth, sleep apnoea, cardiac function, quality of life and mortality. More studies are needed to obtain more information on the long-term effectiveness and safety of enzyme replacement therapy.

Enzyme replacement therapy with idursulfase for mucopolysaccharidosis type II (Hunter syndrome).

BACKGROUND: Mucopolysaccharidosis II, also known as Hunter syndrome, is a rare, X-linked disease caused by a deficiency of the lysosomal enzyme iduronate-2-sulfatase, which catalyses a step in the catabolism of glycosaminoglycans. The glycosaminoglycans accumulate within tissues affecting multiple organs and physiologic systems. The clinical manifestations include neurologic involvement, severe airways obstruction, skeletal deformities and cardiomyopathy. The disease has a variable age of onset and variable rate of progression. In those with severe disease, death usually occurs in the second decade of life, whereas those patients with less severe disease may survive into adulthood. Enzyme replacement therapy with intravenous infusions of idursulfase has emerged as a new treatment for mucopolysaccharidosis type II. OBJECTIVES: To evaluate the effectiveness and safety of enzyme replacement therapy with idursulfase compared to other interventions, placebo or no intervention, for treating mucopolysaccharidosis type II. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Trials Register (date of last search 22 July 2013).We also searched EMBASE, PubMed and the Literature Latino-Americana e do Caribe em Ciências da Saúde (LILACS) (date of last search 09 July 2013). SELECTION CRITERIA: Randomised and quasi-randomised controlled trials of enzyme replacement therapy with idursulfase compared to no intervention, placebo or other options (e.g. behavioral strategies, transplantation). DATA COLLECTION AND ANALYSIS: Two authors independently screened the trials identified, appraised quality of papers and extracted data. MAIN RESULTS: One study (96 patients) met the inclusion criteria, although the primary outcome of this review - z score for height and weight, was not assessed in the study. This trial was considered to be of overall good quality. Following 53 weeks of treatment, patients in the weekly idursulfase 0.5 mg/kg group demonstrated a significant improvement rate compared with placebo for the primary outcome: distance walked in six minutes on the basis of the sum of ranks of change from baseline, mean difference 37.00 (95% confidence interval 6.52 to 67.48). The every-other-week idursulfase 0.5 mg/kg group also showed an improvement, which was not significant compared with placebo, mean difference 23.00 (95% confidence interval -4.49 to 50.49). After 53 weeks, there was no statistical significance difference in per cent predicted forced vital capacity between the three groups and absolute forced vital capacity was significantly increased from baseline in the weekly dosing group compared to placebo, mean difference 0.16 (95% confidence interval CI 0.05 to 0.27). No difference was observed between the every-other-week idursulfase 0.5 mg/kg group and placebo.In addition, liver and spleen volumes and urine glycosaminoglycan excretion were significantly reduced from baseline by both idursulfase dosing regimens. Idursulfase was generally well tolerated, but infusion reactions did occur. Idursulfase antibodies were detected in 31.7% of patients at the end of the study and they were related to a smaller reduction in urine glycosaminoglycan levels. AUTHORS' CONCLUSIONS: The current evidence is limited. While the randomised clinical trial identified was considered to be of good quality, it failed to describe important outcomes. It has been demonstrated that enzyme replacement therapy with idursulfase is effective in relation to functional capacity (distance walked in six minutes and forced vital capacity), liver and spleen volumes and urine glycosaminoglycan excretion in patients with mucopolysaccharidosis type II compared with placebo. There is no available evidence in the included study and in the literature on outcomes such as improvement in growth, sleep apnoea, cardiac function, quality of life and mortality. More studies are needed to obtain more information on the long-term effectiveness and safety of enzyme replacement therapy.

Adequacy of antenatal care and its relationship with low birth weight in Botucatu, São Paulo, Brazil: a case-control study.

BACKGROUND: Birth weight reflects gestational conditions and development during the fetal period. Low birth weight (LBW) may be associated with antenatal care (ANC) adequacy and quality. The purpose of this study was to analyze ANC adequacy and its relationship with LBW in the Unified Health System in Brazil. METHODS: A case-control study was conducted in Botucatu, São Paulo, Brazil, 2004 to 2008. Data were collected from secondary sources (the Live Birth Certificate), and primary sources (the official medical records of pregnant women). The study population consisted of two groups, each with 860 newborns. The case group comprised newborns weighing less than 2,500 grams, while the control group comprised live newborns weighing greater than or equal to 2,500 grams. Adequacy of ANC was evaluated according to three measurements: 1. Adequacy of the number of ANC visits adjusted to gestational age; 2. Modified Kessner Index; and 3. Adequacy of ANC laboratory studies and exams summary measure according to parameters defined by the Ministry of Health in the Program for Prenatal and Birth Care Humanization. RESULTS: Analyses revealed that LBW was associated with the number of ANC visits adjusted to gestational age (OR = 1.78, 95% CI 1.32-2.34) and the ANC laboratory studies and exams summary measure (OR = 4.13, 95% CI 1.36-12.51). According to the modified Kessner Index, 64.4% of antenatal visits in the LBW group were adequate, with no differences between groups. CONCLUSIONS: Our data corroborate the association between inadequate number of ANC visits, laboratory studies and exams, and increased risk of LBW newborns. No association was found between the modified Kessner Index as a measure of adequacy of ANC and LBW. This finding reveals the low indices of coverage for basic actions already well regulated in the Health System in Brazil. Despite the association found in the study, we cannot conclude that LBW would be prevented only by an adequate ANC, as LBW is associated with factors of complex and multifactorial etiology. The results could be used to plan monitoring measures and evaluate programs of health care assistance during pregnancy, at delivery and to newborns, focusing on reduced LBW rates.

Association of adipokines with cardiovascular risk factors in low birth weight children: a case-control study.

UNLABELLED: Our aim was to investigate plasma levels of adiponectin, monocyte chemoattractant protein-1 (MCP-1) and plasminogen activator inhibitor-1 (PAI-1) in low birth weight (LBW) children and to determine correlations among these adipokines and birth weight and cardiovascular disease risk factors. In a case-control study, the concentrations of adiponectin, MCP-1 and PAI-1 were measured in 180 schoolchildren (ages 6-11 years). MCP-1 and PAI-1 levels were significantly elevated in LBW children. Conversely, adiponectin concentration was significantly reduced in these children. Similar findings were observed after adjustment for current age, gender and abdominal circumference. Because the children with LBW had altered adipokine levels, as well as higher abdominal circumference, HOMA-IR and systolic blood pressure (SBP), we evaluated the correlation among these variables. These analyses showed that adiponectin levels were inversely correlated with systolic blood pressure (SBP) (r = -0.501; P < 0.001), HOMA-IR (r = -0.293; P = 0.023) and waist circumference (r = -0.317; P = 0.014). The proinflammatory markers were positively correlated with HOMA-IR (PAI-1: r = 0.358; P = 0.005) and waist circumference (PAI-1: r = 0.571; P < 0.001 and MCP-1: r = 0.267; P = 0.039). CONCLUSION: Adipokines levels were correlated with cardiovascular risk factors in LBW children, and these compounds could be involved in the mechanism that links birth weight to the development of cardiovascular diseases in adulthood.

Association of serum and erythrocyte zinc levels with breastfeeding and complementary feeding in preterm and term infants.

Zinc is an important nutrient involved in cell division, physical growth, and immune system function. Most studies evaluating the nutritional status related to zinc and prematurity were conducted with hospitalized preterm infants. These studies show controversial results regarding the prevalence of deficiency, clinical implications, and the effect of zinc supplementation on mortality, infectious diseases, and growth in these groups. This study aimed to compare serum and erythrocyte zinc levels in a group of preterm and full-term infants after 9 months of age, and related the zinc levels to dietary intake and anthropometric indicators in both groups. This cross-sectional study compared 43 preterm infants (24 to 33 weeks) aged 9-24 months to 47 full-term healthy infants. Outcome measures: anthropometric indicators and dietary intake. Blood sample for serum and erythrocyte zinc levels (ICP-MS, Inductively Coupled Plasma Mass Spectrometry). There was no difference between the groups regarding the mean of serum and erythrocyte zinc. Variables associated with higher serum zinc levels were breastfeeding at evaluation (ß = 20.11 µg/dL, 95% CI 9.62-30.60, p < 0.001) and the later introduction of solid foods (ß = 6.6 µg/dL, 95% CI 5.3-11.4, p < 0.001). Breastfeeding was also associated with higher erythrocyte zinc levels. The zinc levels were adequate in both groups, there was no association with anthropometric indicators or dietary intake and were slightly influenced by breastfeeding and time of solid food introduction.

Association between ultraprocessed food intake and C-reactive protein levels in preterm and term infants.

OBJECTIVES: This study aimed to examine associations between consumption of ultraprocessed food (UPF) and C-reactive protein (CRP) levels in a sample of term and preterm infants. METHODS: In this cross-sectional study, 43 preterm infants (<34 wk), chronological age between 9 and 24 mo, were compared with a group of 47 healthy term infants of the same age. Data were collected on dietary intake, anthropometric measures, and serum CRP level (mg/L). The main exposure of interest was the consumption of UPF (excluding all types of milk), measured as the percentage of total energy intake. RESULTS: The mean birth weight, gestational age, and corrected age were 1,245 ± 381.7 g, 29.9 ± 2.3 wk, and 14.3 ± 6.4 mo, respectively, in the preterm group. Infants in the preterm group consumed UPF less frequently (27-67.5% versus 40-87.0%; P = 0.038) but in a greater amount relative to total energy intake (39.8% [19.1-59.1%]) versus 29.0% (14.5- 41.9%; P = 0.040) when compared with the term group. There was no statistically significant difference between the preterm and term groups regarding CRP levels. The consumption of UPF (percentage of energy intake) was independently associated with CRP levels (ß = 0.007; 95% CI, 0.001-0.014; P = 0.034). A significant interaction between being born preterm and UPF consumption was found for CRP levels (P = 0.049). Breast-feeding was not associated with lower consumption of UPF in both groups (24-75.0% versus 43-79.6%; P = 0.404). CONCLUSIONS: There is a positive relationship between UPF and CRP levels among infants, irrespective of excess weight. At the clinical practice level, a better comprehension of the associations between food processing and chronic inflammation may aid in individual dietary guidance.

Enzyme replacement therapy with idursulfase for mucopolysaccharidosis type II (Hunter syndrome).

BACKGROUND: Mucopolysaccharidosis II, also known as Hunter syndrome, is a rare, X-linked disease caused by a deficiency of the lysosomal enzyme iduronate-2-sulfatase, which catalyses a step in the catabolism of glycosaminoglycans. The glycosaminoglycans accumulate within tissues affecting multiple organs and physiologic systems. The clinical manifestations include neurologic involvement, severe airways obstruction, skeletal deformities and cardiomyopathy. The disease has a variable age of onset and variable rate of progression. In those with severe disease, death usually occurs in the second decade of life, whereas those patients with less severe disease may survive into adulthood. Enzyme replacement therapy with intravenous infusions of idursulfase has emerged as a new treatment for mucopolysaccharidosis type II. OBJECTIVES: To evaluate the effectiveness and safety of enzyme replacement therapy with idursulfase compared to other interventions, placebo or no intervention, for treating mucopolysaccharidosis type II. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Trials Register (date of last search 01 September 2011).We also searched EMBASE, PubMed and the Literature Latino-Americana e do Caribe em Ciências da Saúde (LILACS) (date of last search October 2009). SELECTION CRITERIA: Randomised and quasi-randomised controlled trials of enzyme replacement therapy with idursulfase compared to no intervention, placebo or other options (e.g. behavioral strategies, transplantation). DATA COLLECTION AND ANALYSIS: Two authors independently screened the trials identified, appraised quality of papers and extracted data. MAIN RESULTS: One study (96 patients) met the inclusion criteria, although the primary outcome of this review - z score for height and weight, was not assessed in the study. Following 53 weeks of treatment, patients in the weekly idursulfase 0.5 mg/kg group demonstrated a significant improvement rate compared with placebo for the primary outcome: distance walked in six minutes on the basis of the sum of ranks of change from baseline, mean difference 37.00 (95% confidence interval 6.52 to 67.48). The every-other-week idursulfase 0.5 mg/kg group also showed an improvement, which was not significant compared with placebo, mean difference 23.00 (95% confidence interval -4.49 to 50.49). After 53 weeks, there was no statistical significance difference in per cent predicted forced vital capacity between the three groups and absolute forced vital capacity was significantly increased from baseline in the weekly dosing group compared to placebo, mean difference 0.16 (95% confidence interval CI 0.05 to 0.27). No difference was observed between the every-other-week idursulfase 0.5 mg/kg group and placebo.In addition, liver and spleen volumes and urine glycosaminoglycan excretion were significantly reduced from baseline by both idursulfase dosing regimens. Idursulfase was generally well tolerated, but infusion reactions did occur. Idursulfase antibodies were detected in 31.7% of patients at the end of the study and they were related to a smaller reduction in urine glycosaminoglycan levels. AUTHORS' CONCLUSIONS: The current evidence is limited. While the randomised clinical trial identified was considered to be of good quality, it failed to describe important outcomes. It has been demonstrated that enzyme replacement therapy with idursulfase is effective in relation to functional capacity (distance walked in six minutes and forced vital capacity), liver and spleen volumes and urine glycosaminoglycan excretion in patients with mucopolysaccharidosis type II compared with placebo. There is no available evidence in the included study and in the literature on outcomes such as improvement in growth, sleep apnoea, cardiac function, quality of life and mortality. More studies are needed to obtain more information on the long-term effectiveness and safety of enzyme replacement therapy.

Motor development of infants (6-12 months) with low birth weight.

OBJECTIVE: The aim of this study was to describe the motor development (MD) and growth of infants born with low birth weight (LBW) versus adequate birth weight (ABW) by using the Alberta Infant Motor Scale (AIMS). METHODS: The cross-sectional study including LBW infants (aged 6-12 months) followed at an outpatient clinic from a University Hospital in Brazil and a group of infants of the same age with ABW. The variables were recorded as maternal, birth, and infant conditions. The infants were assessed for MD using the AIMS. RESULTS: In total, 98 infants (38 LBW versus 60 ABW) were evaluated and no statistically significant differences were found in demographic characteristics and in the AIMS results. The AIMS results of the total sample were suspicious or abnormal MD in 44 (45%) of total infants. Higher frequency of suspected or abnormal motor behavior was found in the age group between 9 and 12 (54.6%) months. CONCLUSIONS: A frequency of 45% of suspected or abnormal behavior was observed in the evaluated infants, with a higher frequency of occurrence in those aged 9-12 months (54.6%).

Leukemia, non-Hodgkin's lymphoma, and Wilms tumor in childhood: the role of birth weight.

There is emerging evidence that higher birth weight is associated with increased risk of cancer, in particular childhood leukemia. The purpose of this paper is to study whether this correlation is also significant with other childhood cancer. For this, we conducted a case-control study including 410 childhood cancer patients and 1,575 matched controls to investigate birth weight as a risk factor for leukemia, Wilms tumor, and non-Hodgkin's lymphoma. The estimated risk for all cancers has been found to be statistically and significantly higher in birth weight of more than 4,000 g (odds ratio, 2.50 and 95% confidence intervals (CI), 1.72-3.63). For leukemia, the estimated risk was 1.86 (95% CI, 1.04-3.30), for non-Hodgkin lymphoma, 1.99 (95% CI, 1.08-3.69), and being more remarkable for Wilms tumor, 4.76 (95% CI, 2.73-8.28). Moreover, moderate increased risk of both leukemia and non-Hodgkin lymphoma was also associated with birth weight between 3,000 and 3,999 g. High birth weight was associated with all cancers also when adjusted by gestational age, length at birth, and gender (odds ratio, 6.10 and 95% CI, 1.15-32.57). No associations were found for maternal alcohol consumption during pregnancy, maternal smoking, or smoking by other people at home or presence of obstetric variables (e.g., gestational diabetes, preeclampsia, and abruptio placentae). The present study supports the hypothesis that high birth weight is an independent risk factor for childhood Wilms tumor, leukemia, and non-Hodgkin lymphoma. Further studies should explore biological reasons to explain this relationship and, ultimately, to expand our knowledge about prenatal influences on the occurrence of this disease.

Factors associated with student performance on the medical residency test.

OBJECTIVE: To determine whether the scores of the Progress test, the Skills and Attitude test, and the medical internship are correlated with the medical residency exam performance of students who started medical school at the Federal University of São Paulo in 2009. METHODS: The scores of 684 Progress tests from years 1-6 of medical school, 111 Skills and Attitude exams (5th year), 228 performance coefficients for the 5th and 6th years of internship, and 211 scores on the medical residency exam were analyzed longitudinally. Correlations between scores were assessed by Pearson's correlation. Factors associated with medical residency scores were analyzed by linear regression. RESULTS: Scores of Progress tests from years 1-6 and the Skills and Attitude test showed at least one moderate and significant correlation with each other. The theoretical exam and final exam scores in the medical residency had a moderate correlation with performance in the internship. The score of the theoretical medical residency exam was associated with performance in internship year 6 (ß=0.833; p<0.001), and the final medical residency exam score was associated with the Skills and Attitude score (ß=0.587; p<0.001), 5th-year internship score, (ß=0.060; p=0.025), and 6th-year Progress test score (ß=0.038; p=0.061). CONCLUSIONS: The scores of these tests showed significant correlations. The medical residency exam scores were positively associated with the student's performance in the internship and on the Skills test, with a tendency for the final medical residency exam score to be associated with the 6th-year Progress test.

[Factors associated with excess weight and stunting in schoolchildren born with low birth weight]. / Fatores associados ao excesso de peso e baixa estatura em escolares nascidos com baixo peso.

The scope of this study is to assess the nutritional status of low birth weight (LBW) children and the possible associations with independent maternal variables, gender and neonatal history. It involved a cross-sectional study with 544 LBW schoolchildren (five to ten years of age) in the metropolitan area of São Paulo. Variables: the neonatal data of liveborn infant declarations and the current weight and height of the mothers were collected. The weight and stature used to calculate the height/age z (HAZ) score and the body mass index (BMI) of children were evaluated. Among the LBW children 6.2% were of short stature, 12.3% overweight and 8.6% obese. There was an association between short stature in LBW schoolchildren and short maternal stature < 150 cm (OR = 6.94; 95 % CI 2.34-20.6). Excess weight/obesity in LBW children was independently associated with overweight/obesity of the mother (OR = 2.40; 95% CI 1.44-4.01), and the male gender (OR = 1.77; 95% CI 1.06-2.95). A fifth of schoolchildren with low birth weight were overweight, which was associated with current maternal nutritional status and the male gender and stunting was associated with maternal stature.

O objetivo deste artigo é avaliar a condição nutricional de crianças com baixo peso ao nascer (BPN) e possíveis associações com variáveis independentes maternas, sexo e antecedentes neonatais Estudo transversal com 544 escolares com BPN (5 a 10 anos de idade) da região metropolitana de São Paulo. Variáveis: dados neonatais das declarações de nascidos vivos (peso ao nascer e idade gestacional), informações sobre a gestação e a condição nutricional atual das mães. A avaliação da condição nutricional dos escolares foi realizada por meio da obtenção dos dados de peso e estatura utilizados cálculo do escore z da estatura/idade (ZEI) e índice de massa corporal (ZIMC). Observou-se baixa estatura; sobrepeso e obesidade em 6,2%, 8,6% e 12,3% das crianças avaliadas, respectivamente. A presença de baixa estatura nos escolares associou-se com estatura materna < 150 cm (OR = 6,94; IC95% 2,34­20,6). O sobrepeso/obesidade nas crianças com BPN associou-se de forma independente com o sobrepeso/obesidade da mãe (OR = 2,40; IC95% 1,44­4,01) e o sexo masculino (OR = 1,77; IC95% 1,06­2,95). Um quinto dos escolares com BPN apresentaram excesso de peso, que se associou à condição nutricional materna atual e ao gênero masculino; a baixa estatura associou-se à estatura materna.

Metabolic syndrome among prepubertal Brazilian schoolchildren.

This was a two-stage cross-sectional study that assessed metabolic syndrome and associated factors among prepubertal schoolchildren. In the first stage, nutritional status, blood pressure, personal (low birth weight) and family antecedents for cardiovascular disease (CVD) were collected. In the second stage, schoolchildren with at least one of these criteria participated: obesity, personal or family history. Metabolic syndrome (MS) was defined by ATP III and WHO definitions. Among 929 (6-10 year old) schoolchildren, 27.7% presented with overweight/obesity, 12.2% hypertension, and personal (9.4%) and family (35.3%) antecedents. 205 children finished the second stage. The frequencies of MS-ATP and MS-WHO were 9.3% and 1.9%. Among the obese, MS was present in 25.8% (ATP) and 5.2% (WHO). Children with normal weight presented: low HDL (23.6%), hyperglycaemia (3.6%), HOMA-IR (0.9%) and MS-ATP (0.9%). In conclusion, overweight/obesity was associated with metabolic syndrome in schoolchildren. It was found that children with normal weight with personal and/or family antecedents presented with HOMA-IR and MS-ATP.

Prophylaxis for iron deficiency anemia using ferrous sulfate among infants followed up at a primary healthcare unit in the municipality of Embu-SP (2003/2004).

CONTEXT AND OBJECTIVE: Iron deficiency anemia is an important public health problem in Brazil. In the municipality of Embu, a population study in 1996 found anemia prevalence of 68.5% among children aged one to two years. From these data, prescription of prophylactic ferrous sulfate was instituted in 1998 for children under two years old followed up within the children's healthcare program. After five years of intervention, the prevalence of anemia and associated factors were investigated among children aged 12 to 18 months to whom guidance for prophylactic ferrous sulfate use had been given. DESIGN AND SETTING: Cross-sectional study covering October 2003 to June 2004 at a primary healthcare unit in Embu. METHODS: A randomized sample of children aged 12 to 18 months to whom guidance for prophylactic ferrous sulfate use had been given was obtained. Hemoglobin was measured in capillary blood, using HemoCue apparatus. Hemoglobin < 11 g/100 dl was taken to indicate anemia. RESULTS: The sample comprised 118 children and anemia was found in 41.5%. There was no statistically significant association between anemia presence and the variables of sex, birth weight, neonatal intercurrences, chronic diseases, breastfeeding or iron supplementation use. There was a statistically significant association (p = 0.03) between anemia presence and per capita income, such that the higher the income was, the lower the prevalence of anemia was. CONCLUSION: The prophylaxis program against iron deficiency anemia did not achieve the expected results. New strategies must be considered in the light of the magnitude of the problem.

Mental disorders in pregnancy and newborn conditions: longitudinal study with pregnant women attended in primary care. / Transtornos mentais na gravidez e condições do recém-nascido: estudo longitudinal com gestantes assistidas na atenção básica.

This study aimed to determine the presence and association of possible mental disorders diagnoses in primary care pregnant women and newborns' conditions. This is a longitudinal study with pregnant women (18-39 years), in the second and third trimesters of pregnancy, attended at primary care facilities in the metropolitan region of São Paulo (February to August/2014). The following tools were used: sociodemographic questionnaire; Mental Disorders in Primary Care Assessment tool; and an interview with information and mother´s perception of the behavior of newborns. Of the 300 pregnant women interviewed, 76 had possible diagnosis of mental disorders, 46 women had depression/dysthymia and 58 anxiety/panic symptoms. Low birth weight and prematurity was observed in 14 and 19 newborns, respectively, and there was no association with the probable diagnosis of mental disorders; the possible presence of mental disorders was associated with the mother's perception of newborns behavior. Pregnant women attended at low risk prenatal care showed relevant frequency of mental disorders; thus, the identification of these changes during pregnancy can also contribute to a better understanding of the mother-and-child dynamics and in the quality of family care.

O objetivo do estudo foi verificar a presença e a associação entre diagnósticos prováveis de transtornos mentais em gestantes da atenção básica e condições dos recém-nascidos. Estudo longitudinal com gestantes (18 a 39 anos), no segundo e terceiro trimestres da gravidez, assistidas na atenção básica da região Metropolitana de São Paulo (fevereiro a agosto/2014). Foram aplicados: questionário sociodemográfico, instrumento para Avaliação de Transtornos Mentais na Atenção Primária e entrevista sobre informações e percepção do comportamento do recém-nascido. Das 300 gestantes entrevistadas, 76 apresentaram diagnóstico provável de transtorno mental, sendo que 46 apresentavam sintomas de depressão/distimia e 58, ansiedade/pânico. Observou-se baixo peso ao nascer e prematuridade em 14 e 19 dos recém-nascidos, respectivamente, e não foi verificada associação com diagnósticos prováveis de transtorno mental; a presença destes associou-se com a percepção materna de alterações no comportamento do recém-nascido. Gestantes em acompanhamento de pré-natal de baixo risco apresentam frequência relevante de transtornos mentais, logo, a identificação dessas alterações na gestação pode colaborar para melhor compreensão da dinâmica do binômio mãe-filho e na qualidade na assistência à família.

Birth Weight and Its Relationship with the Cardiac Autonomic Balance in Healthy Children.

Several studies indicate that the fetal environment plays a significant role in the development of cardiometabolic disease later in life. However, a few studies present conflicting data about the correlation between birth weight and the impairment of cardiac autonomic modulation. The purpose of the present study was to provide further knowledge to elucidate this contradictory relationship. One hundred children aged 5 and 14 years had anthropometric parameters, body composition and blood pressure levels determined. Heart rate variability (HRV) was evaluated by heart rate monitoring, including measurements of both the time and frequency domains. The results showed inverse correlation between the HRV parameters with BMI (RMSSD: P = 0.047; PNN50: P = 0.021; HF: P = 0.041), systolic (RMSSD: P = 0.023; PNN50: P = 0.032) and diastolic (PNN50: P = 0.030) blood pressure levels. On the other hand, there were consistent positive correlations between the HRV parameters and birth weight (RMSSD: P = 0.001; PNN50: P = 0.001; HF: P = 0.002). To determine the effect of birth weight on HRV parameters, we perform multivariate linear regression analysis adjusted for potentially confounding factors (prematurity, gender, age, BMI, physical activity index and SBP levels). These findings were preserved even after adjusting for these confounders. Our results suggested that impaired cardiac autonomic modulation characterized by a reduction in the parasympathetic activity occurs in children with low birth weight. One possible interpretation for these data is that a vagal withdrawal, rather than a sympathetic overactivity, could precede the development of hypertension and other cardiometabolic diseases in children with low birth weight. However, long-term studies should be performed to investigate this possibility.

Factor analysis of the performance at the medical residency exam, progress test and clerkship rotations performance coefficient / Análise fatorial do desempenho no exame de residência médica, teste de progresso e coeficiente de desempenho nos estágios do internato

Abstract: Introduction: The relationships between the students' performance on medical residency exams and progress tests and medical clerkship rotations are not well established. Objective: The objective of this study was to measure the correlations between grades on progress tests and clerkship rotations assessments and the medical residency exam and determine which performance had the strongest correlation with the final medical residency exam. Methods: This was a retrospective and longitudinal study with correlation analyses of grades on progress tests from the 1st to 6th year of medical school, the clerkship rotations performance coefficient (5th and 6th years of school) and the final medical residency exam in a cohort of students enrolled in a federal public medical school using factor analysis. Students who performed the progress tests from the 1st to 6th year were included. Results: Of 123 students enrolled in the first year of medical school in 2009, 114 (92.7%) performed the progress tests during the six years and were included. The average grades on the progress tests from 1 to 10 were 2.67 (1st year), 3.01 (2nd year), 4.19 (3rd year), 4.01 (4th year), 5.19 (5th year), and 6.38 (6th year). The average grades in the clerkship rotations were 8.32 (5th year) and 8.26 (6th year). The average score on the theoretical medical residency exam was 7.53 and the final result of the medical residency exam was 8.05. Factor analysis detected three domains with greater correlation strength that accounted for 76.3% of the model variance. Component 1 was identified as the coefficient of academic performance (CAP) 5th, CAP 6th and final medical residency exam grades, whereas component 2 was constituted by the grades of the 5th and 6th years progress tests and the third component comprised the progress tests of the 2nd, 3rd and 4th years. Conclusions: Grades on the progress tests, the clerkship rotations assessments and the final medical residency exam were correlated. Moreover, the performance during the medical clerkship rotations showed the strongest correlations with medical residency exam grades.

Resumo: Introdução: As relações entre o desempenho dos alunos nos exames de residência médica e testes de progresso e os estágios no internato médico não estão bem estabelecidas. Objetivo: Este estudo teve como objetivos medir as correlações entre as notas nos testes de progresso e as notas no internato e o resultado final do exame de residência médica, e determinar qual desempenho teve a maior correlação com o exame final da residência médica. Método: Trata-se de um estudo retrospectivo e longitudinal com análises de correlação de notas em provas de progresso do primeiro ao sexto ano do curso de Medicina, coeficiente de desempenho de estágios do internato (quinto e sexto anos) e notas do exame final de residência médica em uma coorte de alunos matriculados em uma Faculdade de Medicina de uma instituição pública federal, usando análise fatorial. Foram incluídos os alunos que realizaram os testes de progresso do primeiro ao sexto ano. Resultado: Dos 123 alunos matriculados no primeiro ano do curso de Medicina em 2009, 114 (92,7%) realizaram os testes de progresso durante os seis anos letivos e foram incluídos. As notas médias nos testes de progresso de 1 a 10 foram 2,67 (primeiro ano), 3,01 (segundo ano), 4,19 (terceiro ano), 4,01 (quarto ano), 5,19 (quinto ano) e 6,38 (sexto ano). As notas médias nos estágios foram 8,32 (quinto ano) e 8,26 (sexto ano). A nota média no exame teórico da residência médica foi 7,53; e a média no exame final da residência, 8,5. A análise fatorial detectou três domínios com maior força de correlação que responderam por 76,3% da variância do modelo. O componente 1 foi identificado como coeficiente de rendimento acadêmico (CAP) 5º, CAP 6º e o resultado final do exame de residência médica, o componente 2 foi formado pelas notas das provas de progresso do quinto e sextos anos, e o terceiro componente compreendeu as notas do progresso do segundo, terceiro e quarto anos. Conclusão: As notas das provas de progresso, as avaliações do internato e o exame final de residência médica apresentaram correlações significantes. Além disso, o desempenho durante o internato apresentou maior correlação com as notas do exame final de residência médica.

Family history of cardiovascular disease and non-HDL cholesterol in prepubescent non-obese children.

OBJECTIVE: To describe the values of non-HDL cholesterol (NHDL-c) and the frequency of a family history of early cardiovascular disease (family HCVD) in healthy prepubescent children. Analyze the association between NHDL-c and family HCVD, and possible associations with other risk factors for cardiovascular disease (CVD). METHOD: Cross-sectional study including 269 prepubescent (aged 6-10 years) schoolchildren with a normal body mass index (+1SD-2SD). DATA COLLECTED: Family HCVD; weight and height, waist circumference and systemic blood pressure; lipid profile (total cholesterol TC, HDL-c, triglycerides and LDL-c), NHDL-c calculation (CT-HDL-c, cut-off = 145 mg/dL) and insulin resistance (HOMA-IR). RESULTS: High levels were found for NHDL-c in 10 (3.7%) of these schoolchildren, and family early HCVD was found in 46 (17.1%) of them. There was a weak association between family HCVD and NHDL-c (Cramer's-V-test = 0.120; p=0.050). Among the children with NHDL-c≥145 mg/dL, 4 (40%) have family HCVD. The presence of family HCVD was not associated with the variables being studied. The variables independently associated with NHDL-c ≥ 145 mg/dL were: HOMA-IR (OR=1.7; 95CI 1.1-2.6) and diastolic blood pressure (OR=1.1; 95CI 1.02-1.2). CONCLUSION: NHDL-c values were associated with blood pressure and insulin resistance. Family HCVD was not associated with other classic risk factors for CVD, even though the frequency found was five times higher than that of high NHDL-c.

Follow-up of children and adolescents with short stature: the importance of the growth rate.

CONTEXT AND OBJECTIVE: Short stature is defined as a height of more than two standard deviations below the average for a given age and sex in a reference population. The objective was to describe follow-up conducted among short-stature children and adolescents. DESIGN AND SETTING: Descriptive study, at the Growth outpatient clinic, Department of Pediatrics, Universidade Federal de São Paulo. METHODS: The study included 152 patients aged 2 to 15 years who had height for age of less than P5, on the National Center for Health Statistics curve. The children underwent nutritional evaluation, and several variables relating to height and growth rate were calculated to establish etiological diagnosis. Bone age was evaluated by X-ray. RESULTS: The majority (63.2%) were male. In 77.8%, the stature observed was within the family pattern. Among the 99 patients followed up for more than 6 months, 17.2% presented inadequate growth rates. The preponderant etiological diagnosis for short stature was familial/constitutional in 58.6% of the cases; 27 patients (34.2%) with adequate growth rate presented bone age alterations. Even with inadequate growth rates, 75% of such patients had a normal result from growth hormone stimulation testing. Close to 90% of patients with a diagnosis of short stature of familial/constitutional origin and intrauterine growth retardation presented adequate growth rate. The genetic etiology was significantly characteristic of patients with inadequate growth rate. CONCLUSION: Growth rate assessment must form part of the investigation and follow-up of short-stature cases. However, its utilization and validity should form part of an overall view of each patient.

[Prevalence of malnutrition among children in Embu, São Paulo State, Brazil, 1996-1997]. / Prevalência de desnutrição em crianças residentes no Município de Embu, São Paulo, Brasil, 1996-1997.

This paper focused on the nutritional profile of children in the municipality of Embu, São Paulo State, Brazil, in 1996-1997, to identify vulnerable population segments that require specific action by health services. The sample consisted of 320 children < or = 5 years of age distributed into four socioeconomic strata. The indices were expressed as z-scores: weight/age (W/A), height/age (H/A), and weight/height (W/H) to analyze the nutritional status, and the reference for normality was the NCHS curve. In all population strata and age groups, the height/age index was the most frequently affected, while the weight/height index had the fewest deficits. No statistically significant differences were observed in children's nutritional status between the four population strata or between the different age groups. Children with low birth weight showed the highest prevalence of deficits in all indices. In the municipality, the frequency of deficits were: H/A< 2z: 7.1%, W/H< 2z: 0.2%, and W/A< 2z: 2.9%. Height deficit can be used as an early warning, considering that loss observed over the course of years has future consequences.