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1.
Psychiatr Danub ; 32(2): 176-186, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32796782

RESUMO

BACKGROUND: Although an inverse relationship between body mass index (BMI) and Parkinson disease (PD) has been repeatedly reported, to our knowledge, the relationship between BMI and antipsychotic-induced extrapyramidal symptoms (EPS) has rarely been studied in patients with schizophrenia. Our study aimed to evaluate the relationship between BMI and EPS in patients with schizophrenia. SUBJECTS AND METHODS: Using data from the Research on Asian Psychotropic Prescription Patterns for Antipsychotics (REAP-AP) study, we compared the prevalence of EPS in 1448 schizophrenia patients stratified as underweight, normal range, overweight pre-obese, overweight obese I, overweight obese II, and overweight obese III according to the World Health Organization (WHO) classification system for body weight status, and with underweight, normal range, overweight at risk, overweight obese I, and overweight obese II according to the Asia-Pacific obesity classification. RESULTS: In the first step of the WHO classification system for body weight status, adjusting for the potential effects of confounding factors, the multinomial logistic regression model revealed that underweight was significantly associated with greater rates of bradykinesia and muscle rigidity, and a lower rate of gait disturbance. In the second step of the Asia-Pacific obesity classification, adjusting for the potential effects of confounding factors, the multinomial logistic regression model revealed that underweight was significantly associated with a higher rate of muscle rigidity. CONCLUSION: Findings of the present study consistently revealed that underweight was associated with a greater rate of muscle rigidity in a stepwise pattern among Asian patients with schizophrenia. Although the mechanism underlying the inverse relationship between BMI and muscle rigidity cannot be sufficiently explained, it is speculated that low BMI may contribute to the development of muscle rigidity regardless of antipsychotic "typicality" and dose in patients with schizophrenia.


Assuntos
Antipsicóticos , Índice de Massa Corporal , Esquizofrenia , Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Ásia , Humanos , Sobrepeso , Esquizofrenia/tratamento farmacológico , Magreza
2.
Int Heart J ; 61(4): 658-664, 2020 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-32641636

RESUMO

Increased body mass index (BMI) is a well-established risk factor for cardiovascular disease; however, patients with elevated BMI, in comparison to those with low BMI, seem to have better survival, a phenomenon reported as "obesity paradox," which remains controversial. We investigated the effect of BMI on cardiac mortality post acute myocardial infarction (AMI).In this analysis, 3562 AMI patients were included and classified into four groups based on BMI values. The primary endpoint was cardiac death. Compared to normoweight group, overweight and obese group subjects were younger, mostly men, and more likely to receive percutaneous coronary intervention (PCI) and had higher levels of glucose and lipids, but lower level of NTproBNP. Subjects in the underweight group were older, were mostly women, had lower Barthel index (BI), were less likely to receive PCI, and had lower levels of glucose and lipids, but higher level of N-terminal pro-brain natriuretic peptide (NTproBNP) and higher rates of left ventricular ejection fraction (LVEF) < 50%. During a median follow-up period of 1.9 years, cardiac death occurred significantly more in the underweight group (30.0%, 10.6%, 7.0%, and 5.0% among the four groups from underweight to obese; P < 0.001 for trend). The Cox analysis revealed that underweight was an independent predictor of subsequent cardiac death (odds ratio (OR), 1.86; 95% confidence interval (CI), 1.07-3.25) and identified that older age, BI < 60, higher levels of cardiac troponin I (cTnI), LVEF < 50%, and not receiving PCI were independently associated with increased risk of cardiac death.Patients who were underweight were at greater risk of cardiac death post AMI. In addition, older age, frail, higher levels of cTnI, LVEF < 50%, and not receiving PCI also independently predicted cardiac mortality post AMI.


Assuntos
Infarto do Miocárdio/mortalidade , Obesidade/complicações , Magreza/complicações , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/complicações
3.
BMC Public Health ; 20(1): 1187, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32727437

RESUMO

BACKGROUND: Undernourished people have an increased risk of premature mortality from both infectious and non-communicable diseases. Aside from screening purposes, assessment of nutritional status is a useful tool in management and evaluation of various chronic diseases. Body-Mass-Index (BMI) is today the most commonly used marker of nutritional status however, this method presents a challenge in many low resource settings and immobile patients. Mid-upper arm circumference (MUAC) is another anthropometric measure that requires minimal equipment and little training. So far, MUAC cutoffs for undernutrition are well established in children < 5 years but there is still no consensus for a specific cutoff in adults. The objective of this study was to compare MUAC with BMI and suggest a MUAC cut-off corresponding to a BMI of 18.5 kg/m2 to identify underweight in adults. METHODS: A cross-sectional study was conducted at two urban public hospitals in Nepal. The following variables where collected: MUAC, weight, height, sex, age and self-reported medical history. EXCLUSION CRITERIA: < 19 years of age, pregnancy and oedema. Sensitivity and specificity for a MUAC value corresponding to BMI < 18.5 was calculated. ROC analysis was performed for male and female as well as Pearson's correlation of MUAC and BMI. RESULTS: A total of 302 people between 18 and 86 years of age, 197 women and 105 men, were included. Of these, 90 people suffered from rheumatic heart disease. MUAC was highly correlated with BMI in both women r = 0.889 and men r = 0.846. Best statistically derived MUAC cutoff corresponding to a BMI < 18.5 kg/m2 was 24.5 cm (Youdens Index = 0.75; sensitivity 92.86; specificity 82.48), with high predictive value (AUROCC> 0.9). The setting based optimal MUAC cutoff was also 24.5 cm. No considerable variation was found in sex- and disease specific subgroups. CONCLUSION: MUAC is strongly correlated with BMI in adults in Nepal. For simplicity, a MUAC of 24.5 cm is the optimal statistically and setting based cutoff in both women and men to identify underweight (BMI < 18.5 kg/m2).


Assuntos
Braço , Índice de Massa Corporal , Pesos e Medidas Corporais , Avaliação Nutricional , Estado Nutricional , Magreza/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antropometria/métodos , Peso Corporal , Estudos Transversais , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Nepal , Curva ROC , Valores de Referência , Sensibilidade e Especificidade , Adulto Jovem
4.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32620676

RESUMO

OBJECTIVES: To explore the hypothesis that obesity is associated with increased mortality and worse outcomes in children who are critically ill. METHODS: Secondary analysis of the Assessment of Worldwide Acute Kidney Injury, Renal Angina, and Epidemiology study, a prospective, multinational observational study. Patients between 3 months and 25 years across Asia, Australia, Europe, and North America were recruited for 3 consecutive months. Patients were divided into 4 groups (underweight, normal weight, overweight, and obese) on the basis of their BMI percentile for age and sex. RESULTS: A total of 3719 patients were evaluated, of whom 542 (14%) had a primary diagnosis of sepsis. One thousand fifty-nine patients (29%) were underweight, 1649 (44%) were normal weight, 423 (11%) were overweight, and 588 (16%) were obese. The 28-day mortality rate was 3.6% for the overall cohort and 9.1% for the sepsis subcohort and differed significantly by weight status (5.8%, 3.1%, 2.2%, and 1.8% for subjects with underweight, normal weight, overweight, and obesity, respectively, in the overall cohort [P < .001] and 15.4%, 6.6%, 3.6%, and 4.7% in the sepsis subcohort, respectively [P = .003]). In a fully adjusted model, 28-day mortality risk was 1.8-fold higher in the underweight group versus the normal weight group in the overall cohort and 2.9-fold higher in the sepsis subcohort. Patients who were overweight and obese did not demonstrate increased risk in their respective cohorts. Patients who were underweight had a longer ICU length of stay, increased need for mechanical ventilation support, and a higher frequency of fluid overload. CONCLUSIONS: Patients who are underweight make up a significant proportion of all patients in the PICU, have a higher short-term mortality rate, and have a more complicated ICU course.


Assuntos
Peso Corporal , Mortalidade Hospitalar , Adolescente , Índice de Massa Corporal , Doenças Cardiovasculares/mortalidade , Criança , Pré-Escolar , Comorbidade , Cuidados Críticos , Estado Terminal/mortalidade , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Sobrepeso/epidemiologia , Obesidade Pediátrica/epidemiologia , Respiração Artificial/estatística & dados numéricos , Insuficiência Respiratória/mortalidade , Insuficiência Respiratória/terapia , Fatores de Risco , Sepse/mortalidade , Magreza/epidemiologia , Desequilíbrio Hidroeletrolítico/epidemiologia
5.
Medicine (Baltimore) ; 99(22): e20398, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481430

RESUMO

Assessment the prevalence of hypertension and its relation to selected indicators of health status and performance, including classification of BMI, obesity classifications, and body structure in a large test group of 19-year-old men.The study was observational-retrospective, and included a group of 17,282 men, aged 19, from the Malopolska region. All subjects met the qualifications for compulsory military service in 2017. We analyzed selected data obtained from the records of the Ministry of National Defense-spiral-ZINT. Data collection and analysis were carried out from April 1, 2018 to August 31, 2018.Hypertension was found at 0.6%, weak body structure at 0.8% and obesityco-existing with cardiorespiratory insufficiency has been reported 2.6% of respondents and it was more frequent in the recruiters from HT II than I. The underweight concerned almost 7%, and the overweight and obesity of 1/4 of conscripts. The vast majority of people with hypertension were characterized by excessive body weight (74.8%), mainly overweight.Hypertension was seen in a negligible percentage of males studied and was significantly associated with an increase in BMI, particularly with regards to being overweight.


Assuntos
Indicadores Básicos de Saúde , Hipertensão/diagnóstico , Medicina Militar/normas , Índice de Massa Corporal , Humanos , Hipertensão/epidemiologia , Masculino , Medicina Militar/métodos , Medicina Militar/estatística & dados numéricos , Obesidade/diagnóstico , Obesidade/epidemiologia , Sobrepeso/diagnóstico , Sobrepeso/epidemiologia , Polônia/epidemiologia , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/epidemiologia , Estudos Retrospectivos , Magreza/diagnóstico , Magreza/epidemiologia , Adulto Jovem
6.
PLoS One ; 15(6): e0234570, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32569312

RESUMO

BACKGROUND: The National Family Health Surveys (NFHS) in India apply adult cutoffs of nutritional status for the estimation of undernutrition/overweight in the 15-19 age group. The prevalence of thinness in boys and girls thus estimated is 58.1% and 46.8% in NFHS-3, and 45% and 42% in NFHS-4 respectively. But the WHO recommends using age and sex-specific reference for adolescents. We reanalyzed the nutritional status of the adolescents using the WHO 2007 Growth Reference to obtain revised estimates of thinness, overweight and stunting across states, rural-urban residence, and wealth quintiles. METHODS AND FINDINGS: Demographic information, anthropometric data, and wealth index were accessed from the Demographic and Health Survey (DHS) database. We re-analyzed the anthropometric data using WHO AnthroPlus software which uses the WHO 2007 Growth reference. The revised estimates of thinness assessed by BMI-for-age z-scores in boys and girls was 22.3% (95%CI: 21.6, 23.0) and 9.9% (95%CI: 9.5, 10.3) in NFHS-3 and 16.5% (95%CI: 16.0,17.0) and 9% (95%CI: 8.9, 9.2) in NFHS-4 respectively. Stunting was found to be 32.2% (95% CI: 31.6, 32.9) in boys and 34.4% (95% CI: 34.2, 34.7) in girls in NFHS-4. This was higher than that in NFHS-3; 25.2% (95% CI: 24.4, 26) in boys and 31.2 (95% CI: 30.6, 31.8) in girls. There was a clear socioeconomic gradient as there were higher thinness and stunting in rural areas. There was wide variation among the states with pockets of a double burden of malnutrition. CONCLUSION: Using the adult cutoffs significantly overestimates thinness in adolescents in the age group of 15-19 years old in India. Stunting, which is an indicator of long term nutrition is also widely prevalent in them. Future editions of DHS and NFHS should consider adolescents as a separate age group for nutritional assessment for a better understanding of nutritional transition in the population.


Assuntos
Saúde da Família , Inquéritos Epidemiológicos , Estado Nutricional , Adolescente , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Humanos , Índia , Masculino , Sobrepeso/epidemiologia , Sobrepeso/etiologia , População Rural , Fatores Sexuais , Fatores Socioeconômicos , Magreza/epidemiologia , Magreza/etiologia , Organização Mundial da Saúde , Adulto Jovem
7.
PLoS One ; 15(5): e0233615, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32470055

RESUMO

BACKGROUND: Despite the high prevalence of childhood protein-energy malnutrition and vitamin A deficiency in sub-Saharan Africa, their association has not been explored in this region. A better understanding of the epidemiologic link could help define effective preventive strategies. We aimed to explore the association of vitamin A deficiency (VAD) with stunting, wasting, and underweight among preschool children in Uganda. METHOD: We analyzed a population-based, cross-sectional data of 4,765 children aged 6-59 months who participated in 2016 Demographic and Health Surveys conducted in Uganda. We utilized generalized linear mixed-effects models with logit link function, adjusting for potential confounders to estimate associations between VAD and stunting, wasting, and underweight. RESULTS: The prevalence of VAD was 8.9% (95% CI: 8.1% to 9.6%, n = 424). Twenty-seven percent were stunted (95% CI: 26.1% to 28.6, n = 1302), 4% wasted (95% CI: 3.6% to 4.7%, n = 196), and 17% underweight (95% CI: 16.0% to 18.2%, n = 813). After adjusting for household factors (e.g., wealth index, education and working status of parents, owning land for agriculture, livestock, herds, or farm animals), vitamin A supplementation, and community factors (e.g., population density, crop growing season lengths, place of residence), children with VAD had 43% higher odds of stunted growth than those without VAD (adjusted odds ratio, 1.43 (95% CI: 1.08 to 1.89, p = 0.01). No association was observed between VAD and wasting or underweight. CONCLUSION: Vitamin A deficiency was associated with higher odds of stunting, and the association was independent of the individual, household, and community-level variables.


Assuntos
Transtornos do Crescimento/complicações , Deficiência de Vitamina A/complicações , Pré-Escolar , Estudos Transversais , Transtornos do Crescimento/epidemiologia , Humanos , Lactente , Razão de Chances , Prevalência , Magreza/complicações , Magreza/epidemiologia , Uganda/epidemiologia , Deficiência de Vitamina A/epidemiologia , Síndrome de Emaciação/complicações , Síndrome de Emaciação/epidemiologia
8.
Lancet Child Adolesc Health ; 4(6): 455-464, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32450124

RESUMO

Several features and comorbidities in Down syndrome have nutritional implications and consequences. In infancy and early childhood, children with Down syndrome have a high risk of oral motor difficulties and pharyngeal dysphagia with aspiration, which both require systematic attention. To improve nutritional status in children who are underweight and who have clinical signs of feeding problems, further evaluation of underlying causes is required. Clinical interventions should promote swallowing safety and development of feeding abilities. Even from 4-5 years of age, overweight in children with Down syndrome can be a concern. To prevent disease later in life, an urgent need exists for more research on nutritional aspects in the prevention and treatment of obesity in adolescents with Down syndrome. This Review did not find any data to support the use of dietary supplementation, except when deficiency is documented. Additionally, the literature reported the need for more research that uses larger study samples and control groups and that addresses important nutritional challenges in children and adolescents with Down syndrome.


Assuntos
Síndrome de Down/diagnóstico , Síndrome de Down/epidemiologia , Estado Nutricional , Sobrepeso/epidemiologia , Magreza/epidemiologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Incidência , Lactente , Masculino , Necessidades Nutricionais , Obesidade/epidemiologia , Medição de Risco
9.
10.
PLoS One ; 15(5): e0232399, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32374790

RESUMO

Heart failure with a preserved ejection fraction (HFpEF) is associated with multiple comorbidities, such as old age, hypertension, type 2 diabetes and obesity and is more prevalent in females. Although the male obese ZSF1 rat has been proposed as a suitable model to study the development of diastolic dysfunction and early HFpEF, studies in female animals have not been performed yet. Therefore, we aimed to characterize the cardiac phenotype in female obese ZSF1 rats and their lean counterparts. Additionally, we aimed to investigate whether differences exist in disease progression in obese male and female ZSF1 rats. Therefore, male and female ZSF1 rats, lean as well as obese (N = 6-9/subgroup), were used. Every two weeks, from 12 to 26 weeks of age, systolic blood pressure and echocardiographic measurements were performed, and venous blood was sampled. Female obese ZSF1 rats, as compared to female lean ZSF1 rats, developed diastolic dysfunction with cardiac hypertrophy and fibrosis in the presence of severe dyslipidemia, increased plasma growth differentiation factor 15 and mild hypertension, and preservation of systolic function. Although obese female ZSF1 rats did not develop hyperglycemia, their diastolic dysfunction was as severe as in the obese males. Taken together, the results from the present study suggest that the female obese ZSF1 rat is a relevant animal model for HFpEF with multiple comorbidities, suitable for investigating novel therapeutic interventions.


Assuntos
Insuficiência Cardíaca/etiologia , Obesidade/complicações , Animais , Pressão Sanguínea/fisiologia , Colágeno/metabolismo , Diástole/fisiologia , Modelos Animais de Doenças , Ecocardiografia , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Masculino , Síndrome Metabólica/complicações , Miocárdio/metabolismo , Miocárdio/patologia , Ratos , Ratos Endogâmicos SHR , Ratos Zucker , Caracteres Sexuais , Volume Sistólico/fisiologia , Magreza/fisiopatologia , Remodelação Ventricular/fisiologia
11.
PLoS One ; 15(5): e0233060, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32437366

RESUMO

Previous studies conducted in Nepal have not identified the potential maternal risk for underweight among children under-five years of age in resource-poor settings. Therefore, to identify these risk factors for being underweight among children under-five years old, a community-based case-control study was conducted in a rural village in the Chitwan District in Nepal. Cases were defined as children who were diagnosed as underweight based on low weight per age, whereas controls were the children with normal weight for their age. Mothers of 93 cases and 186 controls were invited for an interview to collect the data. More than half of underweight children were female (51.6%) and nearly one third of them (31.2%) were aged 13-24 months. Nearly, 30% of the cases belonged to families in the lowest wealth quintile and 82% of cases were from food insecure families. Logistic regression analysis showed that children of mothers who were illiterate had 1.48 times the odds of being underweight compared to whose mothers were not illiterate (95% Confidence Interval [CI]: 1.53-3.07)). Children whose mother had not completed their postnatal care (PNC) were 3.16 more times likely to be underweight compared to children of mothers who completed PNC (95% CI: 1.24-8.03). The children who received care from other family members besides their mothers were 6.05 times more likely to be underweight (95% CI: 1.44-25.42); the children having mothers who had no income at all had 5.13 times the odds of being underweight (95% CI: 1.27-20.71) and children with diarrhea episodes within one month were 2.09 times more likely to be underweight (95% CI:1.02-4.31) compared to those children without any diarrhea episodes within one month. Women should be encouraged to take care of their children themselves, seek PNC services and take precautions to protect their children from diarrhea. Also, enabling factors such as education and improved income for women can help to reduce malnutrition among children.


Assuntos
Diarreia/epidemiologia , Cuidado Pós-Natal/estatística & dados numéricos , Magreza/epidemiologia , Estudos de Casos e Controles , Pré-Escolar , Diarreia/complicações , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Mães , Estado Nutricional , População Rural , Fatores Socioeconômicos
12.
Lancet Gastroenterol Hepatol ; 5(8): 739-752, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32413340

RESUMO

BACKGROUND: Although non-alcoholic fatty liver disease (NAFLD) is commonly associated with obesity, it is increasingly being identified in non-obese individuals. We aimed to characterise the prevalence, incidence, and long-term outcomes of non-obese or lean NAFLD at a global level. METHODS: For this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, and the Cochrane Library from inception to May 1, 2019, for relevant original research articles without any language restrictions. The literature search and data extraction were done independently by two investigators. Primary outcomes were the prevalence of non-obese or lean people within the NAFLD group and the prevalence of non-obese or lean NAFLD in the general, non-obese, and lean populations; the incidence of NAFLD among non-obese and lean populations; and long-term outcomes of non-obese people with NAFLD. We also aimed to characterise the demographic, clinical, and histological characteristics of individuals with non-obese NAFLD. FINDINGS: We identified 93 studies (n=10 576 383) from 24 countries or areas: 84 studies (n=10 530 308) were used for the prevalence analysis, five (n=9121) were used for the incidence analysis, and eight (n=36 954) were used for the outcomes analysis. Within the NAFLD population, 19·2% (95% CI 15·9-23·0) of people were lean and 40·8% (36·6-45·1) were non-obese. The prevalence of non-obese NAFLD in the general population varied from 25% or lower in some countries (eg, Malaysia and Pakistan) to higher than 50% in others (eg, Austria, Mexico, and Sweden). In the general population (comprising individuals with and without NAFLD), 12·1% (95% CI 9·3-15·6) of people had non-obese NAFLD and 5·1% (3·7-7·0) had lean NAFLD. The incidence of NAFLD in the non-obese population (without NAFLD at baseline) was 24·6 (95% CI 13·4-39·2) per 1000 person-years. Among people with non-obese or lean NALFD, 39·0% (95% CI 24·1-56·3) had non-alcoholic steatohepatitis, 29·2% (21·9-37·9) had significant fibrosis (stage ≥2), and 3·2% (1·5-5·7) had cirrhosis. Among the non-obese or lean NAFLD population, the incidence of all-cause mortality was 12·1 (95% CI 0·5-38·8) per 1000 person-years, that for liver-related mortality was 4·1 (1·9-7·1) per 1000 person-years, cardiovascular-related mortality was 4·0 (0·1-14·9) per 1000 person-years, new-onset diabetes was 12·6 (8·0-18·3) per 1000 person-years, new-onset cardiovascular disease was 18·7 (9·2-31·2) per 1000 person-years, and new-onset hypertension was 56·1 (38·5-77·0) per 1000 person-years. Most analyses were characterised by high heterogeneity. INTERPRETATION: Overall, around 40% of the global NAFLD population was classified as non-obese and almost a fifth was lean. Both non-obese and lean groups had substantial long-term liver and non-liver comorbidities. These findings suggest that obesity should not be the sole criterion for NAFLD screening. Moreover, clinical trials of treatments for NAFLD should include participants across all body-mass index ranges. FUNDING: None.


Assuntos
Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/mortalidade , Obesidade/complicações , Magreza/epidemiologia , Adulto , Índice de Massa Corporal , Doenças Cardiovasculares/epidemiologia , Estudos de Casos e Controles , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Fibrose/classificação , Fibrose/epidemiologia , Humanos , Hipertensão/epidemiologia , Incidência , Masculino , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/patologia , Avaliação de Resultados em Cuidados de Saúde , Prevalência
13.
Am J Trop Med Hyg ; 103(1): 515-519, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32431274

RESUMO

Adequate dietary intake is critically important for child growth and development. This study aimed to analyze the prevalence of undernutrition and its association with infant and child feeding index (ICFI). This cross-sectional study was conducted among children (younger than5 years) and their mothers from Lhaviyani Atoll, Maldives. The data were obtained by interviewing the children's mothers via pretested questionnaires. Infant and child feeding index scores were calculated from the dietary information. Weight-for-age z-scores (WAZ), length/height-for-age z-scores (LAZ/HAZ), and weight-for-length/height z-scores were calculated from anthropometric data taken according to the WHO criterion. Linear regression tests were used to find the association of nutritional status with ICFI scores. A total of 800 children and their mothers participated in this study. The prevalence of underweight, stunting, and wasting was 24.6%, 32.4%, and 16.3%, respectively. The mean ICFI scores (13.0) of children aged 6-8 months were better than those of children in other age-groups. In food groups, the intake of fish was higher among the respondents, whereas the consumption of vegetables and fruits was lower. Infant and child feeding index scores were significantly associated (P < 0.05) with WAZ and LAZ/HAZ after adjustment for confounders. Overall, the findings showed that Maldivian children consumed the limited number of food items that resulted in an inadequate intake of nutrients which further resulted in the high prevalence of malnutrition.


Assuntos
Dieta/estatística & dados numéricos , Transtornos do Crescimento/epidemiologia , Desnutrição/epidemiologia , Magreza/epidemiologia , Síndrome de Emaciação/epidemiologia , Alimentação Artificial/estatística & dados numéricos , Aleitamento Materno/estatística & dados numéricos , Pré-Escolar , Estudos Transversais , Laticínios , Carboidratos da Dieta , Ovos , Feminino , Frutas , Humanos , Ilhas do Oceano Índico/epidemiologia , Lactente , Modelos Lineares , Masculino , Carne , Proteínas de Vegetais Comestíveis , Alimentos Marinhos , Verduras
14.
BMC Public Health ; 20(1): 427, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32238152

RESUMO

BACKGROUND: Social inequalities in bodyweight start early in life and track into adulthood. Dietary patterns are an important determinant of weight development in children, towards both overweight and underweight. Therefore, we aimed to examine weight development between age 5 and 10 years by ethnicity, SES and thereafter by BMI category at age 5, to explore its association with dietary patterns at age 5. METHODS: Participants were 1765 children from the Amsterdam Born Children and their Development (ABCD) cohort that had valid data on BMI at age 5 and 10 and diet at age 5. Linear mixed model analysis was used to examine weight development between age 5 and 10 years and to assess if four previously identified dietary patterns at age 5 (snacking, full-fat, meat and healthy) were associated with weight development. Analyses were adjusted for relevant confounders, stratified by ethnicity and SES and thereafter stratified per BMI category at age 5. RESULTS: Overall, weight decreased in Dutch and high SES children and increased in non-Dutch and low/middle SES children. Across the range of bodyweight categories at age 5, we observed a conversion to normal weight, which was stronger in Dutch and high SES children but less pronounced in non-Dutch and low/middle SES children. Overall, the observed associations between weight development and dietary patterns were mixed with some unexpected findings: a healthy dietary pattern was positively associated with weight development in most groups, regardless of ethnicity and SES (e.g. Dutch B 0.084, 95% CI 0.038;0.130 and high SES B 0.096, 95% CI 0.047;0.143) whereas the full-fat pattern was negatively associated with weight development (e.g. Dutch B -0.069, 95% CI -0.114;-0.024 and high SES B -0.072, 95% CI -0.119;-0.026). CONCLUSIONS: We observed differential weight development per ethnic and SES group. Our results indicate that each ethnic and SES group follows its own path of weight development. Associations between dietary patterns and weight development showed some unexpected findings; follow-up research is needed to understand the association between dietary patterns and weight development.


Assuntos
Índice de Massa Corporal , Peso Corporal , Dieta , Comportamento Alimentar , Obesidade/etiologia , Classe Social , Magreza/etiologia , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Dieta Saudável , Gorduras na Dieta/administração & dosagem , Grupos Étnicos , Feminino , Humanos , Masculino , Países Baixos , Obesidade/etnologia , Sobrepeso/etnologia , Sobrepeso/etiologia , Fatores Socioeconômicos , Magreza/etnologia , Ganho de Peso , Perda de Peso
15.
Cochrane Database Syst Rev ; 4: CD013376, 2020 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-32270495

RESUMO

BACKGROUND: Aflatoxins are carcinogenic mycotoxins that contaminate many food crops. Maize and groundnuts are prone to aflatoxin contamination, and are the major sources of human exposure to aflatoxins, due to their high intake as staple foods, particularly in low- and middle-income countries (LMICs). Observational studies suggest an association between dietary exposure to aflatoxins during pregnancy and early childhood and linear growth in infants and young children. OBJECTIVES: To assess the effects on pre- and postnatal growth outcomes when agricultural and nutritional education interventions during the post-harvest period that aim to reduce aflatoxin exposure are compared to usual support or no intervention. We assessed this in infants, children, and pregnant and lactating women at the household or community level in LMICs. SEARCH METHODS: In July and August 2019, we searched: CENTRAL, MEDLINE, Embase, CINAHL, Web of Science Core Collection, Africa-Wide, LILACS, CAB Abstracts, Agricola, and two trials registers. We also checked the bibliographies of the included studies and contacted relevant mycotoxin organisations and researchers for additional studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and cluster-RCTs of agricultural education and nutritional education interventions of any duration, at the household or community level, aimed at reducing aflatoxin intake by infants, children, and pregnant and lactating women, in LMICs during the post-harvest period, compared to no intervention or usual support. We excluded studies that followed participants for less than four weeks. We assessed prespecified prenatal (at birth) and postnatal growth outcomes (during infancy, childhood, and adolescence), with linear growth (as the primary outcome), infectious disease morbidity, and unintended consequences. DATA COLLECTION AND ANALYSIS: Two authors independently assessed study eligibility using prespecified criteria, extracted data, and assessed risk of bias of included RCTs. We evaluated the certainty of the evidence using GRADE, and presented the main results in a 'Summary of findings' table. MAIN RESULTS: We included three recent cluster-RCTs reporting the effects of agricultural education plus post-harvest technologies, compared to usual agricultural support or no intervention. The participants were pregnant women and their children, lactating women and their infants (< 6 months), women of childbearing age, and young children (< 59 months), from rural, subsistence maize-farming communities in Kenya, Zimbabwe, and Tanzania. Two trials randomised villages to the intervention and control groups, including a total of at least 979 mother-child pairs from 60 villages. The third trial randomised 420 households, including 189 mother-child pairs and 231 women of childbearing age. Duration of the intervention and follow-up ranged between five and nine months. Due to risk of attrition bias, the overall risk of bias was unclear in one trial, and high in the other two trials. None of the included studies addressed the effects of nutritional education on pre- and postnatal growth. One trial reported outcomes not prespecified in our review, and we were unable to obtain unpublished growth data from the second trial, even after contacting the authors. The third trial, in lactating women and their infants in Tanzania, reported on the infants' weight-for-age z-score (WAZ) after six months. This trial found that providing agricultural education aimed at changing farmers' post-harvest practices to reduce aflatoxin exposure, by using demonstrations (e.g. handsorting, de-hulling of maize, drying sheets, and insecticides), may improve WAZ in infants from these farmers' households, on average, by 0.57 (95% confidence interval (CI) 0.16 to 0.98; 1 study; 249 participants; very low-certainty evidence), compared to infants from households where the farmers received routine agricultural extension services. Another way of reporting the effect on WAZ is to compare the proportion of underweight infants (WAZ > 2 SD below the reference median value) per group. This trial found that the intervention may reduce the proportion of underweight infants in the intervention households by 6.7% (95% CI -12.6 to -1.4; 249 participants; very low-certainty evidence) compared to control households. No studies reported on unintended effects of agricultural and nutritional education. AUTHORS' CONCLUSIONS: Evidence on the effects on child growth in LMICs of agricultural or nutritional education interventions that reduce aflatoxin exposure was very limited; no included study reported on linear growth. Very low-certainty evidence suggested that agricultural education aimed at changing farmers' post-harvest practices to reduce aflatoxin exposure by using demonstrations, may result in an increase in WAZ, when compared to usual or no education.


Assuntos
Aflatoxinas/envenenamento , Agricultura/educação , Países em Desenvolvimento , Contaminação de Alimentos/prevenção & controle , Crescimento , Adulto , Agricultura/métodos , Aleitamento Materno , Pré-Escolar , Feminino , Humanos , Lactente , Quênia , Gravidez , Efeitos Tardios da Exposição Pré-Natal/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Tanzânia , Magreza/prevenção & controle , Zimbábue
16.
Wei Sheng Yan Jiu ; 49(1): 51-55, 2020 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-32290914

RESUMO

OBJECTIVE: To examine the prevalence and associated factors of underweight among the elderly in Qionglai City. METHODS: A total of 14 929 residents aged ≥60 years recruited through multistage stratified cluster random sampling in 24 towns or streets of Qionglai City were surveyed from August to October 2018, including 7581 males and 7348 females; 8121 aged 60-69, 5176 aged 70-79, and 1632 aged ≥ 80. Questionnaires and physical examinations were conducted to collect the characteristics, behaviors, healthy history of the subjects, height, and weight, etc. The judgment of underweight was based on the criteria of weight for adults(WS/T 428-2013). The prevalence of underweight was calculated and its determinants were analyzed with a non-conditional logistic regression model. RESULTS: The prevalence of underweight among the elderly was 5. 7%(851/14929), 5. 4% for male(413/7581) and 6. 0% for female(438/7348). The result of logistic regression analysis revealed that female(OR=1. 365, 95%CI 1. 147-1. 624), aged elderly ≥ 70 years(70-79 years: OR=1. 652, 95%CI 1. 402-1. 948; ≥80 years: OR=2. 557, 95%CI 2. 079-3. 145), no spouse(OR=1. 196, 95%CI 1. 008-1. 420), former and current smokers(current smokers: OR=1. 247, 95%CI 1. 018-1. 528; former smokers: OR=1. 536, 95%CI 1. 036-2. 276), daily physical activities less than 6000 steps(OR=1. 259, 95%CI 1. 083-1. 462), those who didn't receive medical diagnosis of hypertension(OR=1. 591, 95%CI 1. 321-1. 915) presented a high prevalence of being underweight. CONCLUSION: The prevalence of underweight is at a low level among the elderly in Qionglai City. Gender, age, marital status, smoking, daily physical activities, hypertension were associated with being underweight.


Assuntos
Magreza/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , China , Cidades , Exercício Físico , Feminino , Humanos , Hipertensão , Masculino , Estado Civil , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Sexuais , Fumar
17.
PLoS One ; 15(4): e0231479, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32275697

RESUMO

BACKGROUND: India is expected to experience an increase in the frequency and intensity of extreme weather events in the coming decades, which poses serious risks to human health and wellbeing in the country. OBJECTIVE: This paper aims to shed light on the possible detrimental effects of monsoon weather shocks on childhood undernutrition in India using the Demographic and Health Survey 2015-16, in combination with geo-referenced climate data. METHODS: Undernutrition is captured through measures of height-for-age, weight-for-height, stunting and wasting among children aged 0-59 months. The standardised precipitation and evapotranspiration index (SPEI) is used to measure climatic conditions during critical periods of child development. RESULTS: The results of a multivariate logistic regression model show that climate anomalies experienced in utero and during infancy are associated with an increased risk of child undernutrition; exposure to excessive monsoon precipitation during these early periods of life elevates the risk of stunting, particularly for children in the tropical wet and humid sub-tropical regions. In contrast, the risk of stunting is reduced for children residing in the mountainous areas who have experienced excessive monsoon precipitation during infancy. The evidence on the short-term effects of climate shocks on wasting is inconclusive. We additionally show that excessive precipitation, particularly during the monsoon season, is associated with an increased risk of contracting diarrhoea among children under five. Diseases transmitted through water, such as diarrhoea, could be one important channel through which excessive rainfall increases the risk of stunting. CONCLUSIONS: We find a positive association between childhood undernutrition and exposure to excessive monsoon precipitation in India. Pronounced differences across climate zones are found. The findings of the present analysis warn of the urgent need to provide health assistance to children in flood-prone areas.


Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Transtornos da Nutrição Infantil/etiologia , Peso Corporal/fisiologia , Pré-Escolar , Feminino , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Estações do Ano , Magreza/epidemiologia , Magreza/etiologia , Tempo (Meteorologia)
18.
Metabolism ; 107: 154229, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32289345

RESUMO

Chronic energy deficiency can impair the hypothalamic-pituitary-gonadal (HPG) axis and lead to hypothalamic anovulation in underweight women. This review presents the syndromes related to underweight status that are associated with infertility, summarizes the underlying mechanisms, and reviews the available treatment options. Eating disorders, such as anorexia nervosa (AN), constitute the most common cause of infertility in underweight women, who, in addition, experience miscarriages, and sexual dysfunction. The relative energy deficiency in sports (RED-S; former terminology: athlete's triad) involves menstrual dysfunction due to low energy availability, which results in anovulation. Moreover, lipodystrophies, malnutrition, starvation, systematic illnesses (malignancies, endocrinopathies, infectious diseases, advanced chronic diseases, neurologic illnesses), and the utilization of drugs can cause excessive weight loss. They may result in fertility problems due to the loss of adipose tissue and the subsequent hormonal disturbances. Each of these conditions requires multidisciplinary management. Nutritional counseling should target the restoration of energy balance by increasing intake and reducing output. Medical treatment, recommended only for patients who did not respond to standard treatment, may include antipsychotics, antidepressants, or leptin administration. Finally, psychiatric treatment is considered an integral part of the standard treatment.


Assuntos
Infertilidade Feminina/etiologia , Infertilidade Masculina/etiologia , Reprodução , Magreza/complicações , Anorexia Nervosa , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/fisiopatologia , Feminino , Humanos , Infertilidade Feminina/epidemiologia , Infertilidade Masculina/epidemiologia , Masculino , Magreza/epidemiologia , Magreza/fisiopatologia
19.
Indian J Gastroenterol ; 39(1): 75-83, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32314167

RESUMO

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is associated with obesity, which is known to be associated with metabolic syndrome (MS). However, the risk factors for NAFLD in absence of obesity (leanness) is not well-studied. This study aimed to investigate and compare the clinical characteristics, metabolic associations, and cardiovascular risk factors among patients having NAFLD with (body mass index [BMI] ≥ 23 kg/m2) or without obesity (BMI < 23 kg/m2). METHODS: The cross-sectional study was conducted among the outdoor and indoor patients diagnosed as NAFLD by ultrasonography in a tertiary care teaching hospital in eastern India. Relevant anthropometric measurements, laboratory investigations, and imaging were performed. Metabolic syndrome was classified by the "International Diabetes Federation, 2005" criteria. RESULTS: Among 120 NAFLD patients, 37 (30.8%) were lean, while 83 (69.2%) were obese. The components of MS such as systolic blood pressure (lean, 138.0 ± 17.6 mmHg; obese, 137.9 ± 15.3 mmHg), diastolic blood pressure (lean, 88.9 ± 6.5 mmHg; obese, 87.3 ± 6.1 mmHg), fasting blood sugar (lean, 127.8 ± 30.8 mg/dL; obese, 135.1 ± 29.5 mg/dL), and serum triglyceride (lean, 170.5 ± 34.2 mg/dL; obese, 186.4 ± 43.8 mg/dL) were comparable among patients with obese and lean NAFLD and were more often abnormal among both the groups of NAFLD as compared with controls. CONCLUSION: The overall prevalence of MS among NAFLD study population was 64.2%. Lean NAFLD was also associated with the component of MS like obese NAFLD.


Assuntos
Síndrome Metabólica , Hepatopatia Gordurosa não Alcoólica , Obesidade , Magreza , Estudos Transversais , Humanos , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Obesidade/epidemiologia , Prevalência , Fatores de Risco , Magreza/epidemiologia
20.
Int J Paediatr Dent ; 30(5): 607-618, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32115793

RESUMO

BACKGROUND: The possible association between obesity, underweight, and dental caries remains in debate. In addition, the role of sugar consumption on the abovementioned relationship was little explored. AIM: This study aimed to investigate the relationship between nutritional status and dental caries in 12-year-old low-income children. DESIGN: This cross-sectional school-based study involved 406 12-year-old children living with limited economic resources. Dental caries was assessed using the decayed component of DMFT and PUFA/pufa index. Children were weighed and measured to assess nutritional status according to z-score/body mass index. Data on socio-economic and demographic characteristics, sugar consumption, sedentary behaviour, and psychosocial factors were collected through validated questionnaires. Multivariable multilevel Poisson regression was performed. RESULTS: Underweight children had 60% (RR = 1.60; 95% CI 1.13-2.57) higher mean of decayed teeth and had mean PUFA/pufa 2.8 times higher than children with normal nutritional status. Underweight children with high annual sugar intake had a greater mean of decayed teeth (RR = 2.72; 95% CI 1.46-5.06) than underweight children with low sugar intake. CONCLUSIONS: Our findings suggest that malnutrition is associated with dental caries among children from low-income families.


Assuntos
Cárie Dentária , Estado Nutricional , Criança , Estudos Transversais , Índice CPO , Humanos , Análise Multinível , Prevalência , Magreza
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