Evidence for impaired insulin production and higher sensitivity in stunted children living in slums.

The objective of the present study was to investigate the changes in glucose and insulin metabolism in nutritionally stunted children that can be involved in the appearance of chronic diseases in adulthood. For this purpose, sixty-one children were selected, thirty-five boys and twenty-six girls, residents of slums in São Paulo, Brazil. The children were classified according to the height-for-age as stunted (-1.5 Z-score; n 40). The glucose and insulin plasma levels were determined and, from these values, the indexes that evaluate the pancreatic beta-cell function (homeostasis model assessment (HOMA-B)) and insulin sensitivity (HOMA-S) were assessed. Stunted children showed lower values of fasting insulin than those of the non-stunted group (boys: 29.7 (SD 14.9) v. 50.4 (SD 29.2) pmol/l, P=0.019; girls: 34.4 (SD 12.6) v. 62.3 (SD 28.7) pmol/l, P=0.016) but the glucose levels were similar (boys: 4.6 (SD 0.3) v. 4.5 (SD 0.3) mmol/l; girls: 4.2 (SD 0.3) v. 4.4 (SD 0.3) mmol/l). Stunted children showed lower HOMA-B values (boys: 83 (SD 22) % v. 115 (SD 36) %, P=0.011; girls: 107 (SD 23) % v. 144 (SD 46) %, P=0.045) and higher HOMA-S values (boys: 196 (SD 92) % v. 120 (SD 62) %, P=0.014; girls: 159 (SD 67) % v. 98 (SD 57) %, P=0.016). The results show a decreased activity of beta-cell function and increased insulin sensitivity in stunted children. The decreased beta-cell function of this group may strongly predict type 2 diabetes.

Lower resting metabolic rate and higher velocity of weight gain in a prospective study of stunted vs nonstunted girls living in the shantytowns of São Paulo, Brazil.

OBJECTIVE: Previous studies have shown that stunting increases the risk of obesity in developing countries, particularly among girls and women, but the underlying reasons are not known. This study aimed to investigate the relationship between stunting, weight gain, and resting metabolic rate. DESIGN AND SUBJECTS: A prospective study was conducted over 36 months with girls from shantytowns in São Paulo, Brazil. A total of 15 stunted girls (S) were compared with 15 nonstunted (N) ones of similar weight for height ratio. INTERVENTIONS: Resting metabolic rate was measured using indirect calorimetry, and the socioeconomic status was determined by interviews in the household. In addition, body composition was measured by skinfold thickness, while the growth rate was calculated dividing the change in weight and the change in height by the follow-up period. RESULTS: The results of the present study, when combined, revealed that the S group had a lower resting metabolic rate throughout the follow-up period with the differences being significant at 24 and 36 months of follow-up, associated with an increase in the rate of weight gain and a decrease in lean mass, when compared to the N group. CONCLUSIONS: These changes are known to be risk factors for obesity and may help to explain the particularly higher prevalence of obesity in women in urban areas of developing countries.

Stunted children gain less lean body mass and more fat mass than their non-stunted counterparts: a prospective study.

The aim of the present study was to analyse the changes in body composition of stunted children during a follow-up period and to test the hypothesis of a tendency to accumulate body fat as a consequence of undernutrition early in life. We selected fifty boys and girls aged 11 to 15, who were residents of slums in Sao Paulo, Brazil. Twenty were stunted (S) and thirty had normal stature (NS). The children's nutritional status and body composition were assessed through anthropometry and dual-energy X-ray absorptiometry, at the beginning of the present study and after 3 years, and changes in lean mass (LM and LM%) and fat mass (FM and FM%) were calculated. Stunted boys accumulated more body fat (FM%: S=1.62%, NS=-3.40%; P=0.003) and gained less lean mass (LM%: S=-1.46, NS=3.21%; P=0.004). Stunted girls gained less lean mass (S=7.87 kg, NS=11.96 kg; P=0.032) and had significantly higher values of FM% at follow-up when compared with their baseline values (P=0.008), whereas non-stunted girls had a non-significant difference in FM% over time (P=0.386). These findings are important to understand the factors involved in the increased prevalence of overweight and obesity among poor populations, which appear to be associated with hunger during infancy and/or childhood.

Short stature, obesity and arterial hypertension in a very low income population in North-eastern Brazil.

BACKGROUND AND AIM: This cross-sectional study involved the adult population (age >18 and <60 years) of a 315-shack slum on the outskirts of the city of Maceió in North-eastern Brazil. The purpose was to investigate whether short stature in adults (an indicator of undernutrition in early life) is associated with arterial hypertension and obesity. METHODS AND RESULTS: We collected the subjects socio-economic data, and arterial hypertension (AH), weight, height, waist circumference and waist/hip (W/H) circumference ratio measurements. Hypertension was diagnosed as diastolic AH f 90 mmHg and/or systolic AH f 140 mmHg. The body mass index (BMI) was used to determine nutritional status, with overweight/obesity being defined on the basis of a cut-off point of 25 kg/m2. A W/H ratio of f 0.80 for women or f 0.95 for men was considered indicative of abdominal obesity. Short stature was defined as falling into the 1st quartile (Q) of height distribution. Hypertension was prevalent in 28.5% of the population (women=38.5%; men=18.4%). The systolic and diastolic AH readings were significantly higher in women in the 1st Q than in those in the 4th Q, and the same was true of W/H. The prevalence of hypertension was statistically significant for the first two Q's in comparison with the last two: 22.1% vs 14.6% (men), and 42.4% vs 34.6% (women). Hypertension was more prevalent in women who were obese and short (50%) than in those who were obese but not short (OR=1.98; CI=1.22-2.96). CONCLUSIONS: Living conditions were extremely precarious and the prevalence of hypertension was quite high. Stature negatively correlated with hypertension and overweight in women but not in men.

Food consumed does not account for the higher prevalence of obesity among stunted adults in a very-low-income population in the Northeast of Brazil (Maceió, Alagoas).

OBJECTIVE: To study the food pattern of stunted and nonstunted, obese and nonobese individuals in a very-low-income population. DESIGN: A household survey. SETTING: Slum set up by the 'Homeless Movement', city of Maceió (Alagoas), Brazil. SUBJECTS AND METHODS: A total of 532 adults classified by sex, stature (Z -2s.d. of the NCHS curves), and body mass index (BMI) were compared using the following variables: waist circumference, waist-hip circumference ratio (W/H), percentage body fat (skinfold thickness and bioelectrical impedance), and food intake (24-h recall). RESULTS: The prevalence of stunting was 22.6%. In all, 30% of the stunted subjects were overweight or obese, compared with 23% for the nonstunted individuals (P<0.05). In women, logistic regression analysis showed a strong association among weight, abdominal fat, and stunting (r=0.81). No significant differences were observed in the values of W/H or in the qualitative menu of the different categories. Energy intake was below the RDA figures (about 63%). There was similarity among the groups regarding the proportion of macronutrients, except for the fact that stunted obese women ingested less fat and protein than nonstunted obese women. Stunted obese individuals consumed less energy (5962 kJ) than the population as a whole (6213 kJ), an amount far lower than their average needs, which were calculated on the basis of their shorter stature (8109 kJ). CONCLUSION: The observed energy consumption seems compatible with the panorama of undernutrition present in the population, but it does not explain the high prevalence of obesity detected.

Obesity and undernutrition in a very-low-income population in the city of Maceió, northeastern Brazil.

Obesity is the nutritional disorder which has shown the greatest increase in prevalence, even in those countries in which deficiency diseases represent a severe public health problem. The goal of the present study was to analyse the anthropometric profile of a community living in the outskirts of Maceió, capital of Alagoas (northeastern Brazil), and to investigate the hypothesis of a coexistence of undernutrition and obesity in a very low-income population. The survey was conducted on 315 families (1247 individuals). Among the children (aged < or =10 years), the prevalence of wasting, stunting and wasting plus stunting was 3.8, 8.3 and 8.7 % respectively. Wasting (10.2 %) was the most prevalent form of undernutrition among adolescents; nonetheless, a higher frequency of stunting (11 %) and overweight-obesity (5.5 %) was seen specifically in girls, in agreement with trends found in other studies. Adults exhibited a high prevalence of overweight-obesity (25 %), but stunting was also present (22 %). Of the stunted individuals, 30 % were overweight-obese and 16.3 % were underweight. There were eighty-six families with at least one parent who was underweight (27 %) and 104 families with at least one parent who was overweight (33 %). Underweight and overweight-obesity were both present in ninety-six households (30 %). These results may indicate that better living conditions in urban areas in a population 'adapted' to chronic famine might increase the susceptibility to obesity. Considering the harm caused by the cumulative effect of these two conditions (undernutrition in childhood and obesity in adult life) there is a clear need for new studies to uncover the determinant factors so that preventive measures can be implemented.

Meal palatability, substrate oxidation and blood glucose in young and older men.

We investigated the effects of food palatability on the thermic effect of feeding (TEF), substrate oxidation and circulating glucose and insulin. Healthy young men (23.4+/-1.0, SD, years, n=10) and older men (69.4+/-1.3, years, n=9) were resident in a metabolic unit for two 2-day study periods. On the second day of each period, they consumed in random order either a palatable test meal containing 2.93 MJ or a nonpalatable control meal containing the same foods in identical amounts but blended and freeze-dried into biscuit form. TEF and respiratory quotient (RQ) were measured over 6 h and blood samples were taken for measurement of glucose and insulin. Age group had no effect on TEF, RQ or circulating glucose other than to delay the time of peak TEF (P<0.002 for both meals). There was no significant effect of meal type on TEF, but RQ and circulating glucose were higher following consumption of the palatable meal (P<0.001 for both parameters). These results suggest that over 6 h postprandial, consumption of palatable foods does not increase TEF, but is instead associated with increased glycemic response and increased carbohydrate oxidation. These changes, combined with previous work on the glycemic index, predict an accelerated return of hunger and increased energy intake at subsequent meals following consumption of palatable vs. control foods. Further studies are needed to examine the possible mechanism for this previously suggested "second meal" effect of diet palatability on energy intake.

Respostas metabólicas e cardiorrespiratórias ao exercício máximo e submáximo em meninas eutróficas e com desnutriçäo pregressa / Metabolic and cardiovascular responses to maximal and submaximal exercise in eutrophic and stunted girls

OBJETIVO: verificar se a desnutriçäo pregressa, além de causar déficit na estatura de meninas também poderia estar causando uma limitaçäo funcional à capacidade de realizaçäo de exercício máximo e submáximo em bicicleta ergométrica. CASUÖSTICA: 24 meninas, 12 eutróficas de idade (média + or - DP) 9,13 + or - 0,79 anos; peso 27,64 + or - 3,64 kg; e altura 131,31 + or - 6,04 cm; e 12 com desnutriçäo pregressa; idade 9,75 + or - 1,10 anos; peso 25,16 + or - 2,33 kg; e altura 125,06 + or - 3,90 cm. METODOLOGIA: Avaliaçäo clínica e teste ergoespirométrico em bicicleta ergométrica, a partir do qual foram obtidas as variáveis metabólicas e cardiorrespiratórias analisadas. Protocolo de teste: 2 minutos iniciais a 25 watts, seguidos de incrementos de 15 watts a cada 2 minutos, até a exaustäo. RESULTADOS: Testes de esforço máximo: näo foram observadas diferenças entre o grupo de meninas eutróficas (E) e o grupo de meninas com desnutriçäo pregressa (D) para nenhuma das variáveis analisadas: VO2max l/min., VO2max ml/min/kg, VEmax , R, FCmax, por centoFCmax prev e Watts max. Teste de esforço submáximo: foram observadas diferenças entre os grupos para as seguintes variáveis: VO2 l/min LA, por cento VO2max , FC LA, por cento FCmax LA, VE LA, por cento VEmax LA. Näo foram encontradas diferenças entre os grupos para: VO2 ml/min/kg LA e Watts LA. CONCLUSAO: O restabelecimento da relaçäo peso para estatura em meninas com desnutriçäo pregressa, considerado como critério de eutrofia, é válido também para indicar ausência de limitaçäo funcional da capacidade de realizaçäo de exercício

Energy expenditure of stunted and nonstunted boys and girls living in the shantytowns of São Paulo, Brazil.

BACKGROUND: Stunting increases the risk of obesity in developing countries, particularly in girls and women, but the underlying reason is not known. OBJECTIVE: Our objective was to test the hypothesis that stunted children have lower energy expenditure than do nonstunted children, a factor that has predicted an increased risk of obesity in other high-risk populations. DESIGN: A cross-sectional study was conducted in shantytown children from São Paulo, Brazil. Twenty-eight stunted children aged 8-11 y were compared with 30 nonstunted children with similar weight-for-height. Free-living total energy expenditure (TEE) was measured over 7 d by using the doubly labeled water method. In addition, resting energy expenditure (REE) was measured by indirect calorimetry and body composition was measured by dual-energy X-ray absorptiometry. RESULTS: There were no significant associations between stunting and any measured energy expenditure parameter, including REE adjusted for weight (f1.gif" BORDER="0"> +/- SEM: 4575 +/- 95 compared with 4742 +/- 91 kJ/d, in stunted and nonstunted children, respectively) and TEE adjusted for weight (8424 +/- 239 compared with 8009 +/- 221 kJ/d, in stunted and nonstunted children, respectively). In multiple regression models that included fat-free mass and fat mass, girls had significantly lower TEE than did boys (P: < 0.05) but not significantly lower REE (P: = 0.17). CONCLUSIONS: There was no association between stunting and energy expenditure after differences between groups in body size and composition were accounted for. However, the girls had lower TEE than did boys, which may help to explain the particularly high risk of obesity in stunted adolescent girls and women in urban areas of developing countries.

Why are nutritionally stunted children at increased risk of obesity? Studies of metabolic rate and fat oxidation in shantytown children from São Paulo, Brazil.

BACKGROUND: Previous research suggested that nutritionally stunted children may have increased risk of obesity, but little is known about potential underlying mechanisms. OBJECTIVE: We sought to test the hypothesis that stunted children have a low metabolic rate and impaired fat oxidation relative to nonstunted children. DESIGN: The subjects were 58 prepubertal boys and girls aged 8-11 y from the shantytowns of São Paulo, Brazil. Twenty-eight were stunted (height-for-age z score <-1.5) and 30 had similar weight-for-height but normal height (height-for-age z score >-1.5). Parents of children in the 2 groups had equivalent height and body mass index values. Fasting and postprandial energy expenditure, respiratory quotient (RQ), and substrate oxidation were measured with indirect calorimetry in a 3-d resident study in which all food was provided and body composition was measured with dual-energy X-ray absorptiometry. RESULTS: Stunted children had normal resting energy expenditure relative to body composition compared with control children (4559 +/- 90 and 4755 +/- 86 kJ/d, respectively; P: = 0.14) and had normal postprandial thermogenesis (2.4 +/- 0.3% and 2.0 +/- 0.3% of meal load, respectively; P: = 0.42). However, fasting RQ was significantly higher in the stunted group (0.92 +/- 0.009 compared with 0.89 +/- 0.007; P: = 0.04) and consequently, fasting fat oxidation was significantly lower (25 +/- 2% compared with 34 +/- 2% of energy expenditure; P: < 0.01). CONCLUSIONS: Childhood nutritional stunting is associated with impaired fat oxidation, a factor that predicted obesity in other at-risk populations. This finding may help explain recent increases in body fatness and the prevalence of obesity among stunted adults and adolescents in developing countries.

Regulation of energy intake may be impaired in nutritionally stunted children from the shantytowns of São Paulo, Brazil.

We tested the hypothesis that nutritionally stunted children have impaired regulation of energy intake (EI), a factor that could help explain the increased risk of obesity associated with stunting in developing countries. A 3-d residency study was conducted in 56 prepubertal boys and girls aged 8-11 y from the shantytowns of Sao Paulo, Brazil. Twenty-seven of the subjects were stunted and 29 were not stunted; weight-for-height Z-scores were not significantly different between the groups. Parents of the two groups had equivalent heights and body mass indices. Measurements were made of voluntary EI from a self-selection menu, resting energy expenditure (REE) and body composition. In addition, a 753-kJ yogurt supplement was administered at breakfast on one study day (with an equal number of children receiving the supplement on each of the 3 study days) and its effect on daily EI assessed. There was no change in EI over time in either group (P: = 0.957), and no significant difference in EI between stunted and nonstunted children, even though the stunted children weighed 10% less. Energy intake per kilogram body weight was significantly higher in the stunted children (278 +/- 89 (SD), vs. 333 +/- 67 kJ/kg, P: < 0.05) and EI/REE was also significantly higher (1.91 +/- 0.34 vs. 1.68 +/- 0.38, P: < 0.05). However, the relationship between EI and body weight was not significantly influenced by stunting (P: = 0.12). There was no significant effect of the breakfast supplement on daily EI in either group although the absolute difference in EI between supplement and control days was greater in stunted than in nonstunted children (DeltaEI: +460 +/- 1574 vs. -103 +/- 1916 kJ/d, P: = 0.25). These data provide preliminary evidence consistent with the suggestion that stunted children tend to overeat opportunistically, but further studies are required to confirm these results in a larger study.

[Influence of socioeconomic conditions in the nutritional changes and at rest metabolic rate in school children living in shantytowns of the city of São Paulo, Brazil]. / Influência das condições socioeconômicas nas alterações nutricionais e na taxa de metabolismo de repouso em crianças escolares moradoras em favelas no município de São Paulo.

PURPOSE: A cross-sectional study was carried out to characterize the alterations in the resting metabolic rate (RMR), and socioeconomic conditions of 15 stunted (DP= height/age < 95% and 110% (3) weight/height >90%) and 15 nonstunted (EU= height/age > 95% and 110% (3) weight/height >90%) school girls living in shantytowns of São Paulo. METHODS: Resting metabolic rate was measured using indirect calorimetry. Socioeconomic data was collected during home visits by administration of a questionnaire. RESULTS: The mildly stunted group had a higher RMR when expressed as Kcal/kg body weight (EU= 40,5 Kcal/kg/day; DP=44,4 Kcal/kg/day; p<0.05) and lean body mass (EU= 49, 2 Kcal/kg/day; DP=52,5 Kcal/kg/day; p<0.05). Stunting was associated with maternal illiteracy (EU= 13,3%; DP=57,1%; p<0.05), income per capita (EU=US$107,14; DP=US$54,40; p< 0.05), number of parasites per child (EU=0; DP=1; p<0.05), birth order (EU=2; DP=4; p< 0.05), and number of siblings (EU=4; DP=6; p<0.01). Stunting was best predicted by income per capita and maternal illiteracy by using multiple logistic regression. CONCLUSIONS: Although the two groups had normal weight/height, the group with mild stunting showed socioeconomic and metabolic alterations, typical of a malnourished condition.

Influência das condições socioeconômicas nas alterações nutricionais e na taxa de metabolismo de repouso em crianças escolares moradoras em favelas no município de São Paulo / Influence of socioeconomic conditions in the nutritional changes and rest metabolic rate in school children living in shantytowns of the city of São Paulo, Brazil

OBJETIVOS: Realizou-se um estudo transversal para avaliar a taxa de metabolismo de repouso (TMR) e condições socioeconômicas em 15 crianças escolares do sexo feminino; eutróficas (EU= estatura/idade > ou = 95 por cento e peso/idade entre 90-110por cento) e 15 com desnutrição pregressa (DP= estatura/idade < 95 por cento e peso/estatura entre 90-110 por cento) moradoras em favelas no município de São Paulo. MÉTODOS: Avaliou-se a TMR por calorimetria indireta, e a situação socioeconômica por entrevista domiciliar. RESULTADOS: O grupo DP apresentou TMR mais alta quando expressa por unidade de peso corpóreo (EU= 40,5 Kcal/kg/dia; DP=44,4 Kcal/kg/dia, p<0,05) e por quilograma de massa magra (EU= 49,2 Kcal/kg/dia; DP=52,5 Kcal/kg/dia, p<0,05); e diferenças significantes para renda per capita, analfabetismo materno, número de parasitas por criança, número de ordem entre os filhos e número de irmãos. Em análise multivariada as variáveis associadas à desnutrição foram renda per capita e analfabetismo materno. CONCLUSÕES: Embora os dois grupos tenham peso/estatura normais, a presença de baixa estatura leve foi acompanhada por alterações metabólicas e socioeconômicas típicas de um quadro de desnutrição.

[Metabolic and cardiorespiratory responses to maximal and submaximal exercise in eutrophic and stunted girls]. / Respostas metabólicas e cardiorrespiratórias ao exercício máximo e submáximo em meninas eutróficas e com desnutrição pregressa.

OBJECTIVE: The metabolic and cardiovascular responses of eutrophic girls and girls who underwent early undernutrition, were examined during physical exercise, in order to verify whether previous undernutrition could, in addition to cause a deficit in the children's height, and limit their functional capability to perform a maximal and submaximal exercise in an ergometric bicycle. SUBJECTS: Our sample was composed of 24 girls, of which 12 were eutrophic, with 9.13 +/- 0.79 years (mean +/- s.d.), 27.64 +/- 3.64 kg of body weight, and 131.31 +/- 6.04 cm in height. The 12 early undernourished girls were 9.75 +/- 1.1 years old, 25.16 +/- 2.33 kg, and 125.06 +/- 3.9 cm high. MEASUREMENTS: The method included clinical evaluation and ergo-spirometric test on an ergometric bicycle, from which all the metabolic and cardiac-respiratory variables were obtained and analyzed. The test protocol was an initial two minutes period with 25 watts, followed by increments of 15 watts every two minutes, until exhaustion. RESULTS: Analysis of the results of the test of maximal effort did not reveal significant differences between eutrophic (E) and early undernourished (UN) girls in any of the variables: VO2max expressed in l/min (E = 1.11 +/- 0.25; UN = 1.02 +/- 0.19); VO2max expressed in ml/min/kg (E = 40.23 +/- 6.98; UN = 40.53 +/- 6.32), VEmax (E = 40.61 +/- 8.79; UN = 38.25 +/- 8.95), R (E = 1.13 +/- 0.07; UN = 1.13 +/- 0.05), HRmax (E = 195.33 +/- 9.13; UN = 193.85 +/- 11.18), previous % HRmax (E = 92.87 +/- 4.33; UN = 92.80 +/- 4.87), and maximum watts (E = 90.00 +/- 20.56; UN = 91.25 +/- 11.33). Analysis of the results obtained in test of submaximal effort, reflected by the intensity of effort in the anaerobic threshold (AT), showed differences between the groups in the following variables: VO2max expressed in l/min. (E = 0.77 +/- 0.14; UN = 0.62 +/- 0.13), % of VO2max (E = 70.07 +/- 7.52; UN = 61.21 +/- 9.83), HR (E = 166.58 +/- 14.25; UN = 146.33 +/- 17.40), % HRmax (E = 85.31 +/-6.41; UN = 75.50 +/- 7.73), VE (E = 24.18 +/- 5.81; UN = 17.69 +/- 4.30), % VEmax (E = 59.64 +/- 8.45; UN = 46.95 +/- 10.59). No differences were found for VO2max, expressed in l/min/kg (E = 28.06 +/- 4.87; UN = 24.81 +/- 5.31) and watts (E = 51.25 +/- 17.47; UN = 45.00 +/- 9.77). CONCLUSION: The reestablishment of the ratio weight/height in early undernourished girls is also useful to indicate lack of limitation of functional capability to perform physical exercises.

Equations for predicting the energy requirements of healthy adults aged 18-81 y.

BACKGROUND: Recent studies have questioned the accuracy of using the current recommended dietary allowances (RDAs) to predict usual energy requirements in adults. OBJECTIVE: We developed equations to predict adult energy requirements from simple anthropometric and laboratory measures by using the doubly labeled water method to determine each subject's total energy expenditure (TEE), which is equal to usual energy requirements in weight-stable individuals. DESIGN: This was a cross-sectional study conducted with 93 healthy, free-living adults [44 men and 49 women; body mass index range (in kg/m2): 18.4-31.8] aged 18-81 y. Body fat and fat-free mass were measured by underwater weighing, physical activity was estimated by using activity monitors, and resting energy expenditure was determined by indirect calorimetry. Information on anthropometric variables and reported strenuous activity was also collected. RESULTS: Three regression equations were developed and verified for accuracy by using bootstrap analysis and doubly labeled water data published by other research groups. The first equation used information on only age, weight, height, and sex and had an SEE for prediction of TEE of 1.80 MJ/d. The second and third equations used different combinations of basic and laboratory data and had SEEs of 1.55 and 1.65 MJ/d, respectively. With use of the same analytic approaches, the RDAs for energy were shown to significantly underestimate usual energy needs by approximately 10%; the extent of underestimation was significantly greater for subjects with high TEEs than for subjects with low TEEs. CONCLUSION: Regression equations based on doubly labeled water measurements of TEE appear to be more accurate than the current RDAs for predicting energy requirements in healthy, nonobese adults living in affluent countries.

[Evaluation of nutritional recovery pattern of malnourished children examined at the center of Recovery and Educational Nutrition, Brazil]. / Avaliação do padrão de recuperação nutricional de crianças desnutridas atendidas no centro de recuperação e educação nutricional.

PURPOSE: To assess the pattern of nutritional recovery in malnourished children. This prospective analysis was conducted between September 1995 and November 1996 at the Center for Recovery and Nutrition Education (CREN) in São Paulo, Brazil. Of the thirty-eight children studied, 47.4% were infants (nine girls and nine boys) and 52.6% preschool children (twelve boys and eight girls). METHOD: Thirty eight children were studied by velocity of W/A and H/A gain in standard deviation or Z score, according to weight and height median of NCHS. RESULTS: There was a statistically significant increase in the weight-for-age (W/A)(p = 0.012), height-for-age (H/A) (p = 0.001) from the time of admission. The difference in the velocity of W/A gain between infants (0.299-Z/year) and preschool children (0.684-Z/year) with more than six months of treatment, was found to be statistically significant (p = 0.038). The difference in the velocity of H/A gain for infants (0.794-Z/year) and for preschool children (0.506-Z/year), was not statistically significant (p = 0.166). In regards to gender, there was not a statistically significant difference between boys and girls in the velocity of W/A gain (0.540 and 0.524-Z/year, respectively). The difference in velocity of H/A gain was statistically significant, 0.485-Z/year for boys and 0.856-Z/year for girls (p = 0.043). CONCLUSION: These findings show that there are differences in the nutritional recovery patterns between gender and age groups.

Avaliaçäo do padräo de recuperaçäo nutricional de crianças desnutridas atendidas no centro de recuperaçäo e educaçäo nutricional / Pattern evaluation of nutritional recovery in malnourished children attended in center of nutritional educational and recuperation

Estudo de acompanhamento do padrao de recuperaçao nutricional de crianças desnutridas atendidas no Centro de Recuperaçao e Educaçao Nutricional (CREN), entre setembro de 1995 e novembro de 1996. Objetivo. Avaliar a recuperaçao nutricional das crianças em termos de velocidade de ganho anul de peso/idade e estatura/idade e identificar variaçoes do precesso de recuperaçao de acordo com o sexo e a idade. Métodos. Foram estudadas 38 crianças, utilizando-se os valores do incremento de peso/idade e estatura/idade em unidades de desvio padrao ou escore Z, em relaçao à mediana de peso e estatura do padrao NCHS, pelo método da velocidade de crescimento por incremento. Resultados. Houve uma relaçao significante entre ganhos de peso/idade (P=0,012) e estatura/idade (P=0,001) e tempo de internaçao. Os pré-escolares tiveram uma velocidade de ganho de peso-idade significantemente maior (0,684 escores Z/ano) que os lactentes (0,299 escores Z/ano), excluídas as crianças com menos de seis meses de internaçao. Em relaçao à velocidade de ganho de estatura-idade, os lactentes apresentaram um ganho maior (0,794 escores Z/ano) em relaçao aos pré-escolares (0,506 escores Z/ano), embora a diferença nao tenha sido estatisticamente significante. Entre os sexos, a velocidade de ganho de peso/idade foi 0,540 e 0,524 escores Z/ano para meninos e meninas, respectivamente. Quanto à velocidade de ganho de estatura/idade as meninas apresentaram um ganho significantemente maior (0,856 escores Z/ano) que os meninos (0,485 escores Z/ano). Conclusao; O presente trabalho evidenciou que existem diferenças no padrao de velocidade de recuperaçao nutricional de acordo com a idade e sexo.

Use of food quotients in human doubly labeled water studies: comparable results obtained with 4 widely used food intake methods.

Information on the macronutrient composition of the diet is needed in doubly labeled water studies to convert measured rates of carbon dioxide production into values for total energy expenditure. There is no general consensus, however, about the best method to determine food intake for this purpose. Four common methods of measuring food intake (7-day weighed food intake, 24-hour recall, and Fred Hutchinson Cancer Research Center/Block and Willett food frequency questionnaires) were tested for their ability to provide comparable food quotient and total energy expenditure data in doubly labeled water studies in 10 young and 10 older women. All methods gave mean values for total energy expenditure that were within 1% of each other. Individual values obtained using the 24-hour recall and food frequency questionnaires were within +/- 3% (standard deviation) of values determined using data from the 7-day weighed food record. These results suggest that it is not necessary to use time-consuming and expensive 7-day food records in doubly labeled water studies; instead, food intake data obtained more easily by 24-hour recall or food frequency questionnaire can provide comparable data.

Increase in skeletal muscle protein content by the beta-2 selective adrenergic agonist clenbuterol exacerbates hypoalbuminemia in rats fed a low-protein diet.

This investigation examined how the nutritional status of rats fed a low-protein diet was affected when the animals were treated with the beta-2 selective agonist clenbuterol (CL). Males (4 weeks old) from an inbred, specific-pathogen-free strain of hooded rats maintained at the Dunn Nutritional Laboratory were used in the experiments (N = 6 rats per group). CL treatment (Ventipulmin, Boehringer-Ingelheim Ltd., 3.2 mg/kg diet for 2 weeks) caused an exacerbation of the symptoms associated with protein deficiency in rats. Plasma albumin concentrations, already low in rats fed a low-protein diet (group A), were further reduced in CL rats (A = 25.05 +/- 0.31 vs CL = 23.64 +/- 0.30 g/l, P < 0.05). Total liver protein decreased below the level seen in either pair-fed animals (group P) or animals with free access to the low-protein diet (A = 736.56 +/- 26 vs CL = 535.41 +/- 54 mg, P < 0.05), whereas gastrocnemius muscle protein was higher than the values normally described for control (C) animals (C = 210.88 +/- 3.2 vs CL = 227.14 +/- 1.7 mg/g, P < 0.05). Clenbuterol-treated rats also showed a reduction in growth when compared to P rats (P = 3.2 +/- 1.1 vs CL = -10.2 +/- 1.9 g, P < 0.05). This was associated with a marked decrease in fat stores (P = 5.35 +/- 0.81 vs CL = 2.02 +/- 0.16 g, P < 0.05). Brown adipose tissue (BAT) cytochrome oxidase activity, although slightly lower than in P rats (P = 469.96 +/- 16.20 vs CL = 414.48 +/- 11.32 U/BAT x kg body weight, P < 0.05), was still much higher than in control rats (C = 159.55 +/- 11.54 vs CL = 414.48 +/- 11.32 U/BAT x kg body weight, P < 0.05). The present findings support the hypothesis that an increased muscle protein content due to clenbuterol stimulation worsened amino acid availability to the liver and further reduced albumin synthesis causing exacerbation of hypoalbuminemia in rats fed a low-protein diet.