Body shape and size in 6-year old children: assessment by three-dimensional photonic scanning.

BACKGROUND: Body shape and size are typically described using measures such as body mass index (BMI) and waist circumference, which predict disease risks in adults. However, this approach may underestimate the true variability in childhood body shape and size. OBJECTIVE: To use a comprehensive three-dimensional photonic scan approach to describe variation in childhood body shape and size. SUBJECTS/METHODS: At age 6 years, 3350 children from the population-based 2004 Pelotas birth cohort study were assessed by three-dimensional photonic scanner, traditional anthropometry and dual X-ray absorptiometry. Principal component analysis (PCA) was performed on height and 24 photonic scan variables (circumferences, lengths/widths, volumes and surface areas). RESULTS: PCA identified four independent components of children's body shape and size, which we termed: Corpulence, Central:peripheral ratio, Height and arm lengths, and Shoulder diameter. Corpulence showed strong correlations with traditional anthropometric and body composition measures (r>0.90 with weight, BMI, waist circumference and fat mass; r>0.70 with height, lean mass and bone mass); in contrast, the other three components showed weak or moderate correlations with those measures (all r<0.45). There was no sex difference in Corpulence, but boys had higher Central:peripheral ratio, Height and arm lengths and Shoulder diameter values than girls. Furthermore, children with low birth weight had lower Corpulence and Height and arm lengths but higher Central:peripheral ratio and Shoulder diameter than other children. Children from high socio-economic position (SEP) families had higher Corpulence and Height and arm lengths than other children. Finally, white children had higher Corpulence and Central:peripheral ratio than mixed or black children. CONCLUSIONS: Comprehensive assessment by three-dimensional photonic scanning identified components of childhood body shape and size not captured by traditional anthropometry or body composition measures. Differences in these novel components by sex, birth weight, SEP and skin colour may indicate their potential relevance to disease risks.

Maternal depression and anxiety predicts the pattern of offspring symptoms during their transition to adulthood.

BACKGROUND: Episodes of depression and anxiety (D&A) during the transition from late adolescence to adulthood, particularly when persistent, are predictive of long-term disorders and associated public health burden. Understanding risk factors at this time is important to guide intervention. The current objective was to investigate the associations between maternal symptoms of D&A with offspring symptoms during their transition to adulthood. METHOD: Data from a large population-based birth cohort study, in South Brazil, were used. Prospective associations between maternal D&A and offspring risk of these symptoms during the transition to adulthood (18/19, 24 and 30 years) were estimated. RESULTS: Maternal D&A in adolescence was associated with offspring symptoms across the transition to adulthood, associations were consistently stronger for females than for males. Daughters whose mothers reported D&A were 4.6 times (95% confidence interval 2.71-7.84) as likely to report D&A at all three time-points, than daughters of symptom-free mothers. CONCLUSIONS: Maternal D&A is associated with persistent D&A during the daughter's transition to adulthood. Intervention strategies should consider the mother's mental health.

Associations of birth weight, linear growth and relative weight gain throughout life with abdominal fat depots in adulthood: the 1982 Pelotas (Brazil) birth cohort study.

BACKGROUND: Several studies have reported on associations of size at birth and early growth with general and central obesity; however, few have examined the potential effects of birth weight and postnatal growth on separate abdominal fat compartments. We investigated the effects of size at birth, linear growth and relative weight gain from birth to adulthood on visceral (VFT) and subcutaneous abdominal (SAFT) fat thicknesses at age 30 years. METHODS: A total of 2663 participants from the 1982 Pelotas (Brazil) birth cohort study had complete information on ultrasound measures of abdominal fat at age 30 years, and anthropometric measurements for at least five visits (0/2/4/23/30 years). We estimated weight and height Z-score changes, conditional relative weight gain and conditional height at several ages. RESULTS: In both men and women, VFT and SAFT showed positive associations with conditional relative weight gain during all age periods beyond 2 years and birth, respectively (all P⩽0.01). Women born with intrauterine growth restriction (IUGR) had greater VFT than other women (difference=0.15 s.d., 95% CI: 0.01-0.29), and they showed a stronger positive influence of infant weight gain 0-2 years on VFT (IUGR: ß=0.17 s.d., 95% CI: 0.05-0.29; non-IUGR: ß=0.01 s.d., 95% CI: -0.04 to 0.06; Pinteraction=0.02). Stunting at 2 years was associated with lower SAFT but not VFT, and it modified the influence of weight gain 2-4 years on SAFT in both sexes (both Pinteraction<0.05). CONCLUSIONS: Our findings reinforce the advantages of being born with an appropriate birth weight, and the hazards of rapid postnatal gains in weight relative to linear growth, particularly after the critical window of the first 1000 days.

The association of birth order with later body mass index and blood pressure: a comparison between prospective cohort studies from the United Kingdom and Brazil.

BACKGROUND: Previous studies have found greater adiposity and cardiovascular risk in first born children. The causality of this association is not clear. Examining the association in diverse populations may lead to improved insight. METHODS: We examine the association between birth order and body mass index (BMI), systolic and diastolic blood pressure (SBP/DBP) in the 2004 Pelotas cohort from southern Brazil and the Avon Longitudinal Study of Parents and Children (ALSPAC) from Bristol, south-west England, restricting analysis to families with two children in order to remove confounding by family size. RESULTS: No consistent differences in BMI, SBP or DBP were observed comparing first and second born children. Within the Pelotas 2004 cohort, first born females were thinner, with lower SBP and DBP; for example, mean difference in SBP comparing first with second born was -0.979 (95% confidence interval -2.901 to 0.943). In ALSPAC, first born females had higher BMI, SBP and DBP. In both cohorts, associations tended to be in the opposite direction in males, although no statistical evidence for gender interactions was found. CONCLUSIONS: The findings do not support an association between birth order and BMI or blood pressure. Differences to previous studies may be explained by differences in populations and/or confounding by family size in previous studies.

Size at birth and abdominal adiposity in adults: a systematic review and meta-analysis.

We performed a systematic literature review on the associations between birth size and abdominal adiposity in adults, while also investigating the role of the adjustment for adult body mass index (BMI). MEDLINE, Scopus, Web of Science, LILACS and SciELO databases were searched for articles published up to February 2013. Only prospective studies were included. After screening 2,570 titles, we selected 31 publications for the narrative synthesis, of which 13 were considered to be of high methodological quality. Six main indicators of birth size were identified, and birth weight (BW) was the most extensively studied. Most studies relied on anthropometric measurements as proxies for abdominal fatness or as indicators of body fat distribution. Few studies assessed abdominal adiposity through imaging methods, generally with small sample sizes. Eleven articles could be included in the meta-analyses. BW was found to be positively associated with waist circumference in adulthood, but the association disappeared after adjustment for adult BMI. In contrast, there was no association between BW and waist-to-hip ratio, whereas a strong negative association became evident after controlling for adult BMI. In conclusion, BW seems to be associated with larger adult size in general, including both waist and hip circumferences. The marked change in coefficients after adjustment for adult BMI suggests that post-natal growth strongly affects relative central adiposity, whereas BW per se does not play a role. Given the potential impact of post-natal growth, further research is needed to identify different growth trajectories that lead to abdominal adiposity, as well as studies on interactions of foetal and post-natal growth patterns.

Association of socioeconomic position with maternal pregnancy and infant health outcomes in birth cohort studies from Brazil and the UK.

BACKGROUND: Socioeconomic inequalities in health outcomes are dynamic and vary over time. Differences between countries can provide useful insights into the causes of health inequalities. The study aims to compare the associations between two measures of socioeconomic position (SEP)-maternal education and family income-and maternal and infant health outcomes between ALSPAC and Pelotas cohorts. METHODS: Birth cohort studies were started in Avon, UK, in 1991 (ALSPAC) and in the city of Pelotas, Brazil, in 1982, 1993 and 2004. Maternal outcomes included smoking during pregnancy, caesarean section and delivery not attended by a doctor. Infant outcomes were preterm birth, intra-uterine growth restriction (IUGR) and breast feeding for <3 months. The relative index of inequality was used for each measure of SEP so that results were comparable between cohorts. RESULTS: An inverse association (higher prevalence among the poorest and less educated) was observed for almost all outcomes, with the exception of caesarean sections where a positive association was found. Stronger income-related inequalities for smoking and education-related inequalities for breast feeding were found in the ALSPAC study. However, greater inequalities in caesarean section and education-related inequalities in preterm birth were observed in the Pelotas cohorts. CONCLUSIONS: Mothers and infants have more adverse health outcomes if they are from poorer and less well-educated socioeconomic backgrounds in both Brazil and the UK. However, our findings demonstrate the dynamic nature of the association between SEP and health outcomes. Examining differential socioeconomic patterning of maternal and infant health outcomes might help understanding of mechanisms underlying such inequalities.

Socio-economic and ethnic group inequities in antenatal care quality in the public and private sector in Brazil.

BACKGROUND: Socio-economic inequalities in maternal and child health are ubiquitous, but limited information is available on how much the quality of care varies according to wealth or ethnicity in low- and middle-income countries. Also, little information exists on quality differences between public and private providers. METHODS: Quality of care for women giving birth in 2004 in Pelotas, Brazil, was assessed by measuring how many of 11 procedures recommended by the Ministry of Health were performed. Information on family income, self-assessed skin colour, parity and type of provider were collected. RESULTS: Antenatal care was used by 98% of the 4244 women studied (mean number of visits 8.3), but the number of consultations was higher among better-off and white women, who were also more likely to start antenatal care in the first trimester. The quality of antenatal care score ranged from 0 to 11, with an overall mean of 8.3 (SD 1.7). Mean scores were 8.9 (SD 1.5) in the wealthiest and 7.9 (SD 1.8) in the poorest quintiles (P < 0.001), 8.4 (SD 1.6) in white and 8.1 (SD 1.9) in black women (P < 0.001). Adjusted analyses showed that these differences seemed to be due to attendance patterns rather than discrimination. Mean quality scores were higher in the private 9.3 (SD 1.3) than in the public sector 8.1 (SD 1.6) (P < 0.001); these differences were not explained by maternal characteristics or by attendance patterns. CONCLUSIONS: Special efforts must be made to improve quality of care in the public sector. Poor and black women should be actively encouraged to start antenatal care early in pregnancy so that they can fully benefit from it. There is a need for regular monitoring of antenatal attendances and quality of care with an equity lens, in order to assess how different social groups are benefiting from progress in health care.

Growth from birth to adulthood and abdominal obesity in a Brazilian birth cohort.

BACKGROUND: Rapid weight gain in childhood may increase the risk of chronic adult diseases. Few studies have examined the effects of lifecourse weight gain on waist circumference (WC), hip circumference (HC), or waist-to-hip ratio (WHR). OBJECTIVE: To evaluate the effects of birthweight and weight gain from birth to age 23 years on WC, HC, and WHR in young adults. DESIGN: Population-based birth cohort study started in 1982. A sample of 856 individuals was examined in 2006. Conditional growth analyses were carried out with adjustment for confounders. WC and HC were also mutually adjusted. RESULTS: Weight gains during all age ranges studied (birthweight, 0-2, 2-4, 4-15, 15-18/19, and 18/19-23 years) were positively associated with WC and HC in both sexes. These effects were strongest from 4 to 15 years range (beta = 5.0 cm for both circumferences). Proxies for visceral adipose tissue (WHR and WC adjusted for HC) were associated with weight gain after 2 years in females and after 4 years in males. Subcutaneous adipose and muscular tissues, assessed by HC adjusted for WC, were associated with birthweight and weight gain from 0 to 2 years in both sexes, and again with weight gains from 4 to 18 years in males and 4 to 15 years in females. CONCLUSIONS: Weight gains in utero and in the first 2 years had long-term effects on HC, but weight gain after age 4 years was strongly associated with WC. Weight gains up to age 2 years may reduce cardiovascular risk associated with adult fat patterns in a middle-income setting.

The role of early life variables on the risk of fractures from birth to early adolescence: a prospective birth cohort study.

UNLABELLED: In a prospective cohort from Brazil, we evaluated the incidence of fractures from birth to early adolescence and examined risk factors for fractures. The incidence was 14.2% (95%CI 13.2, 15.2). Male sex, birth length, and maternal age at delivery were positively associated with the risk of fractures. INTRODUCTION: This study aims to evaluate the incidence of fractures from birth to 11 years of age and to explore the effect of early life variables on the risk of fractures. METHODS: All children (N = 5,249) born in 1993 in the city of Pelotas, Brazil were enrolled in a prospective birth cohort study. In 2004-2005, 87.5% of the cohort members were sought for a follow-up visit. History of fractures, including anatomic site and age of the fracture were asked to mothers. RESULTS: The incidence of fractures from birth to 11 years of age was 14.2% (95%CI 13.2, 15.2). Out of the 628 subjects who experienced a fracture, 91 reported two and only 20 reported three or more fractures. Male sex, birth length, and maternal age at delivery were positively associated with the risk of fractures. No consistent associations were found for family income, maternal body mass index, smoking during pregnancy, and birth weight. CONCLUSIONS: Birth length seems to have long-term effect on musculoskeletal health. The higher risk of fractures among children of older mothers needs to be confirmed by other studies. In accordance to the developmental origins of diseases, fractures seem to be, at least in part, programmed in early life.

Effect of birth size and proportionality on BMI and skinfold thickness in early adolescence: prospective birth cohort study.

OBJECTIVES: To assess the effect of birth weight, length and ponderal index at birth on body mass index (BMI) and skinfold thickness in early adolescence. SUBJECTS/METHODS: Population-based, prospective birth cohort study in Pelotas, Brazil. Out of 5249 cohort members, 87.5% were traced at 11 years of age. Birth weight, length and ponderal index (birth weight/birth length(3) x 100) -- treated as continuous variable and divided into fourths -- were the exposure variables. BMI at 11 years, triceps and subscapular skinfolds were the outcomes. Confounders included sex, gestational age, parity, maternal schooling, family income, maternal smoking during pregnancy and maternal BMI. RESULTS: All three exposure variables were significantly associated with BMI in early adolescence, but the strongest effect was observed for birth weight. Each unit (Z-score) increase in birth weight was associated with 0.46 kg m(-2) increase in BMI at 11 years. The equivalent coefficients for ponderal index and birth length were 0.22 and 0.21 kg m(-2), respectively. High birth weight, length and ponderal index were also associated with increased values for triceps and subscapular skinfolds at 11 years, and with increased prevalence of obesity. CONCLUSIONS: Of the three birth exposures studied, birth weight presented the strongest effect on anthropometry in early adolescence. Ponderal index, a proportionality indicator associated with infant mortality, hospitalizations and anthropometry in infancy, was also associated with anthropometry in early adolescence, but its predictive value for the latter is lower than that of birthweight alone. All three birth size indicators studied presented poor predictability of the later risk of obesity.

Epidemiology of early and late growth in height, leg and trunk length: findings from a birth cohort of Brazilian males.

BACKGROUND/OBJECTIVE: To investigate socioeconomic, gestational and early life exposures as potential determinants of total height, leg and trunk length. SUBJECTS/METHODS: Male subjects from the 1982 Pelotas Birth Cohort Study were examined in 1986 at home, and in 2000 when registering at the local army base. The follow-up rate was 79%. Standing and sitting heights were measured on both occasions. Leg length was calculated as the difference between standing and sitting heights. Outcome measures were height, leg and trunk length at 4 and 18 years and growth in this period. Complete data were obtained for 2012 participants, representing 71% of all eligible male subjects. RESULTS: Mean (s.d.) height, trunk length and leg length at 18 years were 173.4 (6.8), 96.0 (3.5) and 77.5 cm (4.5), respectively. The mean (s.d.) change in height from 1986 to 2000 was 75.4 cm (5.2) and for leg and trunk length 35.4 (3.9) and 40.0 cm (2.9), respectively. Of 11 independent variables analyzed, only maternal height and birthweight were associated with all three variables of growth. Gestational age showed no associations with growth or attained size. CONCLUSIONS: Early growth plays a pivotal role in determining attained height and its components. Both biological and socioeconomic variables strongly influence determinants of height, though socioeconomic factors appear to be more important in early growth. Leg and trunk length contribute almost equally to differences in overall height, regardless of the independent variable influencing the difference. Public health strategies designed to improve chronic disease profiles should focus on the early growth period.

Weight catch-up and achieved schooling at 18 years of age in Brazilian males.

OBJECTIVE: To assess the relationship between weight catch-up in infancy and achieved schooling at 18 years of age in Brazilian males. SUBJECTS: All newborn infants in the city's hospitals were enrolled in 1982; 78.8% (2250) of all male participants were located at age 18 years when enrolling in the national army. RESULTS: According to the Brazilian school calendar, 18-year-olds should be attending the 11th grade, but school failure was very common and 78.5% of all subjects had failed at least once. The average achieved schooling was 7.7 years (s.d.=2.3). After controlling for possible confounding variables, birthweight was positively associated with achieved schooling. With respect to postnatal growth, weight gain in the first 20 months was associated with increased schooling. Among SGA infants who caught-up in weight, achieved schooling was 1.3 higher. Data from a cross-sectional survey in the same population suggest that such a difference corresponds to a 25% difference in adult income levels. CONCLUSION: The study showed that early weight catch-up is associated with achieved schooling. The beneficial effects of early weight gain should be balanced against its potential harms.

Correlates of C-reactive protein levels in young adults: a population-based cohort study of 3827 subjects in Brazil.

The socio-demographic, behavioral and anthropometric correlates of C-reactive protein levels were examined in a representative young adult Brazilian population. The 1982 Pelotas Birth Cohort Study (Brazil) recruited over 99% of births in the city of Pelotas that year (N = 5914). Individuals belonging to the cohort have been prospectively followed up. In 2004-2005, 77.4% of the cohort was traced, members were interviewed and 3827 individuals donated blood. Analyses of the outcome were based on a conceptual model that differentiated confounders from potential mediators. The following independent variables were studied in relation to levels of C-reactive protein in sex-stratified analyses: skin color, age, family income, education, parity, body mass index, waist circumference, smoking, fat/fiber/alcohol intake, physical activity, and minor psychiatric disorder. Geometric mean (95% confidence interval) C-reactive protein levels for the 1919 males and 1908 females were 0.89 (0.84-0.94) and 1.96 mg/L (1.85-2.09), respectively. Pregnant women and those using oral contraceptive therapies presented the highest C-reactive protein levels and all sub-groups of women had higher levels than men (P < 0.001). Significant associations between C-reactive protein levels were observed with age, socioeconomic indicators, obesity status, smoking, fat and alcohol intake, and minor psychiatric disorder. Associations were stronger at higher levels of C-reactive protein and some associations were sex-specific. We conclude that both distal (socio-demographic) and proximal (anthropometric and behavioral) factors exert strong effects on C-reactive protein levels and that the former are mediated to some degree by the latter.

Correlates of C-reactive protein levels in young adults: a population-based cohort study of 3827 subjects in Brazil

The socio-demographic, behavioral and anthropometric correlates of C-reactive protein levels were examined in a representative young adult Brazilian population. The 1982 Pelotas Birth Cohort Study (Brazil) recruited over 99 percent of births in the city of Pelotas that year (N = 5914). Individuals belonging to the cohort have been prospectively followed up. In 2004-2005, 77.4 percent of the cohort was traced, members were interviewed and 3827 individuals donated blood. Analyses of the outcome were based on a conceptual model that differentiated confounders from potential mediators. The following independent variables were studied in relation to levels of C-reactive protein in sex-stratified analyses: skin color, age, family income, education, parity, body mass index, waist circumference, smoking, fat/fiber/alcohol intake, physical activity, and minor psychiatric disorder. Geometric mean (95 percent confidence interval) C-reactive protein levels for the 1919 males and 1908 females were 0.89 (0.84-0.94) and 1.96 mg/L (1.85-2.09), respectively. Pregnant women and those using oral contraceptive therapies presented the highest C-reactive protein levels and all sub-groups of women had higher levels than men (P < 0.001). Significant associations between C-reactive protein levels were observed with age, socioeconomic indicators, obesity status, smoking, fat and alcohol intake, and minor psychiatric disorder. Associations were stronger at higher levels of C-reactive protein and some associations were sex-specific. We conclude that both distal (socio-demographic) and proximal (anthropometric and behavioral) factors exert strong effects on C-reactive protein levels and that the former are mediated to some degree by the latter.

Sleep patterns and television viewing in relation to obesity and blood pressure: evidence from an adolescent Brazilian birth cohort.

BACKGROUND: Disruption of circadian rhythms has been associated with obesity in children and adolescents, and with hypertension in adults, in industrialized populations. OBJECTIVE: We examined cross-sectional associations between sleep duration or television viewing and obesity and blood pressure in Brazilian adolescents. DESIGN: The sample consisted of 4452 adolescents aged 10-12 years participating in a prospective birth cohort study in Pelotas, Brazil. Sleep duration and television viewing were determined through questionnaires. Obesity was assessed using international cut-offs for body mass index (BMI), and body fatness by skinfold thicknesses. Blood pressure was measured using a validated monitor. RESULTS: Short sleep duration was associated with increased BMI, skinfolds, systolic blood pressure, activity levels and television viewing. Each hour of sleep reduced BMI by 0.16 kg/m(2) (s.e. 0.04), and was associated with odds ratio for obesity of 0.86 (s.e. 0.04), both P<0.001. Television viewing was associated with increased BMI and skinfolds, and increased blood pressure. The effects of sleep duration and television viewing on obesity were independent of one another. Their associations with blood pressure were mediated by body fatness. CONCLUSIONS: Both short sleep duration and increased television viewing were associated with greater body fatness, obesity and higher blood pressure, independently of physical activity level. These associations were independent of maternal BMI, identified in other studies as the strongest predictor of childhood obesity. Our study shows that behavioural factors associated with metabolic risk in industrialized populations exert similar deleterious effects in a population undergoing nutritional transition and suggest options for public health interventions.

Tuberculosis and airflow obstruction: evidence from the PLATINO study in Latin America.

The aim of the present study was to evaluate the association between history of tuberculosis and airflow obstruction. A population-based, multicentre study was carried out and included 5,571 subjects aged > or =40 yrs living in one of five Latin American metropolitan areas: Sao Paulo (Brazil); Montevideo (Uruguay); Mexico City (Mexico); Santiago (Chile); and Caracas (Venezuela). Subjects performed pre- and post-bronchodilator spirometry and were asked whether they had ever been diagnosed with tuberculosis by a physician. The overall prevalence of airflow obstruction (forced expiratory volume in one second/forced vital capacity post-bronchodilator <0.7) was 30.7% among those with a history of tuberculosis, compared with 13.9% among those without a history. Males with a medical history of tuberculosis were 4.1 times more likely to present airflow obstruction than those without such a diagnosis. This remained unchanged after adjustment for confounding by age, sex, schooling, ethnicity, smoking, exposure to dust and smoke, respiratory morbidity in childhood and current morbidity. Among females, the unadjusted and adjusted odds ratios were 2.3 and 1.7, respectively. In conclusion, history of tuberculosis is associated with airflow obstruction in Latin American middle-aged and older adults.

Hb A1c in relation to intrauterine growth among male adolescents in southern Brazil.

The fetal origins hypothesis states that nutritional deprivation in utero affects fetal development and contributes to the incidence of diseases associated with the metabolic syndrome in later life. This study investigated whether haemoglobin (Hb) A(1c), an indicator of blood glucose, varied among healthy male adolescents according to their fetal growth rate, in a middle-income setting. Participants were men aged 18 years, belonging to the 1982 Pelotas birth cohort. Complete data, including gestational age and Hb A(1c) at age 18 years, were available for 197 individuals. There was an inverse association between mean Hb A(1c) and birthweight for the gestational age, but not birthweight alone. The association remained significant after adjustment for family income and mother's education, as well as for body mass index at 18 years (P for trend=0.01 and 0.03, respectively).

Are health interventions implemented where they are most needed? District uptake of the integrated management of childhood illness strategy in Brazil, Peru and the United Republic of Tanzania.

OBJECTIVE: To describe geographical patterns of implementation of the Integrated Management of Childhood Illness (IMCI) strategy in three countries and to assess whether the strategy was implemented in areas with the most pressing child health needs. METHODS: We conducted interviews with key informants at the national and district levels in Brazil, Peru and the United Republic of Tanzania, and an ecological study of factors associated with health worker training in IMCI. Explanatory factors included district population, distance from the capital, human development index, other socioeconomic indicators and baseline mortality rates in children younger than five years. FINDINGS: In line with recommendations by WHO, early implementation districts were characterized by proximity to the capital and suitable training sites, presence of motivated health managers and a functioning health system. In the expansion phase, IMCI tended to be adopted by other districts with similar characteristics. In Brazil, uptake by poor and small municipalities and those further away from the state capital was significantly lower. In Peru, there was no association with distance from Lima, and a non-significant trend for IMCI adoption by small and poor departments. In the United Republic of Tanzania, the only statistically significant finding was a lower uptake by remote districts. Implementation was not associated with baseline mortality levels in any country studied. CONCLUSION: Whereas clear and reasonable guidelines are provided for selection of early use districts, no criteria for promoting IMCI expansion had been issued, and areas of greatest need were not prioritized. Equity analyses based on the geographical deployment of new programmes and strategies can contribute to assessing whether they are reaching those who need them most.

Effects of socioeconomic change from birth to early adulthood on height and overweight.

BACKGROUND: In this work we explored the association of height and overweight with change in socioeconomic position between birth and 19 years of age. METHODS: A birth cohort has been followed-up in Pelotas, Brazil, since 1982. All 5914 hospital births were enrolled in the study just after delivery. In 2001, 27% of the cohort subjects were sought, and 1031 (69% of the survivors) were interviewed. Weight and height were obtained for women; men had been examined 6 months earlier. Information on family income in 1982 and 2001 was used to classify the sample into tertiles, the lowest classified as 'poor' and the other two as 'non-poor'. Four trajectories resulted: always poor, never poor, poor at birth/non-poor at 19, and non-poor at birth/poor at 19-which were compared in terms of mean height and prevalence of overweight. RESULTS: Height showed a similar behaviour for men and women, with the never poor presenting the highest mean, followed by those who were non-poor at birth and later became poor. Those who were poor at birth, regardless of later status, were shortest. Overweight was approximately twice as common among men who were never poor in relation to the others. Among women, those who were always poor presented the highest prevalence of overweight. In this case, social determination seems to be complex and may involve aspects of lifestyle and behaviour acting differently for each gender. CONCLUSION: Socioeconomic trajectories affected both height and overweight, the effect on the latter being different for each gender.

Breastfeeding and overweight in childhood: evidence from the Pelotas 1993 birth cohort study.

OBJECTIVES: The effect of breastfeeding duration on the prevalence of overweight and on mean weight for height z-score (WHZ) was evaluated in Brazilian children. DESIGN: Prospective population-based birth cohort study. SUBJECTS: In total, 1,273 children aged 4 years, corresponding to a follow-up rate of 87.2%. MEASUREMENTS: Three explanatory variables were studied: duration of any breastfeeding, duration of exclusive or predominant breastfeeding, and ever breastfeeding. Weight and height were measured using a digital electronic scale and a portable stadiometer. Overweight was defined as WHZ >2 using the National Center for Health Statistics reference curve. RESULTS: Overweight prevalence at the age of 4 years was 10.2% (95% CI 8.4; 11.8). The lowest prevalence (6.5%) was observed among children breastfed for >11 months. Among those breastfed for less than 3 months, the prevalence of overweight was approximately 9.5%. Mean WHZ ranged from 0.38 among children breastfed for less than 1 month to 0.62 among those breastfed for 9-11.9 months. No linear trends were detected in the association between breastfeeding and anthropometric indicators. None of the three breastfeeding variables was significantly associated with the prevalence of overweight or mean WHZ in multivariable analyses. No interactions were detected between breastfeeding and the variables sex, birth weight, socioeconomic status, skin color and pregestational in body mass index. CONCLUSION: Our results do not support the hypothesis that breastfeeding promotion would reduce overweight or obesity in this population. Existing evidence on many other benefits of breastfeeding for the mother and the child supports its continued promotion, protection and support.