Acute and chronic malnutrition and their predictors in children aged 0-5 years in São Tomé: a cross-sectional, population-based study.

OBJECTIVE: Undernutrition is an important cause of morbidity and mortality in infants and children worldwide. The aim of this study was to evaluate the nutritional status and their predictors in children from 0 to 5 years of age in São Tomé. STUDY DESIGN: A cross-sectional study was conducted in São Tomé Island. METHODS: A total of 1285 individuals were enrolled between January and May 2011. Children were measured, and height for age (HAZ), weight for height (WHZ) and body mass index (BAZ) Z-score were computed. Global acute undernutrition is defined as weight for height <-1 Z-score (wasting < -2 Z-scores) and global chronic undernutrition as length/height for age <-1 Z-score (stunting < -2 Z-scores). Relevant information was collected from individual health bulletins, namely gestational age and birth weight, as well as weight at 6, 12, 18 and 24 months for all individual above these ages. Mothers were invited to answer a specific questionnaire. RESULTS: A high percentage of global acute undernutrition (30.9% in <24 months and 21.9% in ≥24 months) and global chronic undernutrition (32.5% in <24 months and 41.1% in ≥24 months) was observed. Appropriate birth weight for gestational age (AGA) is significantly associated with lower odds for both acute (OR 0.485 [95% CI 0.299-0.785]) and chronic undernutrition (OR 0.427 [95% CI 0.270-0.675]) in children >12 months. Weight gain above 0.67 Z-score in the first semester of life was strongly related to lower odds for both acute (OR 0.109 [95% CI 0.040-0.291]) and chronic undernutrition (OR 0.379 [95% CI 0.187-0.770]) in children >12 months of age. Similarly, mother's education seems to protect against acute (>12 months: OR 0.448 [95% CI 0.244-0.825]; >24 months: OR 0.186 [95% CI 0.064-0.540]) and chronic undernutrition (>12 months: OR 0.389 [95% CI 0.232-0.653]; >24 months: OR 0.324 [95% CI 0.171-0.625]). All logistic regressions were adjusted for all children (gender, age, gestational age, birth weight, breastfeeding, begin consumption alcohol), mothers (age, height, body mass index, educational level, number of previous pregnancies, smoking during pregnancy, alcohol consumption during pregnancy) and household (number of siblings and persons at home) variables included in the protocol. CONCLUSIONS: Birth weight, nutritional status, and the mother's education and weight gain particularly in the first year of life were important factors protecting against undernutrition during infancy and childhood. These results emphasize the importance of women's nutrition and of adequate birth weight and particularly weight gain during the first year of life in order to prevent wasting and stunting in childhood.

Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors.

A systematic review and meta-analysis were carried out to study the effects of low-carbohydrate diet (LCD) on weight loss and cardiovascular risk factors (search performed on PubMed, Cochrane Central Register of Controlled Trials and Scopus databases). A total of 23 reports, corresponding to 17 clinical investigations, were identified as meeting the pre-specified criteria. Meta-analysis carried out on data obtained in 1,141 obese patients, showed the LCD to be associated with significant decreases in body weight (-7.04 kg [95% CI -7.20/-6.88]), body mass index (-2.09 kg m(-2) [95% CI -2.15/-2.04]), abdominal circumference (-5.74 cm [95% CI -6.07/-5.41]), systolic blood pressure (-4.81 mm Hg [95% CI -5.33/-4.29]), diastolic blood pressure (-3.10 mm Hg [95% CI -3.45/-2.74]), plasma triglycerides (-29.71 mg dL(-1) [95% CI -31.99/-27.44]), fasting plasma glucose (-1.05 mg dL(-1) [95% CI -1.67/-0.44]), glycated haemoglobin (-0.21% [95% CI -0.24/-0.18]), plasma insulin (-2.24 micro IU mL(-1) [95% CI -2.65/-1.82]) and plasma C-reactive protein, as well as an increase in high-density lipoprotein cholesterol (1.73 mg dL(-1) [95%CI 1.44/2.01]). Low-density lipoprotein cholesterol and creatinine did not change significantly, whereas limited data exist concerning plasma uric acid. LCD was shown to have favourable effects on body weight and major cardiovascular risk factors; however the effects on long-term health are unknown.

A follow up model for patients with atrophic chronic gastritis and intestinal metaplasia.

AIM: To devise a follow up model for patients with gastric cancer associated lesions, such as atrophic chronic gastritis (ACG) and intestinal metaplasia (IM). METHODS: Cohort study of 144 patients, followed for a minimum of one year, in whom at least two upper gastrointestinal endoscopic biopsies in flat gastric mucosa provided a diagnosis of ACG, IM, or low grade dysplasia (LGD). RESULTS: Of those diagnosed with ACG at first endoscopic biopsy (entry biopsy), 12% progressed to LGD in outcome biopsy, as did 8% of those with type I IM, 38% with type II or III IM, and 32% with LGD. Type of IM at entry independently predicted progression to LGD and cancer. Type II and III IM had a higher rate of progression to LGD than type I IM, which showed an indolent behaviour similar to ACG. Patients with type II or III IM were at higher risk for development of dysplasia, and 7% of patients with type III IM at first biopsy progressed to high grade dysplasia (HGD), whereas no cases of ACG or type I/II IM progressed to HGD during the first three years. CONCLUSION: Patients with ACG or IM could possibly be allocated to different management schedules, based on differences in rate and proportion of progression to LGD or HGD. Less intensive follow up (two/three yearly with "serological evaluation" (pepsinogen)) may suit those with ACG or type I IM. Patients with type III IM may benefit from six to 12 monthly improved endoscopic examination (magnification chromoendoscopy).

An interactive web site for research on fetal heart rate monitoring.

BACKGROUND: Traditional methods of exchange of research information may not be rapid enough, especially for international multicenter studies or when discussing controversial issues such as the value of fetal monitoring. The Internet is a useful tool that provides numerous opportunities for immediate communication within a large and diverse community of researchers. METHOD: A Web site at http://www.sisporto.med.up.pt was developed for a multicenter research project with interlinked pages on automated fetal heart rate (FHR) monitoring. It includes background knowledge about the subject, detailed information about the project, and a few interactive pages. These pages allow online discussions, simulations of data analysis, and download of data for local FHR analysis. EXPERIENCE: The Web site has been accessed from all over the world. In particular, participating research centers have had easy and fast access to background project information, and a few other clinicians and researchers participated in our online discussions and used the simulation tools or the data provided for analysis of typical FHR patterns. CONCLUSION: Web sites can be useful in multicenter research projects and for scientific information exchange.

Prevalence and determinants of periodontal disease in Portuguese adults: results from a multifactorial approach.

The purpose of the present investigation was to study prevalence of periodontal disease among 30 to 39-years-old from Oporto in the north of Portugal. In addition, an attempt was made to elucidate possible periodontal disease determinants in this population. A random sample consisting of a total of 322 individuals was drawn based on electoral lists. The attendance rate was 61%. The CPITN index was used and the results indicate a high prevalence of periodontal disease and a substantial need for periodontal treatment in this population, with 41% of the individuals investigated having one or more sites with a CPITN score 4 (pockets deeper than 5.5 mm). Dental visiting habits, gender (lower CPITN scores for females) and oral hygiene were the determinants most significantly associated with variation in CPITN scores.

Variability of self reported measures of alcohol consumption: implications for the association between drinking in pregnancy and birth weight.

STUDY OBJECTIVE: To describe the intra-subject variability of self reported maternal alcohol consumption using different ways of collecting information and to analyse the implications of this variability for research into the effect of low to moderate maternal alcohol consumption on birth weight. DESIGN: This was a longitudinal study. Self reported maternal alcohol consumption before, during, and after pregnancy was assessed on four occasions over two years. The data were collected by two self administered questionnaires and during two personal interviews (one by phone and another face to face). SETTINGS: The Obstetrics Department, Odense University Hospital, Odense, Fünen, Denmark. PARTICIPANTS: A total of 2880 pregnant women were recruited consecutively from the hospital catchment area. Altogether 328 pregnant women and their babies were selected. All women who reported an average alcohol consumption of five drinks or more per week were recruited to the study (164 women) and a 1:1 control group was selected from the remaining women based upon two matching criteria: expected date of delivery and the women's year of birth. Some 279 women (85%) completed the study. MEASUREMENTS AND MAIN RESULTS: Self reported alcohol consumption (number of drinks per week) and birth weight (g) were the main outcomes. Women's self reported alcohol consumption varied over time and according to the data collection method. When different methods of data collection were used to assess alcohol intake in similar periods of time, significant differences in reporting were found despite the relatively high correlations between the measurements. Although a consistent reduction in birth weight with increasing consumption of alcohol was found, there were differences in the shape and strength of this association when comparing the six available alcohol measurements. CONCLUSIONS: The type of questions used, the way the data were collected, the period of time referred to, and the time the questions were asked, should be taken into consideration when describing the drinking pattern of pregnant women. Furthermore, birth weight results from studies that have used different alcohol measures should be interpreted or compared with caution because of possible large differences resulting from the differing methods of assessing fetal exposure to alcohol.