Plasma omega-3 fatty acids are positively associated with appendicular muscle mass index only in adults with low protein intake: Results from NHANES 2011-2012.

BACKGROUND: Omega-3 (ω-3) fatty acids may indirectly increase muscle protein synthesis making the muscle more sensitive to amino acids uptake; therefore, ω-3 could promote benefits on muscle mass mainly when protein intake is low. However, no study has evaluated the association between ω-3 fatty acids and muscle mass according to protein intake. AIM: To evaluate the association between plasma ω-3 fatty acids and appendicular muscle mass index (AMMI) in adults according to the protein intake. METHODS: A cross-sectional study was performed evaluating 1037 individuals aged 20-59 years from a sub-sample of the National Health and Nutrition Examination Survey (NHANES) 2011-2012. Gas chromatography-mass spectrometry method was used to assess plasma ω-3 fatty acids. The lean mass was evaluated by dual-energy x-ray absorptiometry (DXA) and AMMI (kg/m2) was calculated by appendicular lean mass (kg) divided by height squared. The evaluation of protein intake was performed using two 24-h dietary recalls. Linear regression analysis was performed to assess the association of total plasma ω-3, docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), alpha-linolenic acid (ALA), and EPA plus DHA with AMMI according to protein intake (<0.8; ≥0.8; ≥0.8 - <1.2; ≥1.2 - <1.6; and ≥1.6 g/kg/d). RESULTS: Total plasma ω-3 (ß = 0.0030; CI = 0.0013-0.0046; p = 0.002), ALA (ß = 0.0063; CI = 0.0020-0.0107; p = 0.008), EPA (ß = 0.0073; CI = 0.0005-0.0142, p = 0.037), DHA (ß = 0.0057; CI = 0.0022-0.0093; p = 0.004) and EPA + DHA (ß = 0.0040; CI = 0.0010-0.0071; p = 0.013) were positively associated with AMMI in individuals with low protein intake (<0.8 g/kg). However, no association was observed in individuals with protein intake higher than 0.8 g/kg. CONCLUSION: Plasma ω-3 fatty acids were positively associated with AMMI only in individuals with low protein intake.

The Potential Impact of Different Taxation Scenarios towards Sugar-Sweetened Beverages on Overweight and Obesity in Brazil: A Modeling Study.

The adoption of fiscal policies based on the specific taxation of sugar-sweetened beverages (SSBs) has been recommended by international health agencies, as they are measures that potentially reduce consumption. This study is an ex ante risk comparison that estimates the impact of three tax scenarios (20, 25, and 30%) with a 100% pass-on rate to SSBs on the prevalence of high weight and obesity in the Brazilian population. Data on the consumption habits, weight, and height of 46,164 adults aged 20 years or over from Brazilian recent national surveys were used. The shift in consumption after taxation was estimated based on the price elasticity of the demand. The percentage changes in overweight for 20, 25, and 30% taxation were 1.84% (95%CI: 1.82; 1.86), 1.89% (95%CI: 1.87; 1.90), and 2.25% (95%CI: 2.24; 2.27), respectively. The change in the prevalence of obesity was 1.93% (95%CI: 1.87; 2.00), 2.90% (95%CI: 2.80; 3.02), and 4.16% (95%CI: 4.01; 4.32), respectively. Taxes on SSBs may have a more favorable result among the heaviest consumers, who are young adults (20-29 years), especially men, thereby promoting a greater reduction in the prevalence of high weight and obesity.

Serum uric acid is not associated with appendicular muscle mass index in young and middle-aged adults: Results from NHANES 2011-2012.

BACKGROUND: Recent studies have evaluated the association between uric acid (UA) and muscle mass in older adults; however, little is known about this relationship in young and middle-aged individuals. Our aim was to investigate whether serum UA is associated with appendicular muscle mass index (AMMI) in young and middle-aged individuals. We also aimed to evaluate whether this association is sex-specific. METHODS: A cross-sectional study was performed with young and middle-aged individuals aged from 20 to 59 years from National Health and Nutrition Examination Survey (NHANES) 2011-2012. A total of 2255 individuals (1440 young and 815 middle-aged individuals; 1167 men and 1088 women) were evaluated. Body composition was assessed by Dual Energy X-ray absorptiometry (DXA) and AMMI was calculated using the arms plus legs lean mass divided by the height squared. UA levels were measured by colorimetric method. Regression analyzes were performed to evaluate whether AMMI is associated with the tertiles of UA levels after adjustments for potential confounders. RESULTS: In the unadjusted analyzes, serum UA was positively associated with AMMI for total sample, young, and middle-aged individuals of both sexes. However, after adjustments for confounders, UA levels were no longer associated with AMMI independent of the age-rage and sex. CONCLUSION: Serum UA is not associated with AMMI in young or middle-aged individuals independent of the sex.

Impact of a reduction in sugar-sweetened beverage consumption on the burden of type 2 diabetes in Brazil: A modeling study.

AIM: To model the impact of a 20 % tax on sugar-sweetened beverages (SSBs) on the disease burden of T2DM among Brazilian adults. METHODS: This is an ex-ante risk comparative study. The model applied a 20 % tax on SSB and projected the incidence, prevalence, and mortality of T2DM over a 20-year period (2019 to 2039). Using recent national data on consumption, previously published cross- and own-price elasticities of SSBs and diabetes relative risk we estimated changes on T2DM burden. RESULTS: With a 20 % tax on SSBs, after 10 years, we estimated a reduction of 37,303 new cases of T2DM for men and 56,757 for women; 184,129 prevalent cases for men and 219,236 for women; and 5,386 and 6,075 deaths for men and women, respectively. After 20 years, 8.6 % and 12.4 % new cases of T2DM will have been prevented, 4.0 % and 5.5 % prevalent cases, and 13.7 % and 12.7 % deaths among men and women, respectively. CONCLUSIONS: SSB taxes have the potential to reduce the burden of and deaths attributable to T2DM. Our results show that a fiscal policy may significantly impact strategic plans to tackle noncommunicable diseases.

Plasma omega-3 is not associated with appendicular muscle mass index in young and middle-aged individuals: Results from NHANES 2011-2012.

The aim of this study was to evaluate the association between plasma omega-3 (ω-3) and appendicular muscle mass index (AMMI) in young and middle-aged individuals; and also to evaluate whether these associations are sex-specific. A cross-sectional study was performed evaluating 1037 individuals aged 20 to 59 years from a sub-sample of the National Health and Nutrition Examination Survey (NHANES) 2011-2012. Plasma ω-3 was evaluated by gas chromatography-mass spectrometry and lean mass was assessed by dual-energy x-ray absorptiometry (DXA). Total plasma ω-3, docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) and alpha-linolenic acid (ALA) were not associated with AMMI in total sample, men and women after adjustments for confounders. Plasma ω-3 and its subtypes were not associated with AMMI in a subanalysis evaluating young (20 to 44 y) and middle-aged (45 to 59 y) individuals separately. In conclusion, plasma ω-3 fatty acids are not associated with AMMI in young and middle-aged individuals regardless of sex.

Taxing sugar-sweetened beverages as a policy to reduce overweight and obesity in countries of different income classifications: a systematic review.

OBJECTIVE: To evaluate the potential impact of sugar-sweetened beverage (SSB) taxes on overweight and obesity prevalence in countries of different income classifications. DESIGN: Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO number CRD42020161612). Five databases (Cochrane Library, Embase, LILACS (via Virtual Health Library) and MEDLINE (via PubMed), and Web of Science were searched, from January 2009 to December 2019. Articles that reported changes in purchases, sales, intake, body weight, BMI, overweight and/or obesity prevalence due to a tax on or price change in SSB were included. SETTING: Studies conducted in countries of different income classifications. PARTICIPANTS: The search yielded 8349 articles of which 21 met inclusion criteria. RESULTS: Among the sixteen studies selected, only two did not show that consumption, sales and purchase decreased as the price of SSB increased. In eight of the thirteen studies selected, a positive effect of an SSB tax on decreasing overweight and obesity prevalence was expected. It is estimated that a 20 % taxation on SSB would result in a greater decrease in the prevalence of overweight and obesity compared to a 10 % rate. Studies with no significant effect of taxing on sales, purchases, consumption and prevalence of obesity were from high-income countries, while significant effects of taxing on reducing purchase, consumption and/or obesity prevalence were found in studies from upper-middle- and middle-income countries. CONCLUSION: A high SSB tax might be an effective fiscal policy to decrease purchase and consumption of SSB and reduce overweight/obesity prevalence, especially if the tax were specific for beverage volume.

Trends in social inequalities in breastfeeding and infant formulas in Latin American countries between the 1990 and 2010 decades.

OBJECTIVE: To analyse trends of social inequality in breastfeeding and infant formula (IF) use in Latin America between 1990 and 2010 decades. DESIGN: Time-series cross-sectional study with data from Demographic and Health Surveys. We described the prevalence of exclusive breastfeeding (EBF), breastfeeding between 6 and 12 months (BF6-12) and IF for infants under 6 months (IF < 6) and between 6 and 12 months (IF6-12). Social inequalities were assessed using the slope index of inequality (SII) and concentration index (CIX). Trends in the prevalence of breastfeeding, IF and index of social inequality were analysed by a linear regression model with weighted least squares variance. SETTING: Bolivia, Colombia, Dominican Republic, Guatemala, Haiti and Peru. PARTICIPANTS: 51·358 alive infants younger than 12 months. RESULTS: Five countries showed an increasing trend for EBF and BF6-12, four increased for IF < 6 and six for IF6-12. Simultaneous decrease in IF < 6 (Colombia: -0·3/year; Haiti: -0·02/year) and increase in EBF (Colombia: +2·0/year; Haiti: +1·9/year) were observed only in two countries. EBF prevalence was high in the lowest income quintiles in five countries, and IF prevalence was high in the highest income quintiles in all countries and over the decades. For BF6-12, a decrease in inequality (prevalence increased in the highest quintile) was observed in Guatemala (SII1995 = -0·42; SII2015 = -0·28) and the Dominican Republic (SII1996 = -0·54; SII2013 = -0·26). Guatemala was the only country showing a decrease in inequality for BF (SII = -0·005; CIX = -0·0035) and an increase for IF (SII = 0·022; CIX = 0·01). CONCLUSIONS: The inequality in BF and IF remained over time. However, inequality in IF < 6 has decreased because low-income infants have increased use and high-income infants have decreased.

Serum uric acid is positively associated with muscle strength in older men and women: Findings from NHANES 1999-2002.

BACKGROUND: One of the causes of strength loss in older adults is the increased oxidative stress; thus, substances with antioxidants properties may have protective effects on muscle strength. Uric acid (UA) is an important antioxidant and it seems to be positively associated with muscle strength in older adults; however, the current evidence is still limited. AIM: To investigate whether serum UA is associated with muscle strength in older men and women. METHODS: A cross-sectional study was performed evaluating older adults aged from 50 to 85 years from National Health and Nutrition Examination Survey (NHANES) 1999-2000 and 2001-2002. A total of 2361 individuals (1256 men and 1105 women) were evaluated. The peak isokinetic knee extensor strength was assessed by kinetic communicator isokinetic dynamometer; while UA levels were measured by colorimetric method. Linear regression analyses were performed to estimate the coefficients and 95% confidence intervals for muscle strength by quintiles of UA levels, adjusted for potential confounders. RESULTS: In the unadjusted analyses, serum UA was positively associated with peak force in men and total sample, but not in women. However, after adjustments for confounders, UA levels were positively associated with peak force in total sample (p-trend = 0.007), men (p-trend = 0.044) and women (p-trend = 0.016). CONCLUSION: Serum UA is positively associated with muscle strength in older men and women. These results suggest that UA levels seem to be a protective factor for muscle strength in older adults independent of the sex.

Association between omega-3 fatty acids intake and muscle strength in older adults: A study from National Health and Nutrition Examination Survey (NHANES) 1999-2002.

BACKGROUND: Muscle strength is a predictor of mortality in older adults and some dietary components are associated with this variable; however, little is known about the association between omega-3 fatty acids (ω-3) intake and strength in older adults. OBJECTIVE: To assess whether ω-3 intake is associated with muscle strength in individuals over 50 years. We also aimed to evaluate whether an isocaloric substitution of dietary fatty acids types by ω-3 intake could be associated with muscle strength. METHODS: This study included older adults aged from 50 to 85 y, from National Health and Nutrition Examination Survey (NHANES) 1999-2000 and 2001-2002. A total of 2141 individuals (1119 men and 1022 women) were evaluated and provided complete and reliable dietary intake and isokinetic strength of the knee extensors (peak force) data. Linear regression analysis was conducted without (Model 1) and with adjustments (Model 2). Isocaloric substitution analysis was performed to evaluate whether the substitution of polyunsaturated (excluding ω-3), monounsaturated, saturated fats and ω-6 by consumption of ω-3 is associated with strength. RESULTS: Total ω-3, docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) and alpha-linolenic acid (ALA) intakes were positively associated with peak force in men (Model 1). However, after the adjustments for confounders (Model 2), only total ω-3 intake remained significant. Ω-3 intake was not associated with strength in women. The isocaloric substitution of saturated, polyunsaturated, monounsaturated fats and ω-6 by ω-3 was not associated with peak force. CONCLUSION: The intake of total ω-3 was positively associated with muscle strength in older men, but not in older women. In addition, the substitution of other fatty acids by ω-3 intake was not associated with strength.

Evaluation of employees in public day care centers knowledge about breastfeeding and complementary feeding / Evaluacion del conocimiento de funcionarios de escuelas municipales de educacion infantil sobre lactancia materna y alimentacion complementaria / Avaliacao do conhecimento de funcionarias de escolas municipais de educacao infantil sobre aleitamento materno e alimentacao complementar

OBJECTIVE: To evaluate the knowledge of public day care centers employees about breastfeeding and complementary feeding. METHODS: A cross-sectional study was conducted in 15 public day care centers randomly selected in the city of Uberlandia, Southeast Brazil. A questionnaire applied to school principals, teachers, educators and general services assistants (GSA) included demographic and socioeconomic variables and questions about knowledge on breastfeeding, complementary feeding besides employees' perceptions about these subjects. Kruskal-Wallis with multiple comparison and chi-square tests were used to compare variables by professional category. RESULTS: 304 employees participated in the study. The highest percentages of correct answers were noted for questions about exclusive breastfeeding: definition - 97% (n=296) and duration - 65% (n=199). Regarding complementary feeding, 61% (n=187) correctly answered about the appropriate age to introduce it, with a lower percentage for meat (56%; n=170) and sugar (16%; n=50). Concerning employees' perceptions, 9% (n=29) believed that there is weak breast milk, 79% (n=241) and 51% (n=157) reported the negative influence of bottle feeding and pacifier use on breastfeeding. Among the interviewed subjects, 77% (n=234) answered that they had a positive influence on the quality of the food given to the children. There were no differences in the answers according to professional category, except for the negative influence of pacifiers on breastfeeding. CONCLUSIONS: Employees of public day care centers knew more about breastfeeding than about complementary feeding. Educational activities about breastfeeding and complementary feeding are necessary for day care centers employees. .

OBJETIVO: Evaluar el conocimiento de funcionarias de guarderías públicas sobre lactancia materna y alimentación complementaria. MÉTODOS: Estudio transversal, realizado en 15 escuelas municipales de educación infantil de Uberlândia, Minas Gerais, seleccionadas por muestreo probabilístico. Participaron del estudio directoras, maestras, educadoras y ayudantes de servicios generales (ASG). El instrumento de investigación fue un cuestionario compuesto por variables demográficas, socioeconómicas y cuestiones que evaluaron el conocimiento sobre lactancia materna, alimentación complementaria y percepciones de las funcionarias sobre el tema. Se utilizó la prueba de Kruskal-Wallis con comparación múltiple y la prueba del chi-cuadrado, para comparar las variables por categoría profesional. RESULTADOS: Participaron del estudio 304 funcionarias. El porcentaje más grande de acierto ocurrió para las cuestiones sobre lactancia materna exclusiva, siendo el 97% (n=296) para definición y el 65% (n=199) para duración. Respecto a la alimentación complementar, el 61% (n=187) contestó correctamente la edad de introducirla, con porcentaje inferior para la introducción de carne, 56% (n=170) y de azúcar, 16% (n=50). Sobre las percepciones de las funcionarias, el 9% (n=29) relataron existir leche materna débil; el 79% (n=241) y el 51% (n=157) relataron la influencia negativa del biberón y del chupete, respectivamente, en la amamantación, y el 77% (n=234) creen influenciar positivamente en la calidad de la alimentación ofrecida a los niños. No hubo diferencia en las respuestas según el cargo, excepto por la influencia negativa del chupete en la amamantación. CONCLUSIONES: El conocimiento sobre la lactancia materna fue superior al de la alimentación complementaria, a pesar que las funcionarias se ...

OBJETIVO: Avaliar o conhecimento de funcionárias de creches públicas sobre aleitamento materno e alimentação complementar. MÉTODOS: Estudo transversal, realizado em 15 escolas municipais de educação infantil de Uberlândia, Minas Gerais, selecionadas por amostragem probabilística. Participaram do estudo diretoras, professoras, educadoras e auxiliares de serviços gerais (ASG). O instrumento da pesquisa foi um questionário composto por variáveis demográficas, socioeconômicas e questões que avaliaram o conhecimento sobre aleitamento materno, alimentação complementar e percepções das funcionárias sobre o tema. Utilizou-se o teste de Kruskal-Wallis com comparação múltipla e o teste do qui-quadrado para comparar as variáveis por categoria profissional. RESULTADOS: Participaram do estudo 304 funcionárias. O maior percentual de acerto ocorreu para as questões sobre aleitamento materno exclusivo, sendo 97% (n=296) para definição e 65% (n=199) para duração. Quanto à alimentação complementar, 61% (n=187) responderam corretamente a idade de introduzi-la, com percentual inferior para a introdução de carne 56% (n=170) e de açúcar, 16% (n=50). Sobre as percepções das funcionárias, 9% (n=29) relataram existir leite materno fraco; 79% (n=241) e 51% (n=157) relataram a influência negativa da mamadeira e da chupeta na amamentação e 77% (n=234) acreditavam influenciar positivamente a qualidade da alimentação oferecida às crianças. Não houve diferença nas respostas segundo o cargo, com exceção da influência negativa da chupeta na amamentação. CONCLUSÕES: O conhecimento das funcionárias de creches públicas sobre o aleitamento materno foi superior ao da alimentação ...

Translation and cross-cultural adaptation of the Strongkids tool for screening of malnutrition risk in hospitalized children.

OBJECTIVE: To translate into Portuguese and to culturally adapt the malnutrition screening tool for hospitalized children, Strongkids. METHODS: This study documents the translation of the tool from the original version (English) into Portuguese. The translation and cultural adaptation of the content of this tool consisted of six stages, according to the methodology proposed by Beaton et al (initial translation, synthesis of translations, back translation, verification of the cultural equivalence process, pre-test, and evaluation of the cultural adaptation process). In the first stage, translation was performed by two independent translators, followed by their synthesis and reconciliation; in the third one, the reconciled version was back translated and, then, a pre-final one that retained all linguistic equivalence was developed. In the fifth step, a pre-test of the pre-final version was performed in order to verify the understanding of the items and a final version of the tool was developed. RESULTS: The pre-final version of the tool was applied to 30 parents/guardians and to 20 healthcare professionals in order to verify its understanding by both. The main alterations were the adaptation of technical terms in order to meet the recommendations of health professionals, and the adjustment of terms for parents/guardians understanding. CONCLUSIONS: The Portuguese translation of the tool was easily understood by parents/guardians and health professionals, and it should be useful to screen the risk of malnutrition in hospitalized children.

Tradução e adaptação cultural da ferramenta Strongkids para triagem do risco de desnutrição em crianças hospitalizadas / Translation and cross-cultural adaptation of the Strongkids tool for screening of malnutrition risk in hospitalized children / Traducción y adaptación cultural de la herramienta Strongkids para selección del riesgo de desnutrición en niños hospitalizados

OBJETIVO: Realizar a tradução para o português e a adaptação cultural da ferramenta para triagem de desnutrição Strongkids, em crianças hospitalizadas. MÉTODOS: Estudo documental no qual foi realizada a tradução da ferramenta da versão original (inglês) para a língua portuguesa. A tradução e a adaptação cultural do conteúdo de tal instrumento consistiram de seis etapas, segundo a metodologia proposta por Beaton et al (tradução inicial, síntese das traduções, retrotradução, verificação do processo de equivalência cultural, pré-teste e avaliação do processo de adaptação cultural). Na primeira etapa, a tradução foi realizada por dois tradutores independentes; na segunda, envolveu síntese e reconciliação das mesmas; na terceira, a reconciliada foi retrotraduzida e, na quarta, elaborou-se versão pré-final, de forma a manter as equivalências linguísticas. Na quinta etapa, foi realizado o pré-teste da versão pré-final para verificar a compreensão dos itens e, na última, foram feitas as correções necessárias e uma versão final da ferramenta foi elaborada. RESULTADOS: A versão pré-final da ferramenta foi aplicada a 30 pais e/ou responsáveis e a 20 profissionais da saúde para esclarecer o entendimento da mesma por ambos os públicos. As principais alterações realizadas foram adequações de termos técnicos, visando a atender às recomendações dos profissionais da área da saúde, e adequação dos termos para os pais e/ou responsáveis. CONCLUSÕES: A ferramenta em português mostrou-se de simples entendimento para os pais/responsáveis e profissionais da saúde a fim de triar o risco de desnutrição em crianças hospitalizadas.

OBJECTIVE: To translate into Portuguese and to culturally adapt the malnutrition screening tool for hospitalized children, Strongkids. METHODS: This study documents the translation of the tool from the original version (English) into Portuguese. The translation and cultural adaptation of the content of this tool consisted of six stages, according to the methodology proposed by Beaton et al (initial translation, synthesis of translations, back translation, verification of the cultural equivalence process, pre-test, and evaluation of the cultural adaptation process). In the first stage, translation was performed by two independent translators, followed by their synthesis and reconciliation; in the third one, the reconciled version was back translated and, then, a pre-final one that retained all linguistic equivalence was developed. In the fifth step, a pre-test of the pre-final version was performed in order to verify the understanding of the items and a final version of the tool was developed. RESULTS: The pre-final version of the tool was applied to 30 parents/guardians and to 20 healthcare professionals in order to verify its understanding by both. The main alterations were the adaptation of technical terms in order to meet the recommendations of health professionals, and the adjustment of terms for parents/guardians understanding. CONCLUSIONS: The Portuguese translation of the tool was easily understood by parents/guardians and health professionals, and it should be useful to screen the risk of malnutrition in hospitalized children.

OBJETIVO: Realizar la traducción al portugués y adaptación cultural de la herramienta para selección de desnutrición «STRONGkids¼, en niños hospitalizados. MÉTODOS: Estudio documental, en el que se realizó la traducción de la herramienta de la versión original (inglés) para el portugués. La traducción y adaptación cultural del contenido de esa herramienta consistieron en seis etapas, según la metodología propuesta por Beaton et al (2000): traducción inicial, síntesis de las traducciones, retrotraducción, verificación del proceso de equivalencia cultural, pre-prueba y evaluación del proceso de adaptación cultural. En la primera etapa, la traducción fue realizada por dos traductores independientes, en la segunda, hubo la síntesis y reconciliación de estas traducciones; en la tercera, la versión reconciliada fue retrotraducida y, en la cuarta, se elaboró una versión pre-final de modo a mantener las equivalencias lingüísticas. En la quinta etapa, se realizó la pre-prueba de esta versión pre-final para verificar la comprensión de los ítems y, en la última etapa, se realizaron las correcciones necesarias y se elaboró una versión final de la herramienta. RESULTADOS: La versión pre-final de la herramienta fue aplicada a 30 padres y/o responsables y a 20 profesionales de salud para aclarar el entendimiento de los dos públicos sobre la misma. Las principales alteraciones realizadas fueron adecuación de términos técnicos, con el objetivo de atender a las recomendaciones de los profesionales del área de salud y la adecuación de los términos para los padres y/o responsables. CONCLUSIONES: La herramienta en portugués se mostró de simple entendimiento para los padres/responsables y para los profesionales de salud para seleccionar el riesgo de desnutrición en niños hospitalizados.

Evaluation of employees in public day care centers knowledge about breastfeeding and complementary feeding.

OBJECTIVE: To evaluate the knowledge of public day care centers employees about breastfeeding and complementary feeding. METHODS: A cross-sectional study was conducted in 15 public day care centers randomly selected in the city of Uberlandia, Southeast Brazil. A questionnaire applied to school principals, teachers, educators and general services assistants (GSA) included demographic and socioeconomic variables and questions about knowledge on breastfeeding, complementary feeding besides employees' perceptions about these subjects. Kruskal-Wallis with multiple comparison and chi-square tests were used to compare variables by professional category. RESULTS: 304 employees participated in the study. The highest percentages of correct answers were noted for questions about exclusive breastfeeding: definition - 97% (n=296) and duration - 65% (n=199). Regarding complementary feeding, 61% (n=187) correctly answered about the appropriate age to introduce it, with a lower percentage for meat (56%; n=170) and sugar (16%; n=50). Concerning employees' perceptions, 9% (n=29) believed that there is weak breast milk, 79% (n=241) and 51% (n=157) reported the negative influence of bottle feeding and pacifier use on breastfeeding. Among the interviewed subjects, 77% (n=234) answered that they had a positive influence on the quality of the food given to the children. There were no differences in the answers according to professional category, except for the negative influence of pacifiers on breastfeeding. CONCLUSIONS: Employees of public day care centers knew more about breastfeeding than about complementary feeding. Educational activities about breastfeeding and complementary feeding are necessary for day care centers employees.

Prevalência de pressão arterial elevada em crianças e adolescentes do ensino fundamental / Prevalence of elevated blood pressure in children and adolescents attending highschool / Prevalencia de presión arterial elevada en niños y adolescentes de la enseñanza fundamental

Verificar a prevalência de pressão arterial elevada em crianças e adolescentes e sua associação com indicadores antropométricos. MÉTODOS: Estudo transversal de estudantes de três instituições de ensino em Botucatu (SP). As variáveis avaliadas foram: pressão arterial (PA) (obtida em três ocasiões diferentes), peso, estatura, índice de massa corporal (IMC), circunferência braquial, circunferência abdominal (CA), dobras cutâneas tricipital e subescapular. A PA foi aferida por método auscultatório e classificada em pré-hipertensão (PH) e hipertensão arterial (HAS), para os valores entre os percentis 90 e 95 e maior que o percentil 95, respectivamente. Os dados antropométricos foram comparados, segundo o sexo, pelo teste t de Student. A correlação de Pearson foi utilizada para verificar a variação das PA sistólica (PAS) e diastólica (PAD) segundo dados antropométricos. A variação do escore Z da PA segundo percentil de IMC foi avaliada pela análise de variância seguida do teste de Tukey. RESULTADOS: Foram avaliadas 903 crianças (51,7 por cento meninos), com idade de 9,3±2,5 anos para ambos os sexos. A prevalência de PH foi de 9,1 por cento e de HAS foi de 2,9 por cento. Houve correlação positiva significativa entre os níveis de PAS e PAD elevados e as variáveis antropométricas, com valores maiores para peso (r=0,53 e r=0,45, p<0,05, respectivamente) e CA (r=0,50 e r=0,38, p<0,05, respectivamente). CONCLUSÕES: A prevalência de níveis pressóricos elevados nesta casuística foi compatível com outros estudos brasileiros e internacionais, correlacionando-se positivamente com indicadores antropométricos elevados, o que sinaliza a influência do excesso de peso na PA já na infância.

To assess the prevalence of elevated blood pressure in schoolchildren and adolescents and the association of blood pressure with anthropometric measures. METHODS: This cross-sectional study, conducted in three schools in Botucatu, Brazil, collected blood pressure (BP) measurements taken at three different time points and anthropometric data: weight, height, body mass index (BMI), arm circumference, waist circumference, triceps and subscapular skinfolds. Blood pressure was measured using the auscultation method, and children were classified into two groups: pre-hypertension or hypertension for values between the 90th and 95th percentiles or above the 95th percentile. Data were compared according to sex using the Student's t test. The Pearson correlation coefficient was used to evaluate the association between blood pressure and anthropometric data. To evaluate blood pressure, the Z score according to BMI percentile categories, one-factor analysis of variance (ANOVA) and the Tukey post hoc test were used. RESULTS: This study evaluated 903 children and adolescents (51.7 percent boys) whose mean age was 9.3±2.5 years. The prevalence of pre-hypertension and hypertension was 9.1 percent and 2.9 percent. There was a positive correlation between both systolic and diastolic blood pressure and anthropometric variables, especially for weight (r=0.53 and r=0.45, p<0.05) and waist circumference (r=0.50 and r=0.38, p<0.05). CONCLUSIONS: The prevalence of elevated blood pressure in this study was similar to what has been reported in international and national studies. A positive correlation with abnormal anthropometric measures was found. These results suggest that overweight affects blood pressure already in childhood.

Verificar la prevalencia de presión arterial elevada en niños y adolescentes y su asociación con indicadores antropométricos. MÉTODOS: Estudio transversal incluyendo a estudiantes de tres instituciones de enseñanza de Botucatu (São Paulo, Brasil). Las variables evaluadas fueron: presión arterial (PA) (obtenida en tres ocasiones distintas), peso, estatura, índice de masa corporal (IMC), circunferencia braquial, circunferencia abdominal (CA), pliegues cutáneos tricipital y subescapular. La PA fue verificada por método auscultatorio, siendo posteriormente clasificada como pre-hipertensión (PH) e hipertensión arterial (HAS) para los valores entre los percentiles 90 y 95 y superior al percentil 95, respectivamente. Los datos antropométricos fueron comparados, conforme al sexo, por la prueba t de Student. La correlación de Pearson fue utilizada para verificar la variación de las PA sistólica (PAS) y diastólica (PAD) según datos antropométricos. La variación del escore Z de la PA según percentil de IMC fue evaluada por el análisis de variancia seguida por la prueba de Tukey. RESULTADOS: Se evaluaron 903 niños (51,7 por ciento niños), con edad de 9,3±2,5 años para ambos sexos. La prevalencia de PH fue de 9,1 por ciento y de HAS fue de 2,9 por ciento. Hubo correlación positiva significativa entre los niveles presóricos elevados (PAS/PAD > percentil 90) y las variables antropométricas, con valores mayores para peso (r=0,53 y r=0,45, p<0,05, respectivamente) y CA (r=0,50 y r=0,38, p<0,05, respectivamente). CONCLUSIONES: La prevalencia de niveles presóricos elevados en esta casuística fue compatible con otros estudios brasileños e internacionales, correlacionándose positivamente con indicadores antropométricos elevados, lo que señaliza la influencia del exceso de peso en la PA ya en la infancia.

Aptidão física associada às medidas antropométricas de escolares do ensino fundamental / Physical fitness and associations with anthropometric measurements in 7 to 15-year-old school children

OBJETIVO: Analisar a associação da aptidão física relacionada à saúde com os indicadores demográficos e antropométricos de crianças de três escolas do município de Botucatu (SP). MÉTODOS: A amostra deste estudo transversal foi de 988 escolares do ensino fundamental, do 2º ao 9º ano (faixa etária de 7 a 15 anos). As avaliações realizadas foram antropométricas (peso, estatura, circunferência abdominal e dobras cutâneas tricipital e subescapular) e de aptidão física relacionada à saúde (flexibilidade: teste de sentar e alcançar; força/resistência abdominal: teste abdominal em 1 minuto; e resistência aeróbia: teste de correr/andar por 9 minutos). Para a análise dos dados, utilizou-se estatística descritiva, teste t de Student, qui-quadrado ou exato de Fisher e regressão logística com nível de significância de 5 por cento. RESULTADOS: As aptidões físicas estudadas foram significativamente influenciadas por idade (todas), sexo (força/resistência abdominal), obesidade (todas), adiposidade corpórea (flexibilidade, força/resistência abdominal) e adiposidade abdominal (força/resistência abdominal e resistência aeróbia). O sexo feminino mostrou-se mais propenso à inaptidão de força/resistência abdominal, enquanto que a obesidade e a hiperadiposidade abdominal predispõem os escolares à inaptidão de força/resistência abdominal e resistência aeróbia. O excesso de adiposidade corpórea aumentou as chances de ocorrência da flexibilidade do tronco fraca. CONCLUSÕES: As inaptidões físicas foram relacionadas ao sexo feminino, à obesidade e à hiperadiposidade abdominal. Programas de mudança do estilo de vida nas escolas, voltados à aptidão física e à adequação alimentar, preencheriam os objetivos de promoção da eutrofia e da maior aptidão física desses escolares.

OBJECTIVE: To analyze associations between health-related physical fitness and the anthropometric and demographic indicators of children at three elementary schools in Botucatu, SP, Brazil. METHODS: The sample for this cross-sectional study was 988 elementary school students, recruited from the second to ninth grades (an age range of 7 to 15 years). The children underwent anthropometric assessment (weight, height, waist circumference and tricipital and subscapular skin folds) and were tested for health-related physical fitness (flexibility: sit and reach test; abdominal strength/stamina: 1-minute abdominal test; and aerobic stamina: 9-minute running/walking test). Data were analyzed using descriptive statistics plus Student's t test, the chi-square test or Fisher's exact test and logistic regression with a significance level of 5 percent. RESULTS: The physical fitness levels observed were significantly influenced by age (all levels), sex (abdominal strength/stamina), obesity (all levels), body adiposity (flexibility, abdominal strength/stamina) and abdominal adiposity (abdominal strength/stamina and aerobic stamina). Females were more prone to be unfit in abdominal strength/stamina. Both obesity and excessive abdominal adiposity predisposed children to be unfit in abdominal strength/stamina and aerobic stamina. Excess body adiposity increased the likelihood of poor trunk flexibility. CONCLUSIONS: Unhealthy physical fitness levels were related to female sex, obesity and excessive abdominal adiposity. Implementing programs designed to effect lifestyle changes to achieve physical fitness and healthy nutrition in these schools would meet the objectives of promoting healthy body weight and increased physical fitness among these schoolchildren.

Physical fitness and associations with anthropometric measurements in 7 to 15-year-old school children.

OBJECTIVE: To analyze associations between health-related physical fitness and the anthropometric and demographic indicators of children at three elementary schools in Botucatu, SP, Brazil. METHODS: The sample for this cross-sectional study was 988 elementary school students, recruited from the second to ninth grades (an age range of 7 to 15 years). The children underwent anthropometric assessment (weight, height, waist circumference and tricipital and subscapular skin folds) and were tested for health-related physical fitness (flexibility: sit and reach test; abdominal strength/stamina: 1-minute abdominal test; and aerobic stamina: 9-minute running/walking test). Data were analyzed using descriptive statistics plus Student's t test, the chi-square test or Fisher's exact test and logistic regression with a significance level of 5%. RESULTS: The physical fitness levels observed were significantly influenced by age (all levels), sex (abdominal strength/stamina), obesity (all levels), body adiposity (flexibility, abdominal strength/stamina) and abdominal adiposity (abdominal strength/stamina and aerobic stamina). Females were more prone to be unfit in abdominal strength/stamina. Both obesity and excessive abdominal adiposity predisposed children to be unfit in abdominal strength/stamina and aerobic stamina. Excess body adiposity increased the likelihood of poor trunk flexibility. CONCLUSIONS: Unhealthy physical fitness levels were related to female sex, obesity and excessive abdominal adiposity. Implementing programs designed to effect lifestyle changes to achieve physical fitness and healthy nutrition in these schools would meet the objectives of promoting healthy body weight and increased physical fitness among these schoolchildren.

Metabolic syndrome in overweight children from the city of Botucatu - São Paulo State - Brazil: agreement among six diagnostic criteria.

BACKGROUND: The metabolic syndrome has been described in children; however, a standard criterion has not been established for its diagnosis. Also, few studies have been conducted to specifically observe the possible existence of agreement among the existing diagnostic criteria. The purpose of the study is to evaluate agreement concerning prevalence rates of the metabolic syndrome diagnosed by six different criteria in overweight schoolchildren in the city of Botucatu - SP -Brazil. METHODS: This is a cross-sectional study on 128 overweight schoolchildren. Clinical examination included anthropometry, pubertal staging evaluation, and blood pressure. Triacylglycerol, glycemia, HDL-cholesterol, insulin levels, and HOMA-IR were determined. The Kappa index, the Mann-Whitney test and the chi-square test were used for statistical analysis. RESULTS: The prevalence of the metabolic syndrome varied from 10 to 16.5% according to different diagnostic criteria. Results were similar for boys and girls and pubertal stage. Great agreement was observed among the six different diagnostic criteria for the metabolic syndrome. CONCLUSIONS: Different diagnostic criteria, when adopted for subjects with similar demographic characteristics, generate similar and compatible prevalence. Results suggest that it is possible to adopt any of the analyzed criteria, and the choice should be according to the components available for each situation.

Contribuições das práticas alimentares e inatividade física para o excesso de peso infantil: [revisão] / Feeding practices and physical inactivity contributions to childhood overweight: [review]

OBJETIVO: Revisar estudos que abordam as práticas alimentares atuais e o padrão de atividade física como contribuintes do excesso de peso na infância. FONTES DE DADOS: Ovid Journals, Highwire e SciELO, com seleção de artigos originais e de revisão nos últimos dez anos (1997 a 2007), na língua portuguesa e inglesa. SÍNTESE DE DADOS: O acompanhamento do estado nutricional de crianças permite diagnosticar seu estado de saúde atual, bem como predizer parcialmente seu prognóstico na vida adulta. A prevalência de obesidade infantil, no Brasil, apresenta aumento progressivo em todas as classes sociais e sua freqüência varia entre cinco a 18 por cento, dependendo da região estudada. A associação da transição epidemiológica, demográfica e comportamental e a alteração do hábito alimentar são apontadas como fatores causais do aumento progressivo da obesidade infantil. Práticas alimentares caracterizadas por elevado teor de lipídios, sacarose e sódio e por reduzido consumo de cereais integrais, frutas e hortaliças associadas à inatividade física decorrente do uso de computadores, jogos eletrônicos e televisores influenciam parte considerável de crianças. Este estilo de vida reflete os hábitos familiares e pode ser influenciado pelo ambiente escolar no qual a criança está inserida. CONCLUSÕES: Os dados sugerem influência considerável dos fatores ambientais, principalmente hábitos alimentares e inatividade física, no crescente aumento da prevalência de excesso de peso na população pediátrica.

OBJECTIVE: To review the literature in order to show how current feeding and physical activity practices may contribute to childhood overweight. DATA SOURCE: Ovid Journals, Highwire and SciELO, selecting original and review articles from 1997 to 2007, published in English and Portuguese. DATA SYNTHESIS: The periodic assessment of children nutritional status is important to diagnose their current health status and to predict their adult life prognosis. In Brazil, the prevalence of childhood obesity is progressively increasing in all social classes and its frequency varies from five to 18 percent, according to the region assessed. The association between the health, demographic and behavioral transition and the change in feeding practices can explain the increasing prevalence of childhood overweight. The current food consumption with high fat, sugar and sodium intake and low intake of whole cereals, fruits and vegetables associated to physical inactivity due to the excessive use of computers, electronic games and television may play a role in childhood obesity. This life style can be explained by changing family habits and school environment. CONCLUSIONS: These data suggest considerable influence of environmental factors, mainly nutritional habits and physical inactivity, on the increasing prevalence of childhood overweight.