Padrões alimentares de crianças e determinantes socioeconômicos, comportamentais e maternos / Dietary patterns of children and socioeconomical, behavioral and maternal determinants

Objetivo:Identificar os padrões alimentares de crianças e verificar sua associação com determinantes socioeconômicos, comportamentais e maternos.Métodos:Estudo transversal com amostra aleatória de 328 crianças de oito e nove anos. O consumo alimentar foi avaliado por registros alimentares de três dias não consecutivos e quantificado em gramas de grupos alimentares e de nutrientes. Análise fatorial e subsequente rotação ortogonal (varimax) foram usadas para determinar os padrões alimentares. Regressão logística ordinal foi usada para verificar associações entre padrões alimentares e os determinantes estudados.Resultados:Cinco padrões alimentares foram extraídos: “Tradicional”, “Bebidas adoçadas e lanches”, “Monótono”, “Saudável” e “Ovo-lacto”. A maior escolaridade materna se associou de forma direta aos padrões “Bebidas doces e lanches” e “Ovo-lacto”. Crianças de baixo nível econômico e que recebiam maior restrição alimentar pelos pais/responsáveis aderiram mais ao padrão “Tradicional”, representado pelo consumo de arroz, feijão, hortaliças, raízes e tubérculos cozidos e carne vermelha. O padrão “Monótono”, representado pelo elevado consumo de leite e achocolatado, foi mais consumido por crianças de classe econômica intermediária. Crianças que residiam em zona rural consumiam mais alimentos do padrão “Ovo-lacto” comparadas com as de zona urbana.Conclusões:Os padrões alimentares das crianças estiveram associados às condições econômicas da família, escolaridade materna, prática de restrição alimentar pelos pais/responsáveis e localização da residência em zona urbana ou rural. Melhores condições socioeconômicas contribuíram para um padrão alimentar nutricionalmente mais inadequado.

Objective:To identify dietary patterns of children and to verify their association with socio-economical, behavioral and maternal determinants.Methods:A cross-sectional study with a random sample of 328 children aged 8 and 9 years. Dietary intake was assessed by food records in three nonconsecutive days and measured in grams of food groups and nutrients. Factor analysis and subsequent orthogonal rotation (varimax) were used to determine dietary patterns. Ordinal logistic regression was used to assess associations between dietary patterns and the studied determinants.Results:Five dietary patterns were observed: “Traditional,” “Sweetened beverages and snacks,” “Monotonous,” “Healthy” and “Egg-dairy.” A higher maternal level of education was directly associated with “Sweetened beverages and snacks” and “Egg-dairy' standards. Low income children who were submitted to greater food restriction by parents/guardians followed the more “Traditional” standard, represented by the consumption of rice, beans, vegetables, cooked roots and tubers and red meat. The “Monotonous” pattern, represented by a high consumption of milk and chocolate powder, was most followed by children from the middle class. Children living in rural areas consumed more foods from the “Egg-dairy” pattern, when compared to those from the urban area.Conclusions:Dietary patterns of children were associated with family socioeconomic status, maternal level of education, practice of food restriction by parents/guardians and location of residence in urban or rural area. Better socioeconomic conditions contributed to a more nutritionally inadequate dietary pattern.

Prevalência de deficiência de vitamina D e fatores associados em mulheres e seus recém-nascidos no período pós-parto / Prevalence of vitamin D deficiency and associated factors in women and newborns in the immediate postpartum period

Objetivo:Avaliar a prevalência de deficiência de vitamina D e os fatores associados em mulheres e recém-nascidos no período pós-parto.Métodos:Estudo de delineamento transversal; avaliou-se a deficiência/insuficiência de vitamina D em 226 mulheres e seus recém-nascidos no município de Viçosa (MG), entre dezembro de 2011 e novembro de 2012. Coletaram-se 5mL de sangue do cordão umbilical e sangue venoso materno a fim de avaliar os parâmetros bioquímicos: vitamina D, fosfatase alcalina, cálcio, fósforo e paratormônio. Usou-se regressão de Poisson e adotou-se a Razão de Prevalência (95% IC), a fim de se avaliar a deficiência de vitamina D e fatores associados. Fez-se a análise de regressão linear múltipla para identificar os fatores associados à deficiência de 25(OH)D dos recém-nascidos e das mulheres do estudo. O critério para inclusão das variáveis na regressão linear múltipla foi a relação com a variável dependente na análise de regressão linear simples, considerando p<0,20. O nível de significância adotado foi α<5%.Resultados:Das 226 mulheres, 200 (88,5%) tinham entre 20 e 44 anos; a mediana foi de 28. Encontrou-se prevalência de níveis deficientes/insuficientes de vitamina D em 192 (85%) mulheres e 182 (80,5%) recém-nascidos. A 25(OH)D materna e a fosfatase alcalina materna se comportaram como preditores independentes da deficiência de vitamina D dos recém-nascidos.Conclusões:Foi possível identificar a alta prevalência de deficiência e insuficiência de vitamina D nas mulheres e recém-nascidos em nosso meio e a relação entre o estado nutricional materno de vitamina D e o do recém-nascido.

Objective:To assess the prevalence of vitamin D deficiency and its associated factors in women and their newborns in the postpartum period.Methods:This cross-sectional study evaluated vitamin D deficiency/insufficiency in 226 women and their newborns in Viçosa (Minas Gerais, BR) between December 2011 and November 2012. Cord blood and venous maternal blood were collected to evaluate the following biochemical parameters: vitamin D, alkaline phosphatase, calcium, phosphorus and parathyroid hormone. Poisson regression analysis, with a confidence interval of 95%, was applied to assess vitamin D deficiency and its associated factors. Multiple linear regression analysis was performed to identify factors associated with 25(OH)D deficiency in the newborns and women from the study. The criteria for variable inclusion in the multiple linear regression model was the association with the dependent variable in the simple linear regression analysis, considering p<0.20. Significance level was α<5%.Results:From 226 women included, 200 (88.5%) were 20-44 years old; the median age was 28 years. Deficient/insufficient levels of vitamin D were found in 192 (85%) women and in 182 (80.5%) neonates. The maternal 25(OH)D and alkaline phosphatase levels were independently associated with vitamin D deficiency in infants.Conclusions:This study identified a high prevalence of vitamin D deficiency and insufficiency in women and newborns and the association between maternal nutritional status of vitamin D and their infants' vitamin D status.

[Dietary patterns of children and socioeconomical, behavioral and maternal determinants]. / Padrões alimentares de crianças e determinantes socioeconômicos, comportamentais e maternos.

OBJECTIVE: To identify dietary patterns of children and to verify their association with socio-economical, behavioral and maternal determinants. METHODS: A cross-sectional study with a random sample of 328 children aged 8 and 9 years. Dietary intake was assessed by food records in three nonconsecutive days and measured in grams of food groups and nutrients. Factor analysis and subsequent orthogonal rotation (varimax) were used to determine dietary patterns. Ordinal logistic regression was used to assess associations between dietary patterns and the studied determinants. RESULTS: Five dietary patterns were observed: "Traditional", "Sweetened beverages and snacks", "Monotonous", "Healthy" and "Ovo-lacto". A higher maternal level of education was directly associated with "Sweetened beverages and snacks" and "Ovo-lacto" standards. Low income children who were submitted to greater food restriction by parents/guardians followed the more "Traditional" standard, represented by the consumption of rice, beans, vegetables, cooked roots and tubers, and red meat. The "Monotonous" pattern, represented by a high consumption of milk and chocolate milk, was most followed by children from the middle class. Children living in rural areas consumed more foods from the "Ovo-lacto" pattern, when compared to those from the urban area. CONCLUSIONS: Dietary patterns of children were associated with family socioeconomic status, maternal level of education, practice of food restriction by parents/guardians and location of residence in urban or rural area. Better socioeconomic conditions contributed to a more nutritionally inadequate dietary pattern.

Micronutrientes e componentes da síndrome metabólica em crianças: bases bioquímicas e evidências epidemiológicas / Micronutrients and components of metabolic syndrome in children: biochemical basis and epidemiological evidence

Este artigo faz uma revisão dos estudos que avaliaram a influência de diferentes micronutrientes sobre os componentes da síndrome metabólica (SM) em crianças, discutindo as bases bioquímicas e mecanismos envolvidos. O levantamento bibliográfico foi realizado a partir da busca nas bases de dados eletrônicas PubMed, Science Direct e SciELO, utilizando, inicialmente, os descritores "micronutrientes" e "síndrome metabólica" e, em seguida, os termos referentes a cada micronutriente e aos componentes da síndrome metabólica, ambos combinados ao descritor "criança", em português e seus respectivos correlatos em inglês e espanhol. Não se delimitou o período das publicações, tendo em vista que os trabalhos sobre o tema são relativamente novos na população infantil. Foram encontrados estudos com micronutrientes antioxidantes, vitaminas do complexo B, vitamina D, zinco, ferro, sódio, cálcio e magnésio, os quais sugerem uma possível associação destes com a presença de componentes da SM na na infância. Mecanismos bioquímicos e fisiológicos envolvidos fornecem algumas bases plausíveis para sustentar essas evidências epidemiológicas. Observa-se que ainda há uma escassez de trabalhos sobre o tema, sendo necessários mais estudos, de forma a contribuir para o esclarecimento e confirmação de vários aspectos da dieta relacionados com o desenvolvimento da SM.

[Prevalence of vitamin D deficiency and associated factors in women and newborns in the immediate postpartum period]. / Prevalência de deficiência de vitamina D e fatores associados em mulheres e seus recém-nascidos no período pós-parto.

OBJECTIVE: To assess the prevalence of vitamin D deficiency and its associated factors in women and their newborns in the postpartum period. METHODS: This cross-sectional study evaluated vitamin D deficiency/insufficiency in 226 women and their newborns in Viçosa (Minas Gerais, BR) between December 2011 and November 2012. Cord blood and venous maternal blood were collected to evaluate the following biochemical parameters: vitamin D, alkaline phosphatase, calcium, phosphorus and parathyroid hormone. Poisson regression analysis, with a confidence interval of 95% was applied to assess vitamin D deficiency and its associated factors. Multiple linear regression analysis was performed to identify factors associated with 25(OH)D deficiency in the newborns and women from the study. The criteria for variable inclusion in the multiple linear regression model was the association with the dependent variable in the simple linear regression analysis, considering p<0.20. Significance level was α<5%. RESULTS: From 226 women included, 200 (88.5%) were 20 to 44 years old; the median age was 28 years. Deficient/insufficient levels of vitamin D were found in 192 (85%) women and in 182 (80.5%) neonates. The maternal 25(OH)D and alkaline phosphatase levels were independently associated with vitamin D deficiency in infants. CONCLUSIONS: This study identified a high prevalence of vitamin D deficiency and insufficiency in women and newborns and the association between maternal nutritional status of vitamin D and their infants' vitamin D status.

Calcium intake, serum vitamin D and obesity in children: is there an association? / Ingestão de cálcio, níveis séricos de vitamina D e obesidade infantil: existe associação?

OBJECTIVE: To evaluate the association between calcium intake and serum vitamin D levels and childhood obesity by an integrative review. DATA SOURCE: The research was conducted in the databases PubMed/medLine, Science Direct and SciELO with 2001 to 2014 publications. We used the combined terms in English: ''children'' and ''calcium'' or ''children'' and ''vitamin D'' associated with the descriptors: ''obesity'', ''adiposity'' or ''body fat'' for all bases. Cross-sectional and cohort studies, as well as clinical trials, were included. Review articles or those that that have not addressed the association of interest were excluded. DATA SYNTHESIS: Eight articles were part of this review, five of which were related to calcium and three to vitamin D. Most studies had a longitudinal design. The analyzed studies found an association between calcium intake and obesity, especially when age and sex were considered. Inverse relationship between serum vitamin D and measures of adiposity in children has been observed and this association was influenced by the sex of the patient and by the seasons of the year. CONCLUSIONS: The studies reviewed showed an association between calcium and vitamin D with childhood obesity. Considering the possible protective effect of these micronutrients in relation to childhood obesity, preventive public health actions should be designed, with emphasis on nutritional education.

OBJETIVO: Avaliar a associação da ingestão de cálcio e níveis séricos de vitamina D e a obesidade infantil, por meio de uma revisão integrativa. FONTES DE DADOS: A pesquisa foi feita nas bases Pubmed/MedLine, Science Direct e SciELO com publicações de 2001 a 2014. Usaram-se os termos em inglês combinados: "children" e "calcium" ou "children" e "vitamina D" associados, cada um, aos descritores: "obesity", "adiposity" ou "body fat", para todas as bases. Foram incluídos estudos que relacionassem as palavraschave da pesquisa, com delineamento transversal, estudos de coorte e ensaios clínicos. Foram excluídos artigos de revisão ou artigos que não estudaram a associação de interesse. SÍNTESE DOS DADOS: Oito artigos fizeram parte dessa revisão, dos quais cinco eram referentes ao cálcio e três abordaram a vitamina D. A maioria dos estudos foi de delineamento longitudinal. Os estudos analisados encontraram associação entre ingestão cálcio e obesidade, especialmente quando consideradas características como idade e sexo. Tem-se observado relação inversa entre concentrações séricas de vitamina D e medidas de adiposidade em crianças. Essas são influenciadas pelo sexo e pelas estações do ano. CONCLUSÕES: Os estudos avaliados mostraram associação entre cálcio e vitamina D com a obesidade na infância. Assim, considerando o possível efeito protetor desses micronutrientes em relação à obesidade infantil, as ações preventivas de saúde pública podem ser pautadas com ênfase na educação nutricional.

Metabolic syndrome risk assessment in children: use of a single score / Risco de síndrome metabólica em crianças: uso de um escore único

OBJECTIVE: To calculate a score of metabolic syndrome (MetS) in children and set a cutoff point of this score for the prediction of MetS risk. METHODS: The study included a random sample of 348 children aged 8 and 9 years of Viçosa, Southeast Brazil. Factor analysis by principal components (PCA) was used to determine, among various risk factors, those with higher degrees of intercorrelation. The chosen variables were: waist circumference (PC), homeostatic model assessment of insulin resistance (HOMA), high density lipoprotein (HDL), triglycerides (TAG) and mean arterial pressure (MAP). Z-scores were created for each one of these parameters and the sum of these z-scores constituted the MetS score. The receiver operating characteristic (ROC) curve was used to identify the cutoff of MetS score, using as gold standard the presence or absence of MetS determined according to criteria age-modified. RESULTS: The prevalence of MetS in the sample was 8.9% by adopting specific criteria for age, and 24% when considering the cutoff of MetS score. The selected cutoff point of 1.86 was accurate to predict the MetS risk in this sample due to its high sensitivity (96.7%), specificity (82.7%) and AUC of 0.96. CONCLUSIONS: This original Brazilian study presents the MetS score as a suitable alternative for the study of Metabolic Syndrome in children, given the lack of consensus for the definition of this syndrome in childhood.

OBJETIVO: Calcular um escore de síndrome metabólica (SM) em crianças e definir um ponto de corte para a predição de risco de SM nesse grupo. MÉTODOS: Estudo com amostra aleatória de 348 crianças de oito e nove anos do município de Viçosa. Análise fatorial por componentes principais foi usada para verificar, entre vários fatores de risco, aqueles com maiores graus de intercorrelação: perímetro da cintura (PC), modelo homeostático de resistência à insulina (HOMA), lipoproteína de alta densidade (HDL), triacilgliceróis (TAG) e pressão arterial média (PAM). Escores-z foram criados para cada um desses parâmetros e o somatório desses constituiu o escore de SM. A curva receiver operating characteristic (ROC) foi usada para identificar o ponto de corte do escore, considerando-se como padrão-ouro a presença ou ausência de SM, segundo critérios modificados para a idade. RESULTADOS: A prevalência de SM na amostra foi de 8,9% adotando-se critérios específicos para a idade e de 24% quando considerado o ponto de corte do escore. Foi eleito o ponto de corte de 1,86, por ter elevadas sensibilidade (96,7%) e especificidade (82,7%), AUC de 0,96, e, assim, acurácia em predizer a presença de síndrome metabólica em crianças nessa faixa etária. CONCLUSÕES: Este inédito estudo brasileiro apresenta uma opção adequada para o estudo da SM em crianças, vista a ausência de definição consensual para a SM na infância.

[Calcium intake, serum vitamin D and obesity in children: is there an association?]. / Ingestão de cálcio, níveis séricos de vitamina D e obesidade infantil: existe associação?

OBJECTIVE: To evaluate the association between calcium intake and serum vitamin D levels and childhood obesity by an integrative review. DATA SOURCE: The research was conducted in the databases PubMed/medLine, Science Direct and SciELO with 2001 to 2014 publications. We used the combined terms in English: "children" and "calcium" or "children" and "vitamin D" associated with the descriptors: "obesity", "adiposity" or "body fat" for all bases. Cross-sectional and cohort studies, as well as clinical trials, were included. Review articles or those that that have not addressed the association of interest were excluded. DATA SYNTHESIS: Eight articles were part of this review, five of which were related to calcium and three to vitamin D. Most studies had a longitudinal design. The analyzed studies found an association between calcium intake and obesity, especially when age and sex were considered. Inverse relationship between serum vitamin D and measures of adiposity in children has been observed and this association was influenced by the sex of the patient and by the seasons of the year. CONCLUSIONS: The studies reviewed showed an association between calcium and vitamin D with childhood obesity. Considering the possible protective effect of these micronutrients in relation to childhood obesity, preventive public health actions should be designed, with emphasis on nutritional education.

[Metabolic syndrome risk assessment in children: use of a single score]. / Risco de síndrome metabólica em crianças: uso de um escore único.

OBJECTIVE: To calculate a score of metabolic syndrome (MetS) in children and set a cutoff point of this score for the prediction of MetS risk. METHODS: The study included a random sample of 348 children aged 8 and 9 years of Viçosa, Southeast Brazil. Factor analysis by principal components (PCA) was used to determine, among various risk factors, those with higher degrees of intercorrelation. The chosen variables were: waist circumference (PC), homeostatic model assessment of insulin resistance (HOMA), high density lipoprotein (HDL), triglycerides (TAG) and mean arterial pressure (MAP). Z-scores were created for each one of these parameters and the sum of these z-scores constituted the MetS score. The receiver operating characteristic (ROC) curve was used to identify the cutoff of MetS score, using as gold standard the presence or absence of MetS determined according to criteria age-modified. RESULTS: The prevalence of MetS in the sample was 8.9% by adopting specific criteria for age, and 24% when considering the cutoff of MetS score. The selected cutoff point of 1.86 was accurate to predict the MetS risk in this sample due to its high sensitivity (96.7%), specificity (82.7%) and AUC of 0.96. CONCLUSIONS: This original Brazilian study presents the MetS score as a suitable alternative for the study of Metabolic Syndrome in children, given the lack of consensus for the definition of this syndrome in childhood.

Fatores associados à dislipidemia em crianças de 4 a 7 anos de idade / Associated factors with dyslipidemia in children 4 to 7 years old

Objetivo: Avaliar o perfil lipídico e fatores associados à dislipidemia em crianças. Métodos: Estudo transversal que avaliou crianças de 4 a 7 anos acompanhadas nos primeiros meses de vida por um Programa de Extensão da Universidade Federal de Viçosa, Minas Gerais. Foram consideradas as dosagens de colesterol total, lipoproteína de alta densidade, lipoproteína de baixa densidade e triglicerídeos. Foram estudadas variáveis possivelmente associadas ao perfil lipídico, sendo elas variáveis maternas, sociodemográficas e aquelas associadas à criança. Foram realizadas análises bivariada e multivariadas, sendo as últimas por meio de regressão logística múltipla. Resultados: A amostra foi constituída por 185 crianças, de ambos os sexos. Observou-se que 46,5% (n=86) apresentaram valores aumentados de colesterol total, 9,2% (n=17) de lipoproteína de baixa densidade e 4,9% (n=9) de triglicerídeos. Com relação à lipoproteína de alta densidade, 35,1% (n=65) apresentaram valores abaixo do desejável. Demonstrou associação independente com o perfil lipídico das crianças a renda per capita, escolaridade materna e idade materna (associando-se à lipoproteína de baixa densidade) e o excesso de peso, que se associou a maiores prevalências de alterações em triglicerídeos. Conclusão: Foram observadas altas prevalências de dislipidemias. Condições sociodemográficas e estado nutricional demonstraram influenciar, também em crianças, a ocorrência de dislipidemias, as quais são citadas como fatores de risco para as doenças cardiovasculares. Revela-se a importância de se estudar esses fatores desde a infância, realizando-se estudos com outras faixas etárias que verifiquem a prevalência e fatores associados, de forma a promover o cuidado com a saúde desse grupo populacional. .

Objective: To evaluate the lipid profile and associated factors with dyslipidemia in children. Methods: A cross-sectional study that evaluated children 4-7 years old, followed the first months of life in a Program of the Universidade Federal de Viçosa, Minas Gerais. Performed biochemical measurements were total cholesterol, high density lipoprotein, low density lipoprotein and triglycerides. The variables possibly associated with lipid profile were maternal variables, sociodemographic and those associated with the child. Bivariate and multivariate analyses have been done, the latter by multiple logistic regressions. Results: The sample consisted of 185 children, both genders. It was observed that 46.5% (n=86) showed increased levels of total cholesterol, 9.2% (n=17) of low density lipoprotein and 4.9% (n=9) in triglycerides. With relation to the high density lipoprotein, 35.1% (n=65) had values less than desirable. Demonstrated an independent association with the lipid profile of children the per capita income, maternal education and maternal age (with low density lipoprotein) and overweight, which was associated with a higher prevalence of changes in triglycerides. Conclusion: High prevalence of dyslipidemia were observed. Sociodemographic conditions and nutritional status demonstrated influence, also in children, the occurrence of dyslipidemia, which are cited as risk factors for cardiovascular disease. Reveals the importance of studying these factors since childhood, performing studies with other age groups to check the prevalence and associated factors to promote the health care of this population group. .

Diferenças no ponto de corte de hemoglobina para diagnóstico de anemia em função da raça/cor / Differences in the hemoglobin cut-off point for the diagnosis of anemia as a function of race/color

Os níveis de hemoglobina variam em função de idade, sexo, diferentes fases da gestação, hábito de fumar e altitude. No início dos anos 90, pesquisadores começaram a observar diferença inexplicável nos níveis de hemoglobina entre brancos e negros nas mais diversas faixas etárias. A partir de então, estudos começaram a ser publicados a fim de identificar quais possíveis fatores seriam responsáveis por tais diferenças. Objetivou-se, a partir de uma revisão de literatura, expor aspectos relevantes que possam auxiliar no conhecimento sobre por que negros possuem menores níveis de hemoglobina em relação aos brancos. A base de dados utilizada para tal revisão foi Medline, Lilacs e Pubmed. Estudos têm evidenciado que os níveis de hemoglobina em negros são menores, variando entre 0,5 e 1g/dL em relação à raça branca. Essa diferençapermanece, mesmo controlando possíveis fatores de confusão como ingestão e estado nutricional de ferro, nível socioeconômico, idade, comorbidades, entre outros. Os estudos, entretanto, não chegam a uma conclusão sobre o que realmente gera essa diferença entre as raças. Assim, propor pontos de corte específicos em função da raça, como alguns autores sugerem, pode ser precipitado e ter como consequênciaa não identificação de portadores de anemia, que é considerada sério problema de saúde pública no Brasil.

Hemoglobin levels vary according to age, gender, different phases of pregnancy, smoking habit, and altitude. In the early 90s, researchers began to notice unexplained differences in hemoglobin levels between whites and blacks in various age groups. Since then, studies began to be published to identify which factors would be responsible for such differences. From a review of the literature, we aimed at exposing relevant aspects that mayassist in the understanding of why blacks have lower levels of hemoglobin in relation to whites. The Medline, Lilacs, and Pubmed databases were used for this review. Studies have shown that the levels of hemoglobin in blacks are lower, ranging between 0.5 and 1 g/dL in relation to whites. This difference remains, even controlling for possible confounding factors such as intake and iron nutritional status, socioeconomic status, age, andcomorbidities among others. The studies, however, do not come to a conclusion about what raises this difference between races. Therefore, proposing specific cut-off points as a function of race, as some authors suggest, may be precipitated and result in not identifying people with anemia, which is considered a serious public health problem in Brazil.

[Waist circumference, waist/height ratio, and neck circumference as parameters of central obesity assessment in children]. / Perímetro da cintura, relação cintura/estatura e perímetro do pescoço como parâmetros na avaliação da obesidade central em crianças.

OBJECTIVE: To analyze studies that assessed the anthropometric parameters waist circumference (WC), waist-to-height ratio (WHR) and neck circumference (NC) as indicators of central obesity in children. DATA SOURCES: We searched PubMed and SciELO databases using the combined descriptors: "Waist circumference", "Waist-to-height ratio", "Neck circumference", "Children" and "Abdominal fat" in Portuguese, English and Spanish. Inclusion criteria were original articles with information about the WC, WHR and NC in the assessment of central obesity in children. We excluded review articles, short communications, letters and editorials. DATA SYNTHESIS: 1,525 abstracts were obtained in the search, and 68 articles were selected for analysis. Of these, 49 articles were included in the review. The WC was the parameter more used in studies, followed by the WHR. Regarding NC, there are few studies in children. The predictive ability of WC and WHR to indicate central adiposity in children was controversial. The cutoff points suggested for the parameters varied among studies, and some differences may be related to ethnicity and lack of standardization of anatomical site used for measurement. CONCLUSIONS: More studies are needed to evaluate these parameters for determination of central obesity children. Scientific literature about NC is especially scarce, mainly in the pediatric population. There is a need to standardize site measures and establish comparable cutoff points between different populations.

Influence of weight gain rate on early life nutritional status and body composition of children.

OBJECTIVE: To evaluate the influence of the weight gain rate at 4-6 months on nutritional status and body composition in children between 4 and 7 years of age. METHODS: Retrospective cohort study, sample of 257 children. Data collection was performed in two stages, with the first relating to retrospective data of weight gain from birth to the first 4-6 months of life in the patient records. Measurements of weight, height, waist circumference, and body composition in children between ages 4 and 7 years were obtained. Nutritional status was assessed by the BMI/age. Control variables, such as pregnancy, breastfeeding, lifestyle, and sociodemographics, were studied. Descriptive analysis and multiple linear regression were performed. RESULTS: In the nutritional status assessment, the prevalence of overweight observed was 24.9%. After adjusting for control variables, it was found that the increase of the WGR at 4-6 months of age explained the occurrence of higher BMI/age, percentage of total body fat, body fat percentage in the android region, and waist circumference in children between 4 and 7 years of age. CONCLUSION: The increase of the WGR in the first months of life can lead to the occurrence of higher values of parameters of nutritional status and body composition in later life.

Prediction of body fat in adolescents: comparison of two electric bioimpedance devices with dual-energy X-ray absorptiometry / Predicción de la grasa corporal en adolescentes: comparación de dos dispositivos de bioimpedancia eléctrica con absorciometría dual de rayos X

Introduction: An accurate estimate of body composition is important in assessing and monitoring the nutritional status of adolescents. Objectives: To compare the accuracy of 2 electrical bioimpedance devices with that of dual-energy X-ray absorptiometry (DXA) to predict body fat in Brazilian adolescents. Methods: We evaluated 500 adolescents aged between 10 and 19 years, stratified by sex and divided into overweight and non-overweight groups. The percentage of body fat (%BF) was estimated using 2 types of electrical bioimpedance devices: BIA1 (horizontal tetrapolar bioimpedance equipment) and BIA2 (vertical 8-electrode bioimpedance equipment), as well as by DXA. A Bland- Altman plot was used to calculate the total errors and standard errors of estimate. Results: Considering BMI for age, 19.4% were overweight and 47.4% as assessed by %BF of DXA were overweight. The %BF estimated by BIA2 correlated well (p < 0.05) with the %BF predicted by DXA, and only the total errors for BIA2 in the overweight group were acceptable (≤2.5%). The standard errors of estimate was <3.5%, with the lowest values observed for BIA2. Both BIA1 and BIA2 underestimated the %BF in overweight adolescents, while overestimating the %BF in male adolescents of normal weight. Conclusions: The BIA2 was found to be more effective in the evaluation of body fat. Regardless of the method used, the results should be carefully interpreted when assessing the body composition of adolescents (AU)

Introducción: Una estimación precisa de la composición corporal es importante para evaluar y monitorear el estado nutricional de los adolescentes. Objetivos: Comparar la exactitud de 2 dispositivos de bioimpedancia eléctrica con la absortometria de rayos X de doble energía (AXD) para predecir la grasa corporal en adolescentes brasileños. Métodos: Se evaluaron 500 adolescentes entre 10 y 19 años, estratificados por sexo y divididos en grupos con sobrepeso y sin sobrepeso. El porcentaje de grasa corporal (%GC) se estimó utilizando 2 tipos de bioimpedancia eléctrica: BIA1 (equipo de bioimpedancia tetrapolar horizontal) y BIA2 (vertical equipo de bioimpedancia 8 electrodos), así como por AXD. Un gráfico de Bland-Altman se utilizó para calcular los errores totales y errores estándar de estimación. Resultados: Teniendo en cuenta el IMC para la edad, el 19,4% tenían sobrepeso y el 47,4% según la evaluación de %GC de DXA tenían sobrepeso. El %GC estimado por BIA2 buena correlación (p<0,05) con el %GC pronosticado por AXD, y sólo los errores totales para BIA2 en el grupo de sobrepeso eran aceptables (≤2,5%). Los errores estándar de estimación fue <3,5%, con los valores más bajos observados para BIA2. Tanto BIA1 y BIA2 subestimaron el %GC en los adolescentes con sobrepeso, mientras que sobreestimar el %GC de los adolescentes varones de peso normal. Conclusiones: El BIA2 se encontró que era más eficaz en la evaluación de la grasa corporal. Independientemente del método utilizado, los resultados deben interpretarse con cautela al evaluar la composición corporal de los adolescentes (AU)

Prediction of body fat in a dolescents: comparison of two electric bioimpedance devices with dual-energy X-ray absorptiometry.

INTRODUCTION: An accurate estimate of body composition is important in assessing and monitoring the nutritional status of adolescents. OBJECTIVES: To compare the accuracy of 2 electrical bioimpedance devices with that of dual-energy X-ray absorptiometry (DXA) to predict body fat in Brazilian adolescents. METHODS: We evaluated 500 adolescents aged between 10 and 19 years, stratified by sex and divided into overweight and non-overweight groups. The percentage of body fat (%BF) was estimated using 2 types of electrical bioimpedance devices: BIA1 (horizontal tetrapolar bioimpedance equipment) and BIA2 (vertical 8-electrode bioimpedance equipment), as well as by DXA. A Bland- Altman plot was used to calculate the total errors and standard errors of estimate. RESULTS: Considering BMI for age, 19.4% were overweight and 47.4% as assessed by %BF of DXA were overweight. The %BF estimated by BIA2 correlated well (p < 0.05) with the %BF predicted by DXA, and only the total errors for BIA2 in the overweight group were acceptable (≤2.5%). The standard errors of estimate was <3.5%, with the lowest values observed for BIA2. Both BIA1 and BIA2 underestimated the %BF in overweight adolescents, while overestimating the %BF in male adolescents of normal weight. CONCLUSIONS: The BIA2 was found to be more effective in the evaluation of body fat. Regardless of the method used, the results should be carefully interpreted when assessing the body composition of adolescents.

Introducción: Una estimación precisa de la composición corporal es importante para evaluar y monitorear el estado nutricional de los adolescentes. Objetivos: Comparar la exactitud de 2 dispositivos de bioimpedancia eléctrica con la absortometria de rayos X de doble energía (AXD) para predecir la grasa corporal en adolescentes brasileños. Métodos: Se evaluaron 500 adolescentes entre 10 y 19 años, estratificados por sexo y divididos en grupos con sobrepeso y sin sobrepeso. El porcentaje de grasa corporal (%GC) se estimó utilizando 2 tipos de bioimpedancia eléctrica: BIA1 (equipo de bioimpedancia tetrapolar horizontal) y BIA2 (vertical equipo de bioimpedancia 8 electrodos), así como por AXD. Un gráfico de Bland-Altman se utilizó para calcular los errores totales y errores estándar de estimación. Resultados: Teniendo en cuenta el IMC para la edad, el 19,4% tenían sobrepeso y el 47,4% según la evaluación de %GC de DXA tenían sobrepeso. El %GC estimado por BIA2 buena correlación (p.

[Insulin resistance and components of metabolic syndrome, analysis by gender and stage of adolescence]. / Resistência à insulina e componentes da síndrome metabólica, análise por sexo e por fase da adolescência.

OBJECTIVE: To analyze the influence of metabolic syndrome components in insulin resistance, by gender and adolescence phase. SUBJECTS AND METHODS: We evaluated biochemical, clinical, lifestyle and body composition data of 800 adolescents from 10 to 19 years old, from both genders, from Viçosa, MG/Brasil, and there was the division by stage: early (10 to 13 years), intermediate (14 to 16 years) and late (17 to 19 years). RESULTS: 10.3 and 3.4% had, respectively, insulin resistance and metabolic syndrome. In the initial phase there was a higher prevalence of dyslipidemia and intermediate hyperuricemia and excess body fat. Females had a higher prevalence of dyslipidemia, excess body fat and insulin resistance and higher male prevalence of low HDL, hyperuricemia and blood pressure changes. Those from the initial phase had higher levels of total cholesterol, LDL, HDL, triglycerides, fasting glucose and waist/hip ratio, stayed less time sitting and had more meals (p < 0.05) in relation to other phases. The final model, adjusted for gender, was different for each phase of adolescence. CONCLUSIONS: Insulin resistance is associated with inadequate body composition, in biochemical levels and lifestyle, being the factors associated different in each phase of adolescence.

Perímetro da cintura, relação cintura/estatura e perímetro do pescoço como parâmetros na avaliação da obesidade central em crianças / Waist circumference, waist/height ratio, and neck circumference as parameters of central obesity assessment in children

Objetivo: Analisar estudos que avaliaram os parâmetros antropométricos perímetro da cintura (PC), relação cintura/estatura (RCE) e perímetro do pescoço (PP) como indicadores da obesidade central em crianças. Fontes dos dados: Realizou-se busca nas bases de dados PubMed e SciELO utilizando os descritores combinados: "Perímetro da cintura", "Relação cintura/estatura", "Perímetro do pescoço", "Crianças" e "Gordura Abdominal" e seus correlatos em inglês e espanhol. Os critérios de inclusão foram: artigos originais sobre o PC, a RCE e o PP na avaliação da obesidade central em crianças, publicados em português, inglês ou espanhol. Excluíram-se artigos de revisão, comunicação breve, cartas e editoriais. Síntese dos dados: Obtiveram-se 1.525 resumos, sendo selecionados 68 artigos para análise na íntegra. Destes, 49 fizeram parte da revisão. O PC foi o parâmetro mais utilizado nos estudos, seguido pela RCE. Já o PP ainda é pouco estudado em crianças. Houve controvérsias quanto à capacidade preditiva da adiposidade central em crianças do PC e da RCE. Os pontos de corte sugeridos para os parâmetros foram diversificados entre os estudos, e essas diferenças podem estar relacionadas à etnia e à falta de padronização do ponto anatômico utilizado na aferição da medida. Conclusões: Mais estudos são necessários para avaliar esses parâmetros na determinação da obesidade central na infância, especialmente em relação ao PP, para o qual a literatura ainda é escassa, principalmente na população infantil. Há necessidade de padronização do local das medidas para o estabelecimento de pontos de cortes comparáveis entre diversas populações...

Objective: To analyze studies that assessed the anthropometric parameters waist circumference (WC), waist-to-height ratio (WHR) and neck circumference (NC) as indicators of central obesity in children. Data sources: We searched PubMed and SciELO databases using the combined descriptors: "Waist circumference", "Waist-to-height ratio", "Neck circumference", "Children" and "Abdominal fat" in Portuguese, English and Spanish. Inclusion criteria were original articles with information about the WC, WHR and NC in the assessment of central obesity in children. We excluded review articles, short communications, letters and editorials. Data synthesis: 1,525 abstracts were obtained in the search, and 68 articles were selected for analysis. Of these, 49 articles were included in the review. The WC was the parameter more used in studies, followed by the WHR. Regarding NC, there are few studies in children. The predictive ability of WC and WHR to indicate central adiposity in children was controversial. The cutoff points suggested for the parameters varied among studies, and some differences may be related to ethnicity and lack of standardization of anatomical site used for measurement. Conclusions: More studies are needed to evaluate these parameters for determination of central obesity children. Scientific literature about NC is especially scarce, mainly in the pediatric population. There is a need to standardize site measures and establish comparable cutoff points between different populations...

Resistência à insulina e componentes da síndrome metabólica, análise por sexo e por fase da adolescência / Insulin resistance and components of metabolic syndrome, analysis by gender and stage of adolescence

Objetivo: Analisar a influência dos componentes da síndrome metabólica na resistência à insulina, por sexo e fase da adolescência. Sujeitos e métodos: Avaliaram-se dados bioquímicos, clínico, de estilo de vida e composição corporal de 800 adolescentes de 10 a 19 anos, de ambos os sexos, de Viçosa-MG/Brasil, divididos em fases: inicial (10 a 13 anos), intermediária (14 a 16 anos) e final (17 a 19 anos). Resultados: 10,3 e 3,4% apresentavam, respectivamente, resistência à insulina e síndrome metabólica. Na fase inicial, observaram-se maior prevalência de dislipidemia e na intermediária, de hiperuricemia e excesso de gordura corporal. O sexo feminino apresentou maior prevalência de dislipidemia, excesso de gordura corporal e resistência à insulina e o masculino, maior prevalência de HDL baixo, hiperuricemia e pressão arterial alterada. Os da fase inicial apresentaram maiores valores de colesterol total, LDL, HDL, triglicerídeos, glicemia de jejum e relação cintura/quadril, ficaram menos tempo sentados e realizavam maior número de refeições (p < 0,05) em relação às outras fases. O modelo final, ajustado por sexo, foi diferente para cada fase da adolescência. Conclusões: A resistência à insulina está associada à inadequação na composição corporal, nos níveis bioquímicos e no estilo de vida, sendo os fatores associados diferentes em cada fase da adolescência. Arq Bras Endocrinol Metab. 2014;58(6):610-8 .

Objective: To analyze the influence of metabolic syndrome components in insulin resistance, by gender and adolescence phase. Subjects and methods: We evaluated biochemical, clinical, lifestyle and body composition data of 800 adolescents from 10 to 19 years old, from both genders, from Viçosa, MG/Brasil, and there was the division by stage: early (10 to 13 years), intermediate (14 to 16 years) and late (17 to 19 years). Results: 10.3 and 3.4% had, respectively, insulin resistance and metabolic syndrome. In the initial phase there was a higher prevalence of dyslipidemia and intermediate hyperuricemia and excess body fat. Females had a higher prevalence of dyslipidemia, excess body fat and insulin resistance and higher male prevalence of low HDL, hyperuricemia and blood pressure changes. Those from the initial phase had higher levels of total cholesterol, LDL, HDL, triglycerides, fasting glucose and waist/hip ratio, stayed less time sitting and had more meals (p < 0.05) in relation to other phases. The final model, adjusted for gender, was different for each phase of adolescence. Conclusions: Insulin resistance is associated with inadequate body composition, in biochemical levels and lifestyle, being the factors associated different in each phase of adolescence. Arq Bras Endocrinol Metab. 2014;58(6):610-8 .

[Timing of clamping and factors associated with iron stores in full-term newborns]. / Tempo de clampeamento e fatores associados à reserva de ferro de neonatos a termo.

OBJECTIVE: To analyze the impact of timing of clamping and obstetric, biological and socioeconomic factors on the iron stores of full-term newborns. METHODS: Cross-sectional study between October 2011 and July 2012 in which hematological parameters were evaluated for newborns in Viçosa, MG, Southeastern Brazil. It involved collecting 7 mL of umbilical cord blood from 144 full-term not underweight newborns. The parameters investigated were complete blood count, serum iron, ferritin and C-reactive protein. The time of umbilical cord clamping was measured using a digital timer without interfering in the procedures of childbirth. The birth data were collected from Live Birth Certificates and other information was obtained from the mother through a questionnaire applied in the first month postpartum. Analysis of multiple linear regression was then used to estimate the influence of biological, obstetrics and socioeconomic factors on the ferritin levels at birth. RESULTS: The median ferritin was 130.3 µg/L (n = 129, minimum = 16.4; maximum = 420.5 µg/L), the mean serum iron was 137.9 µg/dL (n = 144, SD = 39.29) and mean hemoglobin was 14.7 g/dL (n = 144, SD = 1.47). The median time of cord clamping was 36 seconds, ranging between 7 and 100. The bivariate analysis detected an association between ferritin levels and color of the child, timing clamping of 60 seconds, type of delivery, the presence of gestational diabetes and per capita family income. In multivariate analysis, the variables per capita income, number of antenatal visits and length at birth accounted for 22.0% of variation in ferritin levels. CONCLUSIONS: Iron stores at birth were influenced by biological, obstetric and social characteristics. Tackling anemia should involve creating policies aimed at reducing social inequalities, improving the quality of antenatal care, as well as implementing a criterion of delayed clamping of the umbilical cord within the guidelines of labor.

Tempo de clampeamento e fatores associados à reserva de ferro de neonatos a termo / Tiempo de sujeción y factores asociados a la reserva de hierro en neonatos a término / Timing of clamping and factors associated with iron stores in full-term newborns

OBJETIVO : Analisar o impacto do tempo de clampeamento e parâmetros obstétricos, biológicos e socioeconômicos sobre a reserva de ferro de neonatos nascidos a termo. MÉTODOS : Estudo transversal pelo qual foram avaliados os parâmetros hematológicos de neonatos de Viçosa, MG, de outubro de 2011 a julho de 2012. Foram coletados 7 mL de sangue do cordão umbilical de 144 neonatos a termo e sem baixo peso. Os parâmetros investigados foram: hemograma completo, ferro sérico, ferritina e proteína C-reativa. O tempo de clampeamento do cordão umbilical foi mensurado utilizando cronômetro digital sem interferir nos procedimentos do parto. Os dados de nascimento foram coletados nas Declarações de Nascidos Vivos e as demais informações foram obtidas com a mãe do neonato por aplicação de questionário no primeiro mês pós-parto. Realizou-se análise de regressão linear múltipla visando a estimar a influência de variáveis obstétricas, biológicas e socioeconômicas nos níveis de ferritina ao nascer. RESULTADOS : A mediana de ferritina foi 130,3 µg/L (n = 129, mínimo de 16,4 e máximo 420,5 µg/L), a média de ferro sérico foi 137,9 μg/dL (n = 144, dp = 39,29) e de hemoglobina, 14,7 g/dL (n = 144, dp = 1,47). O tempo mediano de clampeamento do cordão foi 36 segundos, variando entre sete e 100. A análise bivariada detectou associação entre os níveis de ferritina e a cor da criança, tempo de clampeamento de 60 segundos, tipo de parto, a presença de diabetes gestacional e a renda per capita da família. Renda per capita, número de consultas pré-natais e o comprimento ao nascer contribuíram com 22,0% da variação dos níveis de ferritina na análise múltipla. CONCLUSÕES : A reserva ...

OBJETIVO : Analizar el impacto de tiempo de sujeción y parámetros obstétricos, biológicos y socioeconómicos sobre la reserva de hierro en neonatos nacidos a término. MÉTODOS : Estudio transversal por el cual fueron evaluados los parámetros hematológicos de neonatos de Viçosa, MG – Brasil, de octubre de 2011 a julio de 2012. Se colectaron 7 mL de sangre de cordón umbilical de 144 neonatos a término y sin bajo peso. Los parámetros investigados fueron: hemograma completo, hierro sérico, ferritina y proteína C-reactiva. El tiempo de sujeción del cordón umbilical fue medido utilizando cronómetro digital sin interferir en los procedimientos del parto. Los datos de nacimiento fueron colectados en las Declaraciones de Nacidos Vivos y las demás informaciones fueron obtenidas con la madre de neonato por aplicación de cuestionario en el primer mes post-parto. Se realizó análisis de regresión linear múltiple visando a estimar la influencia de variables obstétricas, biológicas y socioeconómicas en los niveles de ferritina al nacer. RESULTADOS : La mediana de ferritina fue 130,3 μg/L (n=129, mínimo de 16,4 y máximo 420,5μg/L), el promedio de hierro sérico fue 137,9 mcg/dL (n=144, ds=39,29) y de hemoglobina, 14,7 g/dL (n=144, ds=1,47). El tiempo mediano de sujeción del cordón fue de 36 segundos, variando entre siete y 100. El análisis bivariado detectó asociación entre los niveles de ferritina y el color del niño, tiempo de sujeción de 60 segundos, tipo de parto, la presencia de diabetes en la gestación y la renta per cápita de la familia. Renta per cápita, número de consultas pre-natales y la estatura al nacer contribuirían con 22,0% de la variación de los niveles de ferritina en el análisis múltiple. ...

OBJECTIVE : To analyze the impact of timing of clamping and obstetric, biological and socioeconomic factors on the iron stores of full-term newborns. METHODS : Cross-sectional study between October 2011 and July 2012 in which hematological parameters were evaluated for newborns in Viçosa, MG, Southeastern Brazil. It involved collecting 7 mL of umbilical cord blood from 144 full-term not underweight newborns. The parameters investigated were complete blood count, serum iron, ferritin and C-reactive protein. The time of umbilical cord clamping was measured using a digital timer without interfering in the procedures of childbirth. The birth data were collected from Live Birth Certificates and other information was obtained from the mother through a questionnaire applied in the first month postpartum. Analysis of multiple linear regression was then used to estimate the influence of biological, obstetrics and socioeconomic factors on the ferritin levels at birth. RESULTS : The median ferritin was 130.3 µg/L (n = 129, minimum = 16.4; maximum = 420.5 µg/L), the mean serum iron was 137.9 μg/dL (n = 144, SD = 39.29) and mean hemoglobin was 14.7 g/dL (n = 144, SD = 1.47). The median time of cord clamping was 36 seconds, ranging between 7 and 100. The bivariate analysis detected an association between ferritin levels and color of the child, timing clamping of 60 seconds, type of delivery, the presence of gestational diabetes and per capita family income. In multivariate analysis, the variables per capita income, number of antenatal visits and length at birth accounted for 22.0% of variation in ferritin levels. CONCLUSIONS : Iron stores at birth were influenced by biological, obstetric and social characteristics. Tackling anemia should involve creating policies aimed at reducing social inequalities, improving the quality of antenatal care, as well as implementing a criterion of delayed clamping of the umbilical cord ...