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1.
Nutrients ; 13(8)2021 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-34444895

RESUMO

(1) Background: Early childhood malnutrition may result in increased fat mass (FM) among school-aged children in low- and middle-income countries (LMICs). We explored whether South African children with shorter stature have greater overall and abdominal FM compared to normal stature children. (2) Methods: Baseline assessments of body composition and weight were determined among school-aged children enrolled in a randomized controlled trial in Port Elizabeth, South Africa, using bioelectrical impedance analysis. Multiple linear regression models tested associations of children's height and degree of stunting with FM, fat free mass (FFM), truncal fat mass (TrFM), and truncal fat free mass (TrFFM) overall and by sex. (3) Results: A total of 1287 children (619 girls, 668 boys) were assessed at baseline. Reduced child height was associated with higher FM and lower FFM and TrFFM, but these associations were reversed with increases in height. Girls classified as mildly or moderately/severely stunted had higher FM and TrFM but lower FFM and TrFFM, while no association was found for boys. (4) Conclusions: Our study suggests that efforts to reduce the non-communicable disease burden in LMICs should target growth-impaired children who may have greater overall FM and greater abdominal FM.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Composição Corporal , Estatura , Transtornos do Crescimento/fisiopatologia , Tecido Adiposo , Criança , Impedância Elétrica , Feminino , Transtornos do Crescimento/epidemiologia , Humanos , Modelos Lineares , Masculino , Estado Nutricional , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores Sexuais , África do Sul/epidemiologia
2.
Nutrients ; 13(8)2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34445025

RESUMO

The health and nutrition of the global adolescent population have been under-researched, in spite of its significant size (1.2 billion). This study investigates the prevalence and associated factors of malnutrition (stunting, thinness and overweight) among adolescents living in South Asia. The sample analysed was 24,053 South Asian schooled adolescents aged 12-15 years that participated in the cross-sectional Global School-Based Student Health Survey (GSHS) between 2009 and 2016. The prevalence of stunting, thinness and overweight was calculated using the World Health Organization (WHO) Child Growth Reference 2007. Associations between the three forms of malnutrition and their possible associated factors were assessed with binary logistic regression analysis using bootstrapping as a resampling method. The overall prevalence of stunting in South Asia was 13%, thinness was 10.8% and overweight was 10.8%. In the logistic regression model of the overall pooled sample, the factors associated with adolescent malnutrition were: age, hygiene behaviours, social support, sedentary behaviour, and tobacco use. A substantial proportion of stunting, thinness and overweight was found among school-going South Asian adolescents, indicating that the double burden of malnutrition is present in this population. Future research should seek to further understand the relationship between all forms of malnutrition and its associated factors in the adolescent population.


Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Transtornos do Crescimento/epidemiologia , Desnutrição/epidemiologia , Obesidade Pediátrica/epidemiologia , Magreza/epidemiologia , Adolescente , Fenômenos Fisiológicos da Nutrição do Adolescente , Fatores Etários , Ásia/epidemiologia , Criança , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/fisiopatologia , Estudos Transversais , Feminino , Transtornos do Crescimento/diagnóstico , Transtornos do Crescimento/fisiopatologia , Inquéritos Epidemiológicos , Humanos , Masculino , Desnutrição/diagnóstico , Desnutrição/fisiopatologia , Estado Nutricional , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/fisiopatologia , Prevalência , Medição de Risco , Fatores de Risco , Magreza/diagnóstico , Magreza/fisiopatologia
3.
Med Sci Sports Exerc ; 53(8): 1561-1571, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34261989

RESUMO

INTRODUCTION: A total of 161 million children a year are growth restricted, leading to a 47% increased risk of chronic disease in adulthood. Physical activity (PA) reduces the risk of mortality from chronic disease. The purpose of the present investigation was to determine the effect of a PA intervention (wheel running) on cardiac and skeletal muscle capacities in gestational (GUN) and postnatal (PUN) growth-restricted mice as compared with nonrestricted controls (CON). METHODS: A low-protein cross-fostering FVB mouse model was used to induce growth restriction during gestation and the first 21 d of postnatal life. Mouse pups were recovered on a healthy diet until mature and provided wheel access for 3 wk. At completion of the PA intervention, mice underwent maximal exercise testing on a treadmill, echocardiography, and skeletal muscle histology. RESULTS: After the PA intervention, CON mice had a 45% improvement in maximal exercise capacity (P = 0.0390) because of cardiac and skeletal muscle adaptations, but GUN and PUN mice did not. Alarmingly, PUN female mice exposed to wheels had 11.45% lower left ventricular volume (P = 0.0540) and 18% lower left ventricle area (P = 0.0585), with blood flow velocities indicative of cardiac fibrosis (GUN had elevated isovolumetric contraction time P = 0.0374; GUN females and PUN males had longer isovolumetric relaxation time P = 0.0703). PUN male mice had mixed skeletal muscle responses with an oxidative shift in the diaphragm (P = 0.0162) but a glycolytic shift in the extensor digitorum longus (P = 0.0647). PUN female mice had a glycolytic shift in the soleus after wheel running. CONCLUSIONS: Unexpectedly, growth-restricted mice were nonresponders to a PA intervention and displayed negative cardiac outcomes.


Assuntos
Tolerância ao Exercício , Transtornos do Crescimento/fisiopatologia , Músculo Esquelético/fisiopatologia , Miocárdio/patologia , Condicionamento Físico Animal , Animais , Feminino , Retardo do Crescimento Fetal , Masculino , Camundongos
4.
Biomed Res Int ; 2021: 6640026, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33997034

RESUMO

Objective: To identify the aetiology of growth and development diseases and assess the long-term effectiveness of recombinant human growth hormone (rhGH) therapy in a real-life clinical setting and provide better guidance in clinical strategy and decision making. Methods: This retrospective study included 1145 children and adolescents with short stature admitted to the Department of Endocrinology, Affiliated Hospital of Jining Medical University, from January 2013 to December 2019, of whom 484 received rhGH treatment. The related anthropometrics and laboratory examinations were assessed in all participants. Results: A total of 1145 children and adolescents with short stature aged 10.5 ± 3.3 years, including 740 boys and 405 girls, were analysed in this study. The number of children and adolescents with short stature gradually increased per year from 2013 to 2019. The mean pretreatment height standard deviation score (SDS) and insulin-like growth factor-1 SDS were -2.93 ± 1.05 and -1.01 (-1.83--0.16), respectively. The majority of the children (658, 57.47%) were prepubescent. In total, 484 subjects aged 10.6 ± 3.2 years received rhGH and were followed up, and among them, 292 children were treated for more than one year. As the treatment time increased, the children's height SDS gradually increased, and most of them attained a height SDS within the normal range. The mean height SDS in children who were treated for more than one year was -3.0 ± 1.0 at baseline and gradually increased to -0.8 ± 0.3 by year 6. The results were consistent across subgroups of different aetiologies of short stature. Conclusions: Increasing attention has been given to the height of children during the period of 2013-2019 in eastern China. The present findings indicate that children with short stature need to be referred to a specialist centre to diagnose the cause of growth failure and that short children receiving rhGH therapy show a significant increase in height over time.


Assuntos
Estatura/fisiologia , Transtornos do Crescimento , Adolescente , Criança , China , Feminino , Transtornos do Crescimento/diagnóstico , Transtornos do Crescimento/tratamento farmacológico , Transtornos do Crescimento/fisiopatologia , Hormônio do Crescimento Humano/uso terapêutico , Humanos , Masculino , Estudos Retrospectivos
5.
Nat Commun ; 12(1): 443, 2021 01 26.
Artigo em Inglês | MEDLINE | ID: mdl-33500411

RESUMO

Exposure to antibiotics in the first days of life is thought to affect various physiological aspects of neonatal development. Here, we investigate the long-term impact of antibiotic treatment in the neonatal period and early childhood on child growth in an unselected birth cohort of 12,422 children born at full term. We find significant attenuation of weight and height gain during the first 6 years of life after neonatal antibiotic exposure in boys, but not in girls, after adjusting for potential confounders. In contrast, antibiotic use after the neonatal period but during the first 6 years of life is associated with significantly higher body mass index throughout the study period in both boys and girls. Neonatal antibiotic exposure is associated with significant differences in the gut microbiome, particularly in decreased abundance and diversity of fecal Bifidobacteria until 2 years of age. Finally, we demonstrate that fecal microbiota transplant from antibiotic-exposed children to germ-free male, but not female, mice results in significant growth impairment. Thus, we conclude that neonatal antibiotic exposure is associated with a long-term gut microbiome perturbation and may result in reduced growth in boys during the first six years of life while antibiotic use later in childhood is associated with increased body mass index.


Assuntos
Antibacterianos/efeitos adversos , Infecções Bacterianas/tratamento farmacológico , Microbioma Gastrointestinal/efeitos dos fármacos , Transtornos do Crescimento/induzido quimicamente , Animais , Estatura/efeitos dos fármacos , Estatura/fisiologia , Índice de Massa Corporal , Peso Corporal/efeitos dos fármacos , Peso Corporal/fisiologia , Criança , Pré-Escolar , Modelos Animais de Doenças , Transplante de Microbiota Fecal , Fezes/microbiologia , Feminino , Seguimentos , Microbioma Gastrointestinal/fisiologia , Vida Livre de Germes , Transtornos do Crescimento/microbiologia , Transtornos do Crescimento/fisiopatologia , Humanos , Recém-Nascido , Mucosa Intestinal/microbiologia , Masculino , Camundongos , Gravidez , Fatores de Risco , Fatores Sexuais
6.
J Nippon Med Sch ; 88(1): 39-44, 2021 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-32475901

RESUMO

BACKGROUND: Since 2002, the Department of Pediatrics of Nippon Medical School Chiba Hokusoh Hospital has offered educational activities for children with short stature. We analyzed outcomes of growth hormone (GH) treatment for children with short stature treated at our hospital, particularly outcomes after the growth spurt. METHODS: We analyzed data from children aged 0 to 17 years who were treated with recombinant GH during the period from 2000 through 2016 and were followed for at least 2 years after the start of treatment. RESULTS: Among children with short stature, 85 had GH deficiency, 5 had Turner syndrome, 9 were small for gestational age, and 1 had Noonan syndrome. The outcomes of GH treatment was similar to those previously reported in Japan. Children with GH deficiency who started GH treatment before the growth spurt exhibited marked height catch-up until the second year, but the effect decreased after 3 years. The effect of treatment for GH deficiency that was started after the growth spurt continued for 4 to 5 years after the start of treatment. CONCLUSIONS: Improvement in height standard deviation score was similar when treatment was started before and after the growth spurt.


Assuntos
Estatura/efeitos dos fármacos , Transtornos do Crescimento/tratamento farmacológico , Hormônio do Crescimento/administração & dosagem , Hormônio do Crescimento/farmacologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Nanismo Hipofisário/tratamento farmacológico , Nanismo Hipofisário/fisiopatologia , Feminino , Seguimentos , Transtornos do Crescimento/fisiopatologia , Hospitais Universitários , Humanos , Lactente , Japão , Masculino , Faculdades de Medicina , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Síndrome de Turner/tratamento farmacológico , Síndrome de Turner/fisiopatologia
7.
Ann Clin Lab Sci ; 50(6): 818-824, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33334799

RESUMO

Baraitser-Winter Cerebro-fronto-facial syndrome (BWCFF, OMIM #243310, #614583) is caused by a heterozygous gain-of-function mutation of ACTB and ACTG1 that encodes actin. The syndrome is characterized by striking facial features, structural brain abnormalities, ocular coloboma, hearing loss, cardiac defects, intellectual disabilities, short stature, and developmental delay. We report a two-year-old girl who had distinctive facial features, including hypertelorism, arched eyebrows, bilateral ptosis, short broad nose with a flat nasal tip, long philtrum, retrognathia, low-set ears, and a thin upper lip. In addition, she also exhibited short stature, pectus excavatum, developmental delay, brain malformation, and hearing loss. Targeted gene panel sequencing identified a de novo heterozygous missense variant c.826G>A (p.Glu276Lys) in ACTB This is the first Korean case of BWCFF with a novel mutation in ACTB.


Assuntos
Actinas/genética , Transtornos do Crescimento/genética , Hidrocefalia/genética , Retardo Mental Ligado ao Cromossomo X/genética , Obesidade/genética , Anormalidades Múltiplas/genética , Actinas/metabolismo , Pré-Escolar , Coloboma/genética , Deficiências do Desenvolvimento/genética , Face , Facies , Feminino , Transtornos do Crescimento/fisiopatologia , Heterozigoto , Humanos , Hidrocefalia/fisiopatologia , Deficiência Intelectual/genética , Retardo Mental Ligado ao Cromossomo X/fisiopatologia , Obesidade/fisiopatologia , República da Coreia , Síndrome
8.
Sci Rep ; 10(1): 20019, 2020 11 18.
Artigo em Inglês | MEDLINE | ID: mdl-33208763

RESUMO

In this study, we examine the concepts of spatial dependence and spatial heterogeneity in the effect of macro-level and micro-level factors on stunting among children aged under five in Uganda. We conducted a cross-sectional analysis of 3624 Ugandan children aged under five, using data from the 2016 Ugandan Demographic and Health Survey. Multilevel mixed-effect analysis, spatial regression methods and multi-scale geographically weight regression (MGWR) analysis were employed to examine the association between our predictors and stunting as well as to analyse spatial dependence and variability in the association. Approximately 28% of children were stunted. In the multilevel analysis, the effect of drought, diurnal temperature and livestock per km2 on stunting was modified by child, parent and household factors. Likewise, the contextual factors had a modifiable effect on the association between child's sex, mother's education and stunting. The results of the spatial regression models indicate a significant spatial error dependence in the residuals. The MGWR suggests rainfall and diurnal temperature had spatial varying associations with stunting. The spatial heterogeneity of rainfall and diurnal temperature as predictors of stunting suggest some areas in Uganda might be more sensitive to variability in these climatic conditions in relation to stunting than others.


Assuntos
Transtornos do Crescimento/epidemiologia , Desnutrição/epidemiologia , Análise Multinível/métodos , Fatores Socioeconômicos , Análise Espacial , Adolescente , Adulto , Pré-Escolar , Estudos Transversais , Escolaridade , Características da Família , Feminino , Transtornos do Crescimento/fisiopatologia , Inquéritos Epidemiológicos , Humanos , Lactente , Masculino , Desnutrição/fisiopatologia , Pessoa de Meia-Idade , Fatores de Risco , Uganda/epidemiologia , Adulto Jovem
9.
J Pediatr Endocrinol Metab ; 33(10): 1335-1339, 2020 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-32866124

RESUMO

Objectives Imprinted genes have important roles for normal growth and development. Imprinting disorders (IDs) such as Silver-Russell syndrome and Temple syndrome are rare diseases that typically cause short children born small for gestational age (SGA). However, some patients with short stature (SS) caused by IDs were born non-SGA. To date, the contribution of IDs to idiopathic short stature (ISS) has been poorly investigated. The aim of this study was to clarify the contribution of IDs to ISS. Methods We conducted methylation analysis for 10 differentially methylated regions using pyrosequencing to detect known IDs in 58 patients (31 male and 27 female children, height standard deviation score -4.2 to -2.0) carrying a clinical diagnosis of ISS. Results We identified no patient with IDs among these patients with ISS. Conclusions These results indicate that IDs are rare in patients having ISS, and that imprinted genes affect fetal growth more than postnatal growth. Because patients with IDs born non-SGA usually have clinical features characteristic of each ID, in addition to SS, the patients with ISS as a clinical diagnosis may not be associated with IDs. It is unlikely that cases clinically diagnosed with ISS are caused by IDs leading to growth failure.


Assuntos
Metilação de DNA , Nanismo/fisiopatologia , Doenças Genéticas Inatas/diagnóstico , Impressão Genômica , Transtornos do Crescimento/fisiopatologia , Programas de Rastreamento , Adolescente , Biomarcadores/análise , Criança , Pré-Escolar , Feminino , Seguimentos , Doenças Genéticas Inatas/epidemiologia , Doenças Genéticas Inatas/genética , Doenças Genéticas Inatas/patologia , Humanos , Japão/epidemiologia , Masculino , Prognóstico
10.
Biochem Biophys Res Commun ; 532(3): 336-340, 2020 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-32873390

RESUMO

Golgi matrix protein 130 (GM130), encoded by GOLGA2, is the classical marker of the Golgi apparatus. It plays important roles in various mitotic events, such as interacting with importin-alpha and liberating spindle assembly factor TPX2 to regulate mitotic spindle formation. A previous study showed that in vitro knockdown of GM130 could regulate the meiotic spindle pole assembly. In the current study, we found that knockout (KO) mice progressively died, had a small body size and were completely infertile. Furthermore, we constructed an oocyte-specific GM130 knockout mouse model (GM130-ooKO) driven by Gdf9-Cre. Through breeding assays, we found that the GM130-ooKO mice showed similar fecundity as control mice. During superovulation assays, the KO and GM130-ooKO mice had comparable numbers of ovulated eggs, oocyte maturation rates and normal polar bodies, similar to the control groups. Thus, this study indicated that deletion of GM130 might have a limited impact on the maturation and morphology of oocytes. This might due to more than one golgin sharing the same function, with others compensating for the loss of GM130.


Assuntos
Desenvolvimento Embrionário/fisiologia , Meiose/fisiologia , Proteínas de Membrana/deficiência , Oócitos/citologia , Oócitos/fisiologia , Animais , Autoantígenos/genética , Autoantígenos/fisiologia , Desenvolvimento Embrionário/genética , Feminino , Fertilidade/genética , Fertilidade/fisiologia , Complexo de Golgi/fisiologia , Transtornos do Crescimento/genética , Transtornos do Crescimento/fisiopatologia , Infertilidade Feminina/genética , Infertilidade Feminina/fisiopatologia , Masculino , Meiose/genética , Proteínas de Membrana/genética , Proteínas de Membrana/fisiologia , Camundongos , Camundongos Knockout , Oogênese/genética , Oogênese/fisiologia , Ovulação/genética , Ovulação/fisiologia , Gravidez
11.
PLoS One ; 15(9): e0239255, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32970709

RESUMO

BACKGROUND: Stunting is a worldwide public health problem caused by factors that vary across regions, including in Ethiopia. Limited evidence to prevent stunting makes it difficult to design and prioritize appropriate interventions. Therefore, this study investigated the intervention priorities for the prevention of stunting among children 6-59 months old in Kemissie City Administration, northeastern Ethiopia. METHODS: A community-based individual matched case-control study was conducted from January to April 2017 including 107 cases and 214 controls. Controls were selected and matched with cases using the matching variable of child's age. Data were collected by open data kit (ODK) software using a structured questionnaire. Data were analyzed using STATA version 13.0 and WHO (World Health Organization) Anthro 2005. A conditional logistic regression model was used for data analysis. From multivariable conditional logistic regression analysis, determinants of stunting were identified. A statistically significant level was declared by a conditional adjusted odds ratio (cAOR) with 95% confidence interval (CI) and p-value of less than 0.05. MAIN FINDINGS: The wealth index 52 (48.6%) of the cases and 108 (50.5%) controls were categorized as poor. The mean height-for-age z-score (HAZ) for the cases and controls was -2.79±.67 and -0.55±.92, respectively. One-sixth (16.8%) of the cases and 29 (13.6%) of the controls were given prelacteal feeding. A majority 82 (86.9%) of the cases and 137 (69.1%) of the controls had undernourished mothers/care-givers. Slightly less than one-third 35 (32.7%) of cases and one-fourth 53 (24.8%) of controls were affected by repeated episodes of diarrhea. Mother's body mass index (BMI) (conditional adjusted odds ratio [cAOR]) = 2.64; 95% CI: 1.28, 5.43), giving food priority to father (cAOR = 2.42; 95% CI: 1.23, 4.75), lack of exclusive breastfeeding for at least 6 months (cAOR = 2.44; 95% CI: 1.15, 5.17), no intake of meat by child (cAOR = 2.35; 95% CI: 1.21, 4.58) and child having repeated diarrheal episodes (cAOR = 2.0: 95% CI: 1.07, 3.86) were factors associated with childhood stunting. CONCLUSION: Maternal nutritional status, food priority, duration of exclusive breastfeeding, no intake of meat and repeated episodes of diarrhea were the main determinants of stunting among children aged 6-59 months. Therefore, intervention measures to avert childhood stunting should include strengthening action on provision of essential nutrition, providing counseling to parents on giving food priority to children, promotion of optimal duration of breastfeeding and preventing diarrheal disease among children 6-59 months old.


Assuntos
Transtornos do Crescimento/epidemiologia , Fenômenos Fisiológicos da Nutrição Materna , Estado Nutricional , Adulto , Pré-Escolar , Etiópia/epidemiologia , Feminino , Transtornos do Crescimento/metabolismo , Transtornos do Crescimento/fisiopatologia , Transtornos do Crescimento/terapia , Humanos , Lactente , Modelos Logísticos , Masculino , Mães , Pais , Prevalência , Fatores de Risco , Fatores Socioeconômicos
12.
Dev Med Child Neurol ; 62(11): 1309-1316, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32779195

RESUMO

AIM: To describe the trajectory of clinical signs in children who developed human immunodeficiency virus encephalopathy (HIVE) after starting early antiretroviral therapy (ART). METHOD: This was a retrospective case-cohort description of HIVE among Cape Town participants from the Children with HIV Early AntiRetroviral treatment (CHER) trial. Criteria for HIVE diagnosis were at least two of: (1) acquired central motor deficit, (2) impaired brain growth, and (3) failure to attain or loss of developmental milestones in the absence of an alternative aetiology. RESULTS: Of 133 surviving participants who initiated ART at a median age of 9 weeks and who were followed until a median age of 6 years, 20 (12%) developed HIVE at a median age 31 months (interquartile range 19-37). In these, the first neurological deterioration was noticed at a median age of 19 months, when 16 were on ART and nine had undetectable HIV viral load for a median of 12 months. Signs of upper motor neurons were present in 18, of whom 12 resolved and four had persistent spastic diplegia; 19 had motor delay, of whom 14 resolved; 12 had language delay, of whom 11 resolved; and 16 had impaired brain growth, of whom only five recovered. For the 16 participants already on ART at HIVE diagnosis, regimens were not altered in response to diagnosis. INTERPRETATION: HIVE may occur despite early ART initiation and virological suppression and then resolve on unchanged ART, most likely as intrathecal inflammation subsides. WHAT THIS PAPER ADDS: Despite suppressive antiretroviral therapy, children can develop human immunodeficiency virus encephalopathy, The most common manifestations are motor deficits and impaired brain growth. Most experience improvement, with many resolving without additional intervention.


Assuntos
Complexo AIDS Demência , Antirretrovirais/administração & dosagem , Encéfalo , Deficiências do Desenvolvimento , Transtornos do Crescimento , Transmissão Vertical de Doenças Infecciosas , Transtornos dos Movimentos , Avaliação de Resultados em Cuidados de Saúde , Complexo AIDS Demência/complicações , Complexo AIDS Demência/tratamento farmacológico , Complexo AIDS Demência/fisiopatologia , Encéfalo/crescimento & desenvolvimento , Encéfalo/fisiopatologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Deficiências do Desenvolvimento/etiologia , Deficiências do Desenvolvimento/fisiopatologia , Feminino , Seguimentos , Transtornos do Crescimento/etiologia , Transtornos do Crescimento/fisiopatologia , Humanos , Lactente , Masculino , Transtornos dos Movimentos/etiologia , Transtornos dos Movimentos/fisiopatologia , Estudos Retrospectivos , África do Sul
13.
Scand J Med Sci Sports ; 30(12): 2408-2419, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32799360

RESUMO

We use a multivariate multilevel model to study the links between physical fitness (PF) and gross motor coordination (GMC) and investigate the influence of predictors affecting their levels across age. We sampled 7918 Peruvians, aged 6-15 years, from sea-level, Amazon region and high-altitude. Composite markers of GMC and PF were derived (GMCz and PFz , respectively). BMI, biological maturation, and stunting were assessed. School characteristics were obtained via an objective audit. School contexts explained 35% of the associations between PFz and GMCz , whereas children's characteristics explained 65% of the total variation. On average, with increasing age, there was a greater increase in GMCz (ß = 0.79 ± 0.04, P < .001) than in PFz (ß = 0.15 ± 0.03, P < .001); boys outperformed girls (PFz , ß = 3.25 ± 0.08, P < .001; GMCz , ß = 1.58 ± 0.09, P < .001); those with lower BMI and ahead in their maturation had higher PFz (ß = -0.13 ± 0.01, P < .001; ß = 1.09 ± 0.05, P < .001, respectively) and GMCz (ß = -0.18 ± 0.01, P < .001; ß = 0.39 ± 0.06, P < .001, respectively) levels. Stunting was negatively related to PFz (ß = -0.30 ± 0.07; P < .001) and GMCz (ß = -0.30 ± 0.08, P < .001) and high-altitude Peruvians had significantly lower GMCz (ß = -0.93 ± 0.33, P < .001), and those living in the Amazon region had significantly higher PFz (ß = 1.21 ± 0.58, P < .001) compared to those living at sea level. A higher number of students was negatively related to PFz (ß = -0.016 ± 0.006, P < .001) and positively with GMCz (ß = 0.005 ± 0.003, P < .001); the duration of physical education classes was positively associated with PFz (ß = 0.70 ± 0.32, P < .001) and GMCz (ß = 0.46 ± 0.15, P < .001); and the existence of policies for physical activity was only negatively associated with GMCz (ß = -1.17 ± 0.34, P < .001). In conclusion, PFz and GMCz were positively correlated and child- and school-level traits predicted their levels.


Assuntos
Desenvolvimento do Adolescente/fisiologia , Desenvolvimento Infantil/fisiologia , Destreza Motora , Aptidão Física , Adolescente , Altitude , Índice de Massa Corporal , Criança , Feminino , Transtornos do Crescimento/fisiopatologia , Habitação , Humanos , Masculino , Análise Multinível , Peru , Fatores Sexuais , Maturidade Sexual , Fatores Socioeconômicos
14.
Am J Clin Nutr ; 112(Suppl 2): 777S-791S, 2020 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-32860401

RESUMO

BACKGROUND: Progress has been made worldwide in reducing chronic undernutrition and rates of linear growth stunting in children under 5 y of age, although rates still remain high in many regions. Policies, programs, and interventions supporting maternal and child health and nutrition have the potential to improve child growth and development. OBJECTIVE: This article synthesizes the available global evidence on the drivers of national declines in stunting prevalence and compares the relative effect of major drivers of stunting decline between countries. METHODS: We conducted a systematic review of published peer-reviewed and gray literature analyzing the relation between changes in key determinants of child linear growth and contemporaneous changes in linear growth outcomes over time. RESULTS: Among the basic determinants of stunting assessed within regression-decomposition analyses, improvement in asset index score was a consistent and strong driver of improved linear growth outcomes. Increased parental education was also a strong predictor of improved child growth. Of the underlying determinants of stunting, reduced rates of open defecation, improved sanitation infrastructure, and improved access to key maternal health services, including optimal antenatal care and delivery in a health facility or with a skilled birth attendant, all accounted for substantially improved child growth, although the magnitude of variation explained by each differed substantially between countries. At the immediate level, changes in several maternal characteristics predicted modest stunting reductions, including parity, interpregnancy interval, and maternal height. CONCLUSIONS: Unique sets of stunting determinants predicted stunting reduction within countries that have reduced stunting. Several common drivers emerge at the basic, underlying, and immediate levels, including improvements in maternal and paternal education, household socioeconomic status, sanitation conditions, maternal health services access, and family planning. Further data collection and in-depth mixed-methods research are required to strengthen recommendations for those countries where the stunting burden remains unacceptably high.


Assuntos
Saúde da Criança/tendências , Transtornos do Crescimento/epidemiologia , Adolescente , Criança , Desenvolvimento Infantil , Pré-Escolar , Feminino , Transtornos do Crescimento/metabolismo , Transtornos do Crescimento/fisiopatologia , Transtornos do Crescimento/prevenção & controle , Humanos , Masculino , Estado Nutricional
15.
Am J Clin Nutr ; 112(Suppl 2): 816S-829S, 2020 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-32860403

RESUMO

BACKGROUND: Peru reduced its under-5 child stunting prevalence notably from 31.3% in 2000 to 13.1% in 2016. OBJECTIVES: We aimed to study factors and key enablers of child stunting reduction in Peru from 2000-2016. METHODS: Demographic and Health Surveys were used to conduct descriptive analyses [height-for-age z scores (HAZ) means and distributions, equity analysis, predicted child growth curves through polynomial regressions] and advanced regression analyses. An ecological (at department level) multilevel regression analysis was conducted to identify the major predictors of stunting decline from 2000 to 2016, and Oaxaca-Blinder decomposition was conducted to identify the relative contribution of each factor to child HAZ change. A systematic literature review, policy and program analysis, and interviews with relevant stakeholders were conducted to understand key drivers of stunting decline in Peru. RESULTS: The distribution of HAZ scores showed a slight rightward shift from 2000 to 2007/2008, and a greater shift from 2007/2008 to 2016. Stunting reduction was higher in the lowest wealth quintile, in rural areas, and among children with the least educated mothers. Decomposing predicted changes showed that the most important factors were increased maternal BMI and maternal height, improved maternal and newborn health care, increased parental education, migration to urban areas, and reduced fertility. Key drivers included the advocacy role of civil society and political leadership around poverty and stunting reduction since the early 2000s. Key enablers included the economic growth and the consolidation of democracy since the early 2000s, and the acknowledgement that stunting reduction needs much more than food supplementation. CONCLUSIONS: Peru reduced child stunting owing to improved socioeconomic determinants, sustained implementation of out-of-health-sector and within-health-sector changes, and implementation of health interventions. These efforts were driven through a multisectoral approach, strong civil society advocacy, and keen political leadership. Peru's experience offers useful lessons on how to tackle the problem of stunting under differing scenarios, with the participation of multiple sectors.


Assuntos
Transtornos do Crescimento/epidemiologia , Desenvolvimento Infantil , Pré-Escolar , Escolaridade , Feminino , Transtornos do Crescimento/economia , Transtornos do Crescimento/fisiopatologia , Transtornos do Crescimento/prevenção & controle , Humanos , Lactente , Masculino , Peru/epidemiologia , Pobreza , Prevalência , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , População Urbana/estatística & dados numéricos
17.
Biol Res Nurs ; 22(4): 552-560, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32666821

RESUMO

While weight gain is common following migration to a new country and Mexican Americans have a disparate prevalence of overweight and obesity. In particular, Mexican American women have one of the world's highest rates of Metabolic Syndrome (MetS), characterized by abdominal obesity, insulin resistance, hypertension, and dyslipidemia, all of which increase the risk for atherosclerotic cardiovascular disease (CVD). Although the etiology of this dilemma is not well understood, using the framework of allostatic load (AL), we posit that exposure to multiple physiologic, psychosocial and environmental stressors over the course of the lifespan may contribute to an increased risk of MetS among indigenous Mexican immigrant women. Two such frequently overlooked stressors are: 1) a history of childhood growth stunting (CGS) and 2) dietary changes post migration that result in decreased diversity of the gut microbiome (dysbiosis). To date, little is known about how migration experiences differentially affect the relationship between CGS and MetS in adulthood. The purpose of this theoretical article is to present a proposed model of how early life stressors (ELS), specifically CGS, may interact with insalubrious aspects of the immigration experience to promote an increased risk for MetS among indigenous Mexican immigrant women. This model may be used in a bi-national effort to guide intervention efforts to decrease CGS in Mexico and to prevent, monitor or delay the components of MetS post migration in the US.


Assuntos
Disbiose/epidemiologia , Disbiose/fisiopatologia , Emigrantes e Imigrantes/estatística & dados numéricos , Transtornos do Crescimento/fisiopatologia , Povos Indígenas/estatística & dados numéricos , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Estados Unidos/epidemiologia
18.
Am J Clin Nutr ; 112(Suppl 2): 806S-815S, 2020 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-32672330

RESUMO

BACKGROUND: Population-based surveys collect crucial data on anthropometric measures to track trends in stunting [height-for-age z score (HAZ) < -2SD] and wasting [weight-for-height z score (WHZ) < -2SD] prevalence among young children globally. However, the quality of the anthropometric data varies between surveys, which may affect population-based estimates of malnutrition. OBJECTIVES: We aimed to develop composite indices of anthropometric data quality for use in multisurvey analysis of child health and nutritional status. METHODS: We used anthropometric data for children 0-59 mo of age from all publicly available Demographic and Health Surveys (DHS) from 2000 onwards. We derived 6 indicators of anthropometric data quality at the survey level, including 1) date of birth completeness, 2) anthropometric measure completeness, 3) digit preference for height and age, 4) difference in mean HAZ by month of birth, 5) proportion of biologically implausible values, and 6) dispersion of HAZ and WHZ distribution. Principal component factor analysis was used to generate a composite index of anthropometric data quality for HAZ and WHZ separately. Surveys were ranked from the highest (best) to the lowest (worst) index values in anthropometric quality across countries and over time. RESULTS: Of the 145 DHS included, the majority (83 of 145; 57%) were conducted in Sub-Saharan Africa. Surveys were ranked from highest to lowest anthropometric data quality relative to other surveys using the composite index for HAZ. Although slightly higher values in recent DHS suggest potential improvements in anthropometric data quality over time, there continues to be substantial heterogeneity in the quality of anthropometric data across surveys. Results were similar for the WHZ data quality index. CONCLUSIONS: A composite index of anthropometric data quality using a parsimonious set of individual indicators can effectively discriminate among surveys with excellent and poor data quality. Such indices can be used to account for variations in anthropometric data quality in multisurvey epidemiologic analyses of child health.


Assuntos
Desenvolvimento Infantil , Mineração de Dados/normas , Transtornos do Crescimento/fisiopatologia , Antropometria , Estatura , Peso Corporal , Pré-Escolar , Confiabilidade dos Dados , Feminino , Transtornos do Crescimento/epidemiologia , Humanos , Lactente , Masculino , Estado Nutricional
19.
Am J Clin Nutr ; 112(Suppl 2): 830S-843S, 2020 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-32672334

RESUMO

BACKGROUND: Chronic malnutrition among infants and children continues to represent a global public health concern. The Kyrgyz Republic has achieved rapid declines in stunting over the last 20 y, despite modest increases in gross domestic product per capita. OBJECTIVE: This study aimed to conduct a systematic, in-depth assessment of national, community, household, and individual drivers of nutrition change and stunting reduction, as well as nutrition-specific and -sensitive policies and programs, in the Kyrgyz Republic. METHODS: This mixed methods study employed 4 inquiry methods, including: 1) a systematic scoping literature review; 2) retrospective quantitative data analyses, including linear regression multivariable hierarchical modeling, difference-in-difference analysis, and Oaxaca-Blinder decomposition; 3) qualitative data collection and analysis; and 4) analysis of key nutrition-specific and -sensitive policies and programs. RESULTS: Stunting prevalence has decreased in the Kyrgyz Republic, however, subnational variations and inequities persist. Child growth Victora curves show improvements in height-for-age z-scores (HAZ) for children in the Kyrgyz Republic between 1997 and 2014, indicating increased intrauterine growth and population health improvements. The decomposition analysis explained 88.9% (0.637 SD increase) of the predicted change in HAZ for children under 3 y (1997-2012). Key factors included poverty (61%), maternal nutrition (14%), paternal education (6%), fertility (6%), maternal age (3%), and wealth accumulation (2%). Qualitative analysis revealed poverty reduction, increased migration and remittances, food security, and maternal nutrition as key drivers of stunting decline. Systematic scoping literature review findings supported quantitative and qualitative results, and indicated that land reforms and improved food security represented important factors. Key nutrition-specific and -sensitive policies and programs implemented involved breastfeeding promotion, social protection schemes, and land and health sector reforms. CONCLUSIONS: Improvements in stunting were achieved amidst political and economic changes. Multilevel enablers, including poverty reduction, improved food security, and introduction of land and health reforms have contributed to improvements in health, nutrition, and stunting among children in the Kyrgyz Republic.


Assuntos
Transtornos do Crescimento/epidemiologia , Criança , Desenvolvimento Infantil , Pré-Escolar , Estudos de Avaliação como Assunto , Feminino , Segurança Alimentar , Transtornos do Crescimento/economia , Transtornos do Crescimento/fisiopatologia , Transtornos do Crescimento/prevenção & controle , Migração Humana , Humanos , Lactente , Quirguistão/epidemiologia , Masculino , Estado Nutricional , Pobreza , Estudos Retrospectivos
20.
Arch Dis Child ; 105(10): 964-968, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32354718

RESUMO

INTRODUCTION: Growth impairment has often been described in children who develop coeliac disease (CD). Based on data from the multicentre, longitudinal PreventCD study, we analysed the growth patterns of infants at genetic risk of CD, comparing those who developed CD by 6 years of age (CD 'cases', 113 infants) versus those who did not develop CD by 6 years (no CD 'controls', 831 infants). METHODS: Weight and length/height were measured using a longitudinal protocol. Raw measurements were standardised, computing z-scores for length/height and weight; a linear mixed model was fitted to the data in order to compare the rate of growth in the two cohorts. RESULTS: Neither cases nor controls had significant growth failure. However, when the mean z-scores for weight and height were analysed, there was a difference between the two groups starting at fourth month of life. When the growth pattern in the first year was analysed longitudinally using mixed models, it emerged that children who develop CD had a significantly lower growth rate in weight z-score (-0.028/month; 95% CI -0.038 to -0.017; p<0.001) and in length/height z-score (-0.018/month; 95% CI -0.031 to -0.005; p=0.008) than those who do not develop CD. When the whole follow-up period was analysed (0-6 years), differences between groups in both weight and length/height z-scores were confirmed. CONCLUSION: The growth of children at risk of CD rarely fell below 'clinical standards'. However, growth rate was significantly lower in cases than in controls. Our data suggest that peculiar pathways of growth are present in children who develop CD, long before any clinical or serological signs of the disease appear.


Assuntos
Doença Celíaca/fisiopatologia , Transtornos do Crescimento/fisiopatologia , Estatura/fisiologia , Peso Corporal/fisiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino
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