Cesarean Delivery and Risk of Excess Weight Among Brazilian Preschool Children.

OBJECTIVE: To study the relationship between cesarean Delivery (CD) and overweight in preschool children, considering the presence of birth aspects and demographic characteristics that have been associated with the risk of excess weight. METHODS: This retrospective cross-sectional analysis used representative data of children from 2 to 6 years of age at municipal daycare centers in Taubaté, São Paulo, Brazil. The sample included 752 preschoolers. Weight and height were collected in daycare centers, and the nutritional status classification was performed using z scores of Body Mass Index (zBMI). Data analysis was performed in the bivariate and multivariate manner, the latter with the inclusion of another possible risk factor. Adjustments were made for daycare centers time, sex, birth length and weight and maternal schooling. RESULTS: The mean age of preschool children was 4.7 years, and 53.8% were boys. The prevalence of overweight children was 21.7%. The median zBMI of the children born by CD was higher than that of vaginal Delivery (p = 0.0194). The prevalence of overweight showed association with CD (p = 0.0196; PR = 1.397 with 95% CI of 1065-1831). Logistic binary multivariate regression analysis confirmed the association, even in the presence of other possible risk factors (CR: 1.580, 95% CI: 1.072-2.330). CONCLUSION FOR PRACTICE: Birth by CD is one of the factors that are associated with the early development of overweight in preschoolers.

Tri-Ponderal Mass Index: A Screening Tool for Risk of Central Fat Accumulation in Brazilian Preschool Children.

Background and Objectives: To verify the use of the tri-ponderalmass index (TMI) as a screening tool for risk of central fat accumulation in preschool children. Materials and Methods: An observational, analytical study was carried out on samples from children 2 to 5 years of age. The body mass index (BMI) and the tri-ponderalmass index (TMI: Weight/height3) were calculated. The waist circumference-to-height ratio (WHtR) was used to classify central fat accumulation risk. Preschoolers whose WHtRwas in the upper tertile of the sample were classified as at risk for central fat accumulation. A comparison of the two indicators (BMI and TMI) was made from the area under the receiver operator characteristics (ROC) curve (AUC) in the discrimination of the WHtR. Results: The sample used for analysis was 919 preschoolers. The mean age of the children was 3.9 years (SD = 0.7). The difference in AUC was 5% higher for TMI (p < 0.0001). In the individual analysis of the ROC curve of the TMI, favoring a higher sensitivity, the cutoff point of 14.0 kg/m3 showed a sensitivity of 99.3% (95% CI: 97.6-99.9). Conclusion: Considering WHtR as a marker of possible future metabolic risk among preschool children, TMI proved to be a useful tool, superior to BMI, in screening for risk of central fat accumulation in preschool children.

Breastfeeding, comnlementarv food introduction and overweight in preschool children.

Growing phenomenon, which involves high morbidity and consequently high costs for health systems, obesity has been found also among the pediatric population and is currently considered a public health problem. The aim of this study was to verify if in children in the early preschool age we can see the prevalence of overweight and if introducing complementary feeding as well as the type of food introduced, are associated with this condition in this age group. It is an observational analytic study with children born in 2011-2012 that attended public schools in Taubat6 -SP during 2014. In addition to the weight and height of children, information about the history of feeding and birth were collectedusing a standardized questionnaire.The nutritional status was defined as having overweight children with z-scores for body mass index (zIMC) > 1.We conducted bivariate analysis and then linear regression analysis of multiple variables.The prevalence of overweight was elevated (27.5%). Only birth weight showed significant correlation with respect to zIMC (r = 0.22, p < 0.0001). The multivariable analysis showed no relationship with the various foods, but showed birth weightas a high risk factor, the male and the total duration of breastfeeding as protective factors. As a result, we conclude that the early introduction of new foods is not a risk factor for the development of overweight at the beginning of pre-school age.

Evaluation of mid-upper arm circumference in pre-school children: comparison between NCHS/CDC-2000 and WHO-2006 references.

We aimed to evaluate the classification of arm circumference (AC) in pre-school children by using National Center for Health Statistics (NCHS/CDC-2000) and World Health Organization (WHO-2006) references. We evaluated 205 children: weight, height and AC were assessed and the body mass index (BMI) was calculated. The BMI values were classified into Z-scores by the WHO referential. The AC was classified into Z-cores by two references, comparing the whole-sample value and among groups (tercis) of BMI Z-score. The correlation was also evaluated between differences of AC with BMI Z-score. The WHO referential classified the AC in Z-scores greater than the NCHS/CDC, which is more specific and less sensitive than the NCHS/CDC for lean children and at the same time more sensitive and less specific for children with overweight. In conclusion, a significant difference in the AC classification occurs according to the referential used.

Nutritional Status Trends in Brazilian Preschoolers: A Cohort Study.

Background: Determining trends in the nutritional status of children may guide care prevention beyond this age in an effort to reduce the prevalence and incidence of overweight and/or obese children. The objective of this study is to evaluate the evolution of the nutritional status of preschool children in two moments, with an interval of 2 years. Methods: This is a cohort study of a random probabilistic sample of preschool children attending public schools within an urban area of high human development index city, in the hinterland of São Paulo state. In 2016, we reassessed the nutritional status of 351 preschoolers evaluated in 2014, comparing the prevalence of overweight according to BMI >1 z-score. Results: The prevalence of overweight was 31.05% (2014) and 31.06% (2016) and mean BMI z-scores were 0.58 and 0.57, respectively. The nutritional status classification of the preschool children showed almost no agreement between the two time points (κ = 0.053). Nevertheless, children with overweight in 2014 had a relative risk of 1.96 of being overweight or obese in 2016 (p = 0.0473). Conclusions: Prevalence of overweight among preschoolers was the same at 2 and 5 years of age, with no tendency to grow. Despite this, 2-year-old preschoolers with overweight present a twofold higher relative risk for excessive weight at 5 years of age. These changes of nutritional status at preschool age evince the great flexibility of their nutritional condition during this period of life.

TNF-alpha and IL-6 in the diagnosis of bacterial and aseptic meningitis in children.

The objective of this study was to analyze the usefulness of tumor necrosis factor-alpha and interleukin-6 cerebrospinal fluid concentrations for the differential diagnosis between bacterial and aseptic meningitis in children and in the prognostic evaluation. A cross-sectional study was performed on 35 children between 1 month and 12 years of age with suspected meningitis. Cytokines determination was performed by enzyme-linked immunosorbent assay technique. The Mann-Whitney test and Spearman's correlation coefficients were used for statistical analysis. Six children presented bacterial meningitis, 13 aseptic, and 16 had no meningitis. The tumor necrosis factor-alpha concentrations were significantly higher in the bacterial meningitis group as compared with the aseptic group (P = 0.001) and among groups with and without meningitis (P = 0.000). There was correlation between tumor necrosis factor-alpha and cerebrospinal fluid leukocytes (P = 0.019), protein (P = 0.000), and glucose (P = 0.038). There was no association between cytokines and complications of the meningitis. The tumor necrosis factor-alpha concentrations in the cerebrospinal fluid were useful markers for distinguishing bacterial from aseptic meningitis and were demonstrated to be useful in evaluating the intensity of the inflammatory process in the central nervous system.

Maternal breastfeeding, early introduction of non-breast milk, and excess weight in preschoolers. / Aleitamento materno, introdução precoce de leite não materno e excesso de peso na idade pré­escolar.

OBJECTIVE: Investigate associations between excess weight in preschool children, breastfeeding duration and age of non-breast milk introduction. METHODS: Cross-sectional study of a representative sample of 817 preschool children, aged 2 to 4 years, attending municipal day care centers in the city of Taubaté. The weight and height of children were measured in the day care centers in 2009, 2010 and 2011. The body mass index z-score (BMIz) was calculated and children were classified as risk of overweight (BMIz≥1 to<2) or excess weight (BMIz≥2). Data analysis was carried out by comparison of proportions, coefficient of correlation and multivariate linear regression. RESULTS: The prevalence of risk of overweight was 18.9% and of excess weight (overweight or obesity) was 9.3%. The median duration of breastfeeding and age of introduction of non-breast milk was 6 months. The child's BMIz showed direct correlation with birth weight (r=0.154; p<0.001) and maternal Body Mass Index (BMI) (r=0.113; p=0.002). The correlation was inverse with the total duration of breastfeeding (r=-0.099; p=0.006) and age at non-breast milk introduction (r=-0.112; p=0.002). There was no correlation between the child's BMIz with birth length, duration of exclusive breastfeeding and mother's age. CONCLUSIONS: The earlier the introduction of non-breast milk, the higher the correlation with excess weight at preschool age.

Mothers' conceptions about excess weight in infancy and the nutritional status of their children.

OBJECTIVE: To analyze maternal conceptions about excess weight in infancy and the nutritional status of their preschool-aged children. METHODS: A mixed, exploratory study was performed using semi-structured interviews. Two study groups were defined: a group of 16 mothers of children with excess weight and a group of 15 mothers of eutrophic children. The interviews were submitted to content analysis using CHIC software (Classification Hiérarchique Implicative et Cohésitive¯). RESULTS: The mothers of children with excess weight tended to conceive thin children as malnourished, while those of normal weight children emphasized the influence of family and genetics as determinants of a child's nutritional status. Although there was a certain consensus among the mothers that an unhealthy diet contributes to the risk of a child developing excess weight, the concept of genetics as a determinant of a child's nutritional status was also present in the dialogue from the mothers of both groups. This result indicates a lack of clarity regarding the influence of eating behavior and family lifestyle on weight gain and the formation of a child's eating habits. Both groups indicated that the mother has a decisive role in the eating habits of her child; however, the mothers of children with excess weight did not seem to take ownership of this concept when addressing the care of their own children. CONCLUSION: Differences in conceptions, including taking ownership of care, may contribute to the development of excess weight in preschool-aged children.

[Oropharyngeal carriage of Streptococcus pneumoniae by children attending day care centers in Taubate, SP: correlation between serotypes and the conjugated heptavalent pneumococcal vaccine]. / Colonizaçâo de orofaringe por Streptococcus pneumoniae em crianças de creches municipais de Taubaté-SP: correlação entre os principais sorotipos e a vacina pneumocócica conjugada heptavalente.

OBJECTIVE: Streptococcus pneumoniae usually colonizes the oropharynx of healthy people. Oropharyngeal carriage is related to the invasion of adjacent structures and to the development of invasive disease. A descriptive cross-sectional study was performed aiming at verifying the prevalence of oropharyngeal colonization by S. pneumoniae in children attending day care centers in the city of Taubaté - SP; verifying the frequency of S. pneumoniae serotypes in isolated strains; and relating the most frequent serotypes to the composition of the conjugated heptavalent pneumococcal vaccine currently in use. METHODS: From June 29 to December 15 1998, samples of oropharyngeal material were collected from 987 children, ranging from 8 to 71 months old, enrolled in day care centers in Taubaté - SP. The identification of S. pneumoniae was based on the observation of the colonies that presented partial hemolysis in agar-blood and agar-blood with gentamycin plates and on the observation of inhibited growth around the optochin disc. Serotyping was performed by the Quellung reaction, using specific antiserum, provided by the Centers for Disease Control and Prevention (Atlanta, GA/USA), and the Danish nomenclature system. RESULTS: S. pneumoniae was isolated from the oropharynx in 209 out of 987 children (colonization rate of 21.2%). Twenty eight serotypes were identified. The seven most frequent serotypes were: 6A/6B (21.5%), 19F (14.8%), 18C (7.4%), 23F (7.4%), 9V (6.7%), 14 (5.2%), 10A (4.4%). Except for serotype 10A, all the other six are included in the vaccine. The only vaccine serotype which was not found was serotype 4. CONCLUSION: Agreement of 63% between the oropharynx colonizer serotypes and the serotypes present in the vaccine was found.

Body composition of preschool children and relation to birth weight.

OBJECTIVE: to evaluate the relationship between body composition of preschool children suffering from excess weight and birth weight (BW). METHODS: probabilistic sample, by conglomerates, with 17 daycare centers (of a total of 59) composing a final sample of 479 children. We used Z-score of Body Mass Index (zBMI) ≥ +1 and ≥ +2, respectively, to identify preschool children with risk of overweight and excess weight (overweight or obesity). The arm muscle area (AMA) and the arm fat area (AFA) were estimated from measurements of arm circumference, triceps skin fold thickness. RESULTS: the prevalence of risk of overweight was 22.9% (n=110) and excess weight was 9.3% (n=44). The risk of overweight and excess weight in children did not show correlation between BW and AFA, but it did with adjusted arm muscle area (AMAa) (rp= 0.21; p= 0.0107). The analysis of the group with excess weight alone also showed a positive correlation between BW and AMAa (rp= 0.42; p= 0.0047). CONCLUSION: among overweight children, lower BW is associated with a lower arm muscle area in early preschool age, regardless of the fat arm area presented by them.

Family Health Strategy and prevalence of anemia in women in an urban region of high Human Development Index / Estratégia de Saúde da Família e prevalência de anemia em mulheres de uma região urbana de alto Índice de Desenvolvimento Humano

INTRODUCTION: Iron deficiency anemia is a major public health problem. OBJECTIVE: To analyze the hemoglobin value and the prevalence of anemia in women in reproductive age, mothers of children enrolled in municipal day care centers in a municipality with a high Human Development Index, in the Southeast region of Brazil, and related factors, including being attended by the Family Health Strategy. METHOD: This is a cross-sectional study with a sample of 230 women between 15 and 49 years old. Data collection was performed through a form, addressing socioeconomic variables and maternal health. It was verified: weight, height and hemoglobin concentration dosage. : The prevalence of anemia in women was 9.6%, with an average hemoglobin concentration of 14.6 g / dL. In the bivariate analysis, the following variables were associated with anemia: age, having a disease, obstetric complications in the pregnancy of the studied child and, as a protective factor, being in the Family Health Strategy program. In the binary logistic analysis, only being met by the Family Health Strategy proved to be a significant protective effect against anemia (OR = 0.391, p <0.05). CONCLUSION: Although there is a slight prevalence of anemia, according to World Health Organization criteria, in urban areas with a high Human Development Index, well-conducted health care policies, the Family Health Strategy in particular can contribute to further reduce plus the prevalence of this condition in the health of women of reproductive age.

INTRODUÇÃO: Anemia ferropriva é um importante problema de saúde pública. OBJETIVO: Analisar o valor de hemoglobina e a prevalência de anemia em mulheres em idade reprodutiva, mães de filhos inscritos em creches municipais de um município com alto Índice de Desenvolvimento Humano, na região Sudeste, além de fatores a elas relacionados, incluindo serem atendidas pela Estratégia de Saúde da Família. MÉTODO: Trata-se de um estudo transversal com amostra constituída por 230 mulheres entre 15 e 49 anos de idade. A coleta de dados foi realizada por meio de formulário, abordando variáveis socioeconômicas e saúde materna. Verificaram-se: peso, estatura e dosagem da concentração da hemoglobina. RESULTADOS: A prevalência de anemia nas mulheres foi de 9,6%, com média de concentração da hemoglobina de 14,6g/dL. Na análise bivariada, mostraram associação com anemia as variáveis: idade, ter alguma doença, intercorrências obstétricas na gestação da criança estudada e, como fator de proteção, estar no programa Estratégia de Saúde da Família. Na análise binária logística, apenas ser atendida pela Estratégia de Saúde da Família demonstrou ser significante efeito protetor frente à anemia (OR=0,391, p<0,05). CONCLUSÃO: Apesar de haver uma prevalência leve de anemia, pelo critério da Organização Mundial da Saúde, em área urbana de alto Índice de Desenvolvimento Humano, políticas de atenção à saúde e bem conduzidas, a Estratégia de Saúde da Família em particular, podem contribuir para reduzir ainda mais a prevalência desse agravo na saúde das mulheres em idade reprodutiva.

Prevalence of overweight preschool children in public day care centers: a cross-sectional study.

CONTEXT AND OBJECTIVE: Brazil is undergoing a period of epidemiological transition associated with demographic and nutritional changes. The prevalence of obesity is also increasing in children and is causing numerous health problems that are becoming public health issues. The aim here was to evaluate the prevalence of overweight among children of two and three years of age. DESIGN AND SETTING: Cross-sectional study in municipal day care centers in Taubaté, state of São Paulo, Brazil. METHODS: Weight and height measurements were made on 447 preschool children forming a probabilistic randomized sample. Their body mass index (BMI) was calculated. Their nutritional status was classified using the World Health Organization reference cutoff points (2006). Their mean weight, height and BMI were compared according to their age and sex. RESULTS: The mean values for the final sample (n = 447) were as follows: mean age: 38.6 months (± 3.5) and Z scores for: weight/height (W/H): 0.50 (± 1.22); height/age: -0.03 (± 1.07); weight/age (W/A): 0.51 (± 1.23); and BMI: 0.51(± 1.23). The prevalence of overweight children (BMI > 1 z) was 28.86%, while the prevalence of underweight children (BMI < -2 z) was 0.89%. There were no differences in mean BMI among the two and three-year age groups (P = 0.66). CONCLUSION: A high prevalence of overweight was observed in the sample of two and three-year-old children, with practically no malnutrition, thus showing that a significant nutritional transition may already be occurring, even in medium-sized cities of developing countries.

Ratio of weight to height gain: a useful tool for identifying children at risk of becoming overweight or obese at preschool age.

PURPOSE: To analyze the usefulness of the weight gain/height gain ratio from birth to two and three years of age as a predictive risk indicator of excess weight at preschool age. METHODS: The weight and height/length of 409 preschool children at daycare centers were measured according to internationally recommended rules. The weight values and body mass indices of the children were transformed into a z-score per the standard method described by the World Health Organization. The Pearson correlation coefficients (rP) and the linear regressions between the anthropometric parameters and the body mass index z-scores of preschool children were statistically analyzed (alpha = 0.05). RESULTS: The mean age of the study population was 3.2 years (± 0.3 years). The prevalence of excess weight was 28.8%, and the prevalence of overweight and obesity was 8.8%. The correlation coefficients between the body mass index z-scores of the preschool children and the birth weights or body mass indices at birth were low (0.09 and 0.10, respectively). There was a high correlation coefficient (rP = 0.79) between the mean monthly gain of weight and the body mass index z-score of preschool children. A higher coefficient (rP = 0.93) was observed between the ratio of the mean weight gain per height gain (g/cm) and the preschool children body mass index z-score. The coefficients and their differences were statistically significant. CONCLUSION: Regardless of weight or length at birth, the mean ratio between the weight gain per g/cm of height growth from birth presented a strong correlation with the body mass index of preschool children. These results suggest that this ratio may be a good indicator of the risk of excess weight and obesity in preschool-aged children.

NÍVEL DE ATIVIDADE FÍSICA EM ADOLESCENTES SAUDÁVEIS / PHYSICAL ACTIVITY IN HEALTHY ADOLESCENTS / NIVEL DE ACTIVIDAD FÍSICA EN ADOLESCENTES SANOS

RESUMO Introdução: A recomendação atual para prática de atividades físicas na infância e adolescência é de que todo jovem deveria envolver-se diariamente por 60 minutos ou mais em atividades físicas moderadas em cinco ou mais dias da semana, somando-se pelo menos 300 minutos de atividades físicas por semana. Poucos estudos sobre o nível de atividade física foram encontrados com amostras de crianças e adolescentes brasileiros. Objetivo: Esta pesquisa tem como objetivo a aplicação de um questionário para avaliar o nível de atividade física realizada e suas correlações com estágios da puberdade e índice de massa corporal (IMC) em adolescentes saudáveis matriculados na rede municipal de ensino da cidade de Taubaté, SP, Brasil. Métodos: Foi realizado um estudo transversal por meio de aplicação de um questionário (IPAQ) para avaliar o nível de atividade física e sua correlação com peso, altura e IMC de 202 adolescentes saudáveis. Resultados: O grupo de 15 a 17 anos, considerado pós-púbere nesta pesquisa, apresentou tempos significantemente maiores do que os demais grupos, quanto à resposta da questão 4b (p = 0,002), que indaga sobre o tempo total gasto sentado durante um dia de final de semana. Conclusão: O grupo de 9 a 11 anos, considerado pré-púbere nesta pesquisa, apresentou números significantemente maiores do que os demais grupos quanto às atividades lúdicas moderadas.

ABSTRACT Introduction: The current recommendation for physical activity in childhood and adolescence is that every young person should engage daily for 60 minutes or more in moderate physical activity on five or more days a week, totalizing at least 300 minutes of physical activity per week. Few studies on the level of physical activity were found in samples of Brazilian children and adolescents. Objective: This research aims to apply a questionnaire to assess the level of physical activity and its correlation with stages of puberty and body mass index (BMI) in healthy adolescents enrolled in municipal schools in the city of Taubaté, SP, Brazil. Methods: This is a cross-sectional study conducted through the application of a questionnaire (IPAQ) to assess the level of physical activity and its correlation with weight, height and BMI of 202 healthy adolescents. Results: The group of 15 to 17 years, considered post-pubertal in this study, showed significantly longer times than the other groups regarding the answer to the question 4b (p=0.002), which inquires about the total time spent sitting during a day of the weekend. Conclusion: The group 9-11 years, considered pre-pubertal in this study, showed significantly longer times than the other groups with regard to moderate ludic activity.

RESUMEN Introducción: La recomendación actual para la actividad física en la infancia y la adolescencia es que todos los jóvenes deben participar todos los días durante 60 minutos o más de actividad física moderada, cinco o más días de la semana, sumando por lo menos 300 minutos de actividad física semanal. Se encontraron pocos estudios sobre el nivel de actividad física en muestras de niños y adolescentes brasileños. Objetivo: Esta investigación tiene como objetivo aplicar un cuestionario para evaluar el nivel de actividad física realizada y su correlación con las etapas de la pubertad y el índice de masa corporal (IMC) en adolescentes sanos inscritos en las escuelas municipales en la ciudad de Taubaté, SP, Brasil. Métodos: Se realizó un estudio transversal mediante la aplicación de un cuestionario (IPAQ) para evaluar el nivel de actividad física y su correlación con el peso, la altura y el IMC de 202 adolescentes sanos. Resultados: El grupo de 15 a 17 años, considerado pospuberal en este estudio, tuvo tiempos significativamente más largos que los otros grupos, según la respuesta a la pregunta 4b (p = 0,002), que indaga sobre el total de tiempo dedicado a estar sentado durante un día del fin de semana. Conclusión: El grupo de 9 a 11 años, considerado prepuberal en este estudio, tuvo tiempos significativamente más largos que otros grupos con respecto a las actividades lúdicas moderadas.

Maternal breastfeeding, early introduction of non-breast milk, and excess weight in preschoolers / Aleitamento materno, introdução precoce de leite não materno e excesso de peso na idade pré-escolar

Abstract Objective: Investigate associations between excess weight in preschool children, breastfeeding duration and age of non-breast milk introduction. Methods: Cross-sectional study of a representative sample of 817 preschool children, aged 2-4 years, attending municipal day care centers in the city of Taubaté. The weight and height of children were measured in the day care centers in 2009, 2010 and 2011. The body mass index z-score (BMIz) was calculated and children were classified as risk of overweight (BMIz≥1 to<2) or excess weight (BMIz≥2). Data analysis was carried out by comparison of proportions, coefficient of correlation and multivariate linear regression. Results: The prevalence of risk of overweight was 18.9% and of excess weight (overweight or obesity) was 9.3%. The median duration of breastfeeding and age of introduction of non-breast milk was 6 months. The child's BMIz showed direct correlation with birth weight (r=0.154; p<0.001) and maternal body mass index (BMI) (r=0.113; p=0.002). The correlation was inverse with the total duration of breastfeeding (r=−0.099; p=0.006) and age at non-breast milk introduction (r=−0.112; p=0.002). There was no correlation between the child's BMIz with birth length, duration of exclusive breastfeeding and mother's age. Conclusions: The earlier the introduction of non-breast milk, the higher the correlation with excess weight at preschool age.

Resumo Objetivo: Investigar relações existentes entre excesso de peso em pré-escolares, duração do aleitamento materno e a idade de introdução de leite não materno. Métodos: Estudo transversal de amostra representativa de 817 pré-escolares, 2-4 anos de idade, de creches municipais de Taubaté. O peso e a altura das crianças foram mensurados nas creches em 2009, 2010 e 2011. Calculado o escore z de Índice de Massa Corporal (zIMC), as crianças foram classificadas como risco de sobrepeso (zIMC≥1 a<2) ou como excesso de peso (zIMC≥2). A análise dos dados foi feita por comparação de proporções, coeficiente de correlação e regressão linear multivariada. Resultados: A prevalência de risco de sobrepeso foi 18,9% e de excesso de peso (sobrepeso ou obesidade) de 9,3%. A mediana de duração do aleitamento materno e a idade de introdução do leite não materno foi de 6 meses. O zIMC da criança evidenciou correlação direta com o peso ao nascer (r=0,154; p<0,001) e com o Índice de Massa Corporal (IMC) materno (r=0,113; p=0,002). A correlação foi inversa com a duração total do aleitamento materno (r=−0,099; p=0,006) e a idade de introdução de leite não materno (r=−0,112; p=0,002). Não houve correlação entre o zIMC da criança com o comprimento ao nascer, duração do aleitamento exclusivo e idade da mãe. Conclusões: Quanto mais precoce a introdução de leite não materno, maior a correlação com excesso de peso na idade pré-escolar.

Aleitamento materno, introdução da alimentação complementar e excesso de peso em pré-escolares / Breastfeeding, complementary food introduction and overweight in preschool children

Fenômeno crescente, que envolve alta morbidade e altos custos para os sistemas de saúde, a obesidade está sendo encontrada também entre a população pediátrica, sendo considerada atualmente um problema de saúde pública. O objetivo do presente estudo foi verificar se em crianças no início da idade préescolar já se observa prevalência de excesso de peso e se a introdução de novos alimentos, assim como o tipo de alimento, está associada à essa condição nutricional. Trata-se de um estudo observacional, analítico, de uma coorte histórica com crianças nascidas em 2011/12, frequentadoras de creches públicas em Taubaté - SPem 2014. Além do peso e estatura das crianças, coletou-se informações quanto aos antecedentes de alimentação e de nascimento utilizando um questionário padronizado. Quanto aoestado nutricional definiu-se como portadoras de excesso de peso (EP) crianças com escores z do índice de massa corpórea (zIMC) ≥ 1. Realizou-se a análise bivariada e posteriormente análise de regressão linear de múltiplas variáveis. A prevalência de EP encontrada foi elevada (27,5%). Apenas o peso ao nascer (PN) mostrou correlação significante em relação ao zIMC (r= 0,22, p<0,0001). Aanálise de múltiplas variáveis não mostrou relação com os diversos alimentos, mas evidenciou o PN elevado como fator de risco, o sexo masculino e a duração total do aleitamento materno como fatores de proteção. Como consequência, é possível concluir que a introdução precoce de novos alimentos não representa fator de risco para o desenvolvimento do excesso de peso no início da idade pré-escolar(AU)

Growing phenomenon, which involves high morbidity and consequently high costs for health systems, obesity has been found also among the pediatric population and is currently considered a public health problem. The aim of this study was to verify if in children in the early preschool age we can see the prevalence of overweight and if introducing complementary feeding as well as the type of food introduced, are associated with this condition in this age group. It is an observational analytic study with children born in 2011-2012 that attended public schools in Taubaté -SP during 2014. In addition to the weight and height of children, information about the history of feeding and birth were collectedusing a standardized questionnaire.The nutritional status was defined as having overweight children with z-scores for body mass index (zIMC) ≥ 1.We conducted bivariate analysis and then linear regression analysis of multiple variables.The prevalence of overweight was elevated (27.5%). Only birth weight showed significant correlation with respect to zIMC (r = 0.22, p < 0.0001). The multivariable analysis showed no relationship with the various foods, but showed birth weightas a high risk factor, the male and the total duration of breastfeeding as protective factors. As a result, we conclude that the early introduction of new foods is not a risk factor for the development of overweight at the beginning of preschool age(AU)

Mothers' conceptions about excess weight in infancy and the nutritional status of their children

OBJECTIVE: To analyze maternal conceptions about excess weight in infancy and the nutritional status of their preschool-aged children. METHODS: A mixed, exploratory study was performed using semi-structured interviews. Two study groups were defined: a group of 16 mothers of children with excess weight and a group of 15 mothers of eutrophic children. The interviews were submitted to content analysis using CHIC software (Classification Hiérarchique Implicative et Cohésitive¯). RESULTS: The mothers of children with excess weight tended to conceive thin children as malnourished, while those of normal weight children emphasized the influence of family and genetics as determinants of a child’s nutritional status. Although there was a certain consensus among the mothers that an unhealthy diet contributes to the risk of a child developing excess weight, the concept of genetics as a determinant of a child’s nutritional status was also present in the dialogue from the mothers of both groups. This result indicates a lack of clarity regarding the influence of eating behavior and family lifestyle on weight gain and the formation of a child’s eating habits. Both groups indicated that the mother has a decisive role in the eating habits of her child; however, the mothers of children with excess weight did not seem to take ownership of this concept when addressing the care of their own children. CONCLUSION: Differences in conceptions, including taking ownership of care, may contribute to the development of excess weight in preschool-aged children.

Percepção materna do estado nutricional de crianças em idade pré-escolar frequentadoras de creches públicas / Maternal perception of nutritional status of pre-school children through the marketing of public day care

OBJETIVO ­ Analisar a correlação entre a percepção materna e o estado nutricional de seus filhos em idade pré-escolar. MÉTODOS ­ Estudo transversal realizado com 661 crianças com idade entre 2 e 4 anos incompletos. A classificação do estado nutricional foi baseada na distribuição do escore z do Índice de Massa Corporal (zIMC), segundo critério do Ministério da Saúde (2009). Além disso, foi estimado o coeficiente de correlação de Pearson entre zIMC e a percepção materna em relação ao peso da criança. A percepção materna foi caracterizada a partir da questão: "Em relação ao peso da criança você acha que: está adequado; abaixo do adequado; muito abaixo do adequado; acima do adequado; ou muito acima do adequado". RESULTADOS ­ A média de escore z de IMC foi de 0,57 (IC 95%: 0,48 a 0,66) com desvio padrão de 1,19 e mediana de 0,52. A prevalência de excesso de peso dos pré-escolares (risco de sobrepeso, sobrepeso e obesidade) foi de 29,8%. A percepção materna da condição nutricional percebida e o diagnosticado evidenciou uma correlação direta significante com o escore z de IMC da criança (r=0,46; p<0,0001). CONCLUSÃO ­ Observa-se que existe uma tendência positiva de correlação entre a percepção materna e o estado nutricional dos pré-escolares, sugerindo que em geral a mãe tem uma percepção razoavelmente adequada da condição nutricional do filho

OBJECTIVE­ Analyze the correlation between the perception and the nutritional status of their children in preschool age. METHODS­ Crosssectional study conducted with 661 children aged between 2 and 4 years of age. The classification of nutritional status was based on z score distribution of body mass index (zBMI), according to the Ministry of Health (2009). In addition, it was estimated the Pearson correlation coefficient between zBMI and maternal perceptions regarding the child's weight. Maternal perception was characterized from the question: "in relation to the weight of the child do you think: is appropriate; below the appropriate; far below the appropriate; above the appropriate; or well above the appropriate". RESULTS­ The average BMI z score was 0.57 (95% CI: 0.48-0.66) with standard deviation of 1.19 and median of 0.52. The prevalence of overweight of preschoolers (risk of overweigh, overweight and obesity) was 29.8%. Maternal perception of perceived nutritional condition and diagnosed showed a direct correlation significant with the child's BMI z score (rp =0.46; p < 0.0001). CONCLUSION­ It is observed that there is a positive trend of correlation between the perception and the nutritional status of pre-school children, suggesting that in general the mother has a reasonably adequate perception of the nutritional condition of the son.

Infant growth during the first year of life / Crescimento de lactentes durante o primeiro ano de vida

OBJECTIVE: The aim of this study was to describe and analyse the profile of growth in normal infants during the first year of life, including their patterns of weight and length, and the duration of breastfeeding METHODS: This is a retrospective cohort study conducted based on 85 records of infants who met the inclusion criteria. The total duration of breastfeeding was recorded along with weight and length at three ages: birth, 6 and 12 months. The data were analysed as Z-scores based on WHO (2006) using the software products MedCalc 12.0 and GraphPad Prism 6.0 RESULTS: Although 76.5% of the infants showed a growth pattern compatible with WHO references at 12 months of age, the others presented as overweight as at risk of being overweight. A significant correlation was observed between birth weight and BMI Z-score at two ages: 6 months (r = 0.26; p = 0.01) and 12 months (r = 0.32; p = 0.002). A correlation between birth weight and length Z-score was also found at 6 months (r = 0.4034; p = 0.0001) and 12 months (r = 0.3309; p = 0.002). Birth length was also correlated with length Z-score at 6 months (r = 0.4829; p < 0.0001) and 12 months (r = 0.3407; p = 0.0014). Breastfeeding duration did not show any correlation with anthropometric data at 6 and 12 months of age CONCLUSION: The growth pattern of the sample during the first year of life was found to be appropriate or faster than normal. Growth pattern also seems to be influenced by anthropometric characteristics at birth, which does not depend on breastfeeding duration.(AU)

OBJETIVO: Analisar o perfil do crescimento durante o primeiro ano de vida em lactentes normais e suas relações com o peso e o comprimento ao nascer e com o aleitamento materno MÉTODO: Estudo de coorte retrospectiva com levantamento de dados de prontuários de 85 crianças que preencheram os critérios de inclusão. Registrou-se com peso e comprimento ao nascer, aos 6 e 12 meses de vida, e o tempo total de aleitamento materno. Os dados de crescimento foram analisados em escores z com base na referência da OMS (2006), utilizando os softwares MedCalc 12.0 e GraphPad Prism 6.0 RESULTADOS: Aos 12 meses de vida 76,5% dos lactentes apresentavam valores de crescimento compatíveis com o referencial da OMS, enquanto os demais estavam em risco de sobrepeso e sobrepeso. Observou-se correlação entre o peso de nascimento e o escore z do Índice de Massa Corporal aos 6 meses (r = 0,26; p= 0,01) e aos 12 meses (r = 0,32; p = 0,002) e também com o escore z do comprimento para idade aos 6 (r = 0,4034; p = 0,0001) e 12 meses (r = 0,3309; p = 0,0020). O comprimento ao nascer também mostrou correlação com o escore z de comprimento aos 6 (r = 0,4829; p < 0,0001) e 12 meses (r = 0,3407; p = 0,0014). A duração do aleitamento materno não evidenciou correlação com os dados antropométricos dos 6 e 12 meses de idade CONCLUSÃO: O crescimento alcançado durante o primeiro ano foi adequado ou acima do mesmo, sendo influenciado pelas características antropométricas ao nascer, independentemente da duração do aleitamento materno.(AU)

Crescimento de lactentes durante o primeiro ano de vida / Infant growth during the first year of life

The aim of this study was to describe and analyse the profile of growth in normal infants during the first year of life, including their patterns of weight and length, and the duration of breastfeeding METHODS: This is a retrospective cohort study conducted based on 85 records of infants who met the inclusion criteria. The total duration of breastfeeding was recorded along with weight and length at three ages: birth, 6 and 12 months. The data were analysed as Z-scores based on WHO (2006) using the software products MedCalc 12.0 and GraphPad Prism 6.0 RESULTS: Although 76.5% of the infants showed a growth pattern compatible with WHO references at 12 months of age, the others presented as overweight as at risk of being overweight. A significant correlation was observed between birth weight and BMI Z-score at two ages: 6 months (r = 0.26; p = 0.01) and 12 months (r = 0.32; p = 0.002). A correlation between birth weight and length Z-score was also found at 6 months (r = 0.4034; p = 0.0001) and 12 months (r = 0.3309; p = 0.002). Birth length was also correlated with length Z-score at 6 months (r = 0.4829; p < 0.0001) and 12 months (r = 0.3407; p = 0.0014). Breastfeeding duration did not show any correlation with anthropometric data at 6 and 12 months of age CONCLUSION: The growth pattern of the sample during the first year of life was found to be appropriate or faster than normal. Growth pattern also seems to be influenced by anthropometric characteristics at birth, which does not depend on breastfeeding duration.

Analisar o perfil do crescimento durante o primeiro ano de vida em lactentes normais e suas relações com o peso e o comprimento ao nascer e com o aleitamento materno MÉTODO: Estudo de coorte retrospectiva com levantamento de dados de prontuários de 85 crianças que preencheram os critérios de inclusão. Registrou-se com peso e comprimento ao nascer, aos 6 e 12 meses de vida, e o tempo total de aleitamento materno. Os dados de crescimento foram analisados em escores z com base na referência da OMS (2006), utilizando os softwares MedCalc 12.0 e GraphPad Prism 6.0 RESULTADOS: Aos 12 meses de vida 76,5% dos lactentes apresentavam valores de crescimento compatíveis com o referencial da OMS, enquanto os demais estavam em risco de sobrepeso e sobrepeso. Observou-se correlação entre o peso de nascimento e o escore z do Índice de Massa Corporal aos 6 meses (r = 0,26; p= 0,01) e aos 12 meses (r = 0,32; p = 0,002) e também com o escore z do comprimento para idade aos 6 (r = 0,4034; p = 0,0001) e 12 meses (r = 0,3309; p = 0,0020). O comprimento ao nascer também mostrou correlação com o escore z de comprimento aos 6 (r = 0,4829; p < 0,0001) e 12 meses (r = 0,3407; p = 0,0014). A duração do aleitamento materno não evidenciou correlação com os dados antropométricos dos 6 e 12 meses de idade CONCLUSÃO: O crescimento alcançado durante o primeiro ano foi adequado ou acima do mesmo, sendo influenciado pelas características antropométricas ao nascer, independentemente da duração do aleitamento materno.