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Introduction: scientific evidence has highlighted the role of chronobiological disruptions in promoting obesity through mechanisms involving important circadian rhythm hormones: melatonin and cortisol. These hormones are present in human colostrum and serve as crucial maternal and child protection mechanisms against obesity and childhood infections, owing to the intense interaction between mother and child during pregnancy and breastfeeding. Consequently, the melatonin and cortisol hormones present in human colostrum hold promise as potential candidates for yielding clinically applicable results and supporting future intervention strategies aimed at reducing obesity and neonatal infections. However, there is a scarcity of literature on this subject. Objective: the objective of this study is to to analyze the impact of maternal obesity on the levels and functions of melatonin and cortisol in colostrum and breast milk. Methods: a systematic review of the scientific literature was conducted following the recommendations outlined in the PRISMA protocol. Original articles published in English were searched in the PubMed, Medline, Lilacs, and Scopus databases. There were no restrictions on the publication year. Results: a total of 37 articles were identified from the searched databases. After removing duplicates and applying the inclusion and exclusion criteria, only five studies were relevant to the topic: two studies addressing melatonin and three studies analyzing cortisol. This review revealed that melatonin levels are elevated in the colostrum of obese women, and for this particular group, it has the potential to restore phagocyte activity and increase lymphocyte proliferation. Studies on cortisol have demonstrated that maternal obesity does not alter the levels of this hormone in breast milk. Conclusion: breastfeeding should be encouraged for all populations, and further original research should be conducted to elucidate the protective mechanisms of colostrum and breast milk.

Introdução: evidências científicas enfatizam que disrupções cronobiológicas podem promover a obesidade por mecanismos envolvendo ação de importantes hormônios marcadores do ritmo circadiano: a melatonina e cortisol. Estes hormônios estão presentes no colostro humano e representam importante mecanismo de proteção materno infantil frente à obesidade e infecções infantis, devido à intensa interação entre mãe e filho durante a gravidez e amamentação. Assim, os hormônios melatonina e cortisol presentes no colostro humano representam promissores candidatos para fornecer resultados com capacidade de aplicação clínica e de embasamento de futuras estratégias de intervenção com enfoque na redução da obesidade e de infecções neonatais. Entretanto, são escassos os estudos na literatura sobre o tema. Objetivo: analisar as repercussões da obesidade materna sobre os níveis e as ações da melatonina e do cortisol no colostro e leite materno. Método: foi realizada uma revisão sistematizada da literatura científica seguindo as recomendações do protocolo Prisma. Foram pesquisados artigos originais, publicados em inglês, nas bases de dados PubMed, Medline, Lilacs e Scopus. Não houve restrição quanto ao ano de publicação. Resultados: foram identificados 37 artigos nas bases de dados pesquisados, 15 artigos foram excluídos por estarem duplicados, após aplicação do critério de inclusão e exclusão apenas 5 estudos tiveram relação ao tema, sendo 2 estudos abordando sobre melatonina e 3 pesquisas que analisaram o cortisol. Esta revisão mostrou que a melatonina está elevada em colostro de obesas e para este grupo ela possui potencial de restaurar atividade de fagócitos e de elevar a proliferação de linfócitos. Os estudos sobre o cortisol ilustraram que os níveis deste hormônio no leite materno não foram alterados pela obesidade materna. Conclusão: o aleitamento materno deve ser encorajado para todos os públicos, assim como mais pesquisas originais devem ser desenvolvidas para descrever os mecanismos protetores do colostro e leite materno

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BACKGROUND: Cow's milk protein allergy (CMPA) is a common allergy in infants and can affect proper growth and development. This study verified factors associated with the evolution of the nutritional status (NS) among infants with CMPA fed with hypoallergenic formulas (HF). METHODS: This is a longitudinal study of infants (n = 1036) participating on a governmental program in Brazil. Researchers assessed Nutritional status before HF treatment (T1) and after HF treatment (T2). The causality of exposure variables on the evolution of NS was verified by Multinomial Logistic Regression (MLR). RESULTS: We observed an increase in anthropometric indexes analyzed with statistically significant results (p < 0.01). The weight/age and height/age scores showed a significant reduction in infants with nutritional deficit. The Body Mass Index (BMI) showed a decrease in the number of infants with nutritional deficit (< -2 z-score). On the other hand, there was an increase in those classified as at risk of overweight, overweight and obese. MLR showed that those who remained < 12 months in the program had a lower odds ratio (95% CI = 0.355-0.906; p = 0.018) to have inadequate NS with increasing BMI. Preterm infants were 4 times more likely (CI 95% = 1.520-10.694; p = 0.005) to have their BMI decreased and those who received nutritional counseling had a lower odds ratio (CI 95% = 0.411-0.953; p = 0.029) to maintain adequate NS. CONCLUSION: The program has a significant impact on the NS of infants with CMPA. The constant management and implementation of differentiated criteria according to the evolution of NS for the supply of HF is fundamental in the continuity of this public policy.

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OBJECTIVE: To investigate whether tri-ponderal mass index and body mass index Z scores are equivalent for screening children and adolescents with insulin resistance. METHODS: Cross-sectional study with 296 children and adolescents enrolled at public schools of Vitória, Espírito Santo, Brazil, aged eight to 14 years. The tri-ponderal mass index was calculated as the ratio between weight and height cubed. The body mass index was calculated as the ratio between weight and height squared. Insulin resistance was defined with the homeostatic model assessment (HOMA-IR). RESULTS: The HOMA-IR was higher in the 4th quartile of body mass index Z scores and tri-ponderal mass index compared to 1st and 2nd quartiles for both girls and boys. The areas under the age-adjusted receiver operating characteristic curves were similar between the indices for girls (body mass index Z scores=0.756; tri-ponderal mass index=0.763) and boys (body mass index Z scores=0.831; tri-ponderal mass index=0.843). In addition, according to the simple linear regression analyses estimations, both body mass index Z scores and tri-ponderal mass index explained a significant fraction of the homeostatic model assessment variability for girls (body mass index Z scores: R2=0.269; tri-ponderal mass index: R2=0.289; p<0.001) and boys (body mass index Z scores: R2=0.175; tri-ponderal mass index: R2=0.210; p<0.001). CONCLUSIONS: The tri-ponderal mass index and body mass index Z scores were similar to discriminate children and adolescents with insulin resistance. It is noteworthy that the use of tri-ponderal mass index is clearly advantageous, because it can be calculated with no concerns on adjustments for the age, a fact that makes it very applicable in the clinical practice.

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ABSTRACT Objective: To investigate whether tri-ponderal mass index and body mass index Z scores are equivalent for screening children and adolescents with insulin resistance. Methods: Cross-sectional study with 296 children and adolescents enrolled at public schools of Vitória, Espírito Santo, Brazil, aged eight to 14 years. The tri-ponderal mass index was calculated as the ratio between weight and height cubed. The body mass index was calculated as the ratio between weight and height squared. Insulin resistance was defined with the homeostatic model assessment (HOMA-IR). Results: The HOMA-IR was higher in the 4th quartile of body mass index Z scores and tri-ponderal mass index compared to 1st and 2nd quartiles for both girls and boys. The areas under the age-adjusted receiver operating characteristic curves were similar between the indices for girls (body mass index Z scores=0.756; tri-ponderal mass index=0.763) and boys (body mass index Z scores=0.831; tri-ponderal mass index=0.843). In addition, according to the simple linear regression analyses estimations, both body mass index Z scores and tri-ponderal mass index explained a significant fraction of the homeostatic model assessment variability for girls (body mass index Z scores: R2=0.269; tri-ponderal mass index: R2=0.289; p<0.001) and boys (body mass index Z scores: R2=0.175; tri-ponderal mass index: R2=0.210; p<0.001). Conclusions: The tri-ponderal mass index and body mass index Z scores were similar to discriminate children and adolescents with insulin resistance. It is noteworthy that the use of tri-ponderal mass index is clearly advantageous, because it can be calculated with no concerns on adjustments for the age, a fact that makes it very applicable in the clinical practice.

RESUMO Objetivo: Investigar se o índice de massa tri-ponderal e os escores-z do índice de massa corporal são equivalentes na triagem de crianças e adolescentes com resistência à insulina. Métodos: Estudo transversal com 296 crianças e adolescentes matriculados em escolas públicas de Vitória, Espírito Santo, Brasil, com idades entre oito e 14 anos. O índice de massa tri-ponderal foi calculado como a razão entre o peso e a altura ao cubo. O índice de massa corporal foi calculado como a razão entre o peso e a altura ao quadrado. A resistência à insulina foi definida pelo modelo de avaliação da homeostase para resistência à insulina (HOMA-IR). Resultados: O HOMA-IR foi maior no 4º quartil dos escores-z do índice de massa corporal e do índice de massa tri-ponderal, em relação ao 1º e 2º quartis em ambos os sexos. As áreas sob as curvas receiver operating characteristic ajustadas por idade foram semelhantes em meninas (escores-z do índice de massa corporal=0,756; índice de massa tri-ponderal=0,763) e meninos (escores-z do índice de massa corporal=0,831; índice de massa tri-ponderal=0,843). Além disso, de acordo com as estimativas das análises de regressão linear simples, os escores-z do índice de massa corporal e o índice de massa tri-ponderal explicaram uma fração significativa da variabilidade do modelo de avaliação da homeostase para meninas (escores-z do índice de massa corporal: R2=0,269; índice de massa tri-ponderal: R2=0,289; p<0,001) e meninos (escores-z do índice de massa corporal: R2=0,175; índice de massa tri-ponderal: R2=0,210; p<0,001). Conclusões: O índice de massa tri-ponderal e os escores-z do índice de massa corporal foram semelhantes na triagem de crianças e adolescentes com resistência à insulina. É importante ressaltar que o uso do índice de massa tri-ponderal é claramente vantajoso, pois pode ser calculado sem ajustes por idade, fato que o torna muito aplicável à prática clínica.

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We studied the relationship between different anthropometric indexes and plasma lipids. Data were collected from 2014 to 2016 in 854 schoolchildren (6-18 years). Waist circumference (WC), body fat percentage (BFP) by bioimpedance, body mass index (BMI), and waist-to-height ratio (WHtR) were measured. Total cholesterol (TC), HDLc, and triglycerides were measured in fasting blood samples and Non-HDL cholesterol (Non-HDLc) was calculated. Data are presented as mean ± standard deviation, with percentages. Means were compared using the t test or ANOVA followed by Tukey's test. The association between variables was tested by linear regression. The study was approved by the Research Ethics Committee of the Universidade Federal do Espírito Santo. Obese boys had higher TC, non-HDLc, and LDLc than eutrophic boys (p < 0.05). In girls this difference was found only for non-HDLc (p < 0.05). Children with inappropriate BFP and WHtR presented higher LDLc and non-HDLc concentrations (p < 0.001), which showed positive association (p<0.001) with lipid fractions (TC and non-HDLc). Excess body fat increased the probability of cholesterol above the reference value (170 mg/dL) by 21%. Excess body fat was associated with an atherogenic lipid profile (higher non-HDLc), especially in boys.

Verificou-se a relação entre diferentes índices antropométricos e os lipídios plasmáticos. Os dados foram coletados de 2014 a 2016 em 854 escolares (6-18 anos). Foram aferidas a circunferência da cintura (CC), o percentual de gordura corporal (%G) por bioimpedância, o índice de massa corporal (IMC) e relação da cintura/estatura (RCE). Em sangue coletado em jejum mediu-se o colesterol total (CT), HDLc, e triglicerídeos e calculou-se o colesterol não HDL (Não HDLc). Os dados são apresentados por média ± desvio padrão, porcentagens. A comparação de médias foi feita pelo teste t ou ANOVA seguida de teste de Tukey. A associação entre variáveis foi testada por regressão linear. O estudo foi aprovado pelo Comitê de Ética da Universidade Federal do Espírito Santo. Meninos obesos tinham CT, Não HDLc e LDLc mais elevados do que os eutróficos. Em meninas este achado foi apenas para o Não HDLc. Crianças com o %G e RCE inadequados apresentaram LDLc e Não HDLc maiores (p < 0,001), os quais associaram-se positivamente (p < 0,001) com as frações lipídicas (CT e Não HDLc). O excesso de gordura corporal elevou em 21% a probabilidade de ocorrência de colesterol acima da referência (170 mg/dL). O excesso de gordura corporal associou-se com o perfil lipídico aterogênico (maior Não HDLc), principalmente em meninos.

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Resumo Verificou-se a relação entre diferentes índices antropométricos e os lipídios plasmáticos. Os dados foram coletados de 2014 a 2016 em 854 escolares (6-18 anos). Foram aferidas a circunferência da cintura (CC), o percentual de gordura corporal (%G) por bioimpedância, o índice de massa corporal (IMC) e relação da cintura/estatura (RCE). Em sangue coletado em jejum mediu-se o colesterol total (CT), HDLc, e triglicerídeos e calculou-se o colesterol não HDL (Não HDLc). Os dados são apresentados por média ± desvio padrão, porcentagens. A comparação de médias foi feita pelo teste t ou ANOVA seguida de teste de Tukey. A associação entre variáveis foi testada por regressão linear. O estudo foi aprovado pelo Comitê de Ética da Universidade Federal do Espírito Santo. Meninos obesos tinham CT, Não HDLc e LDLc mais elevados do que os eutróficos. Em meninas este achado foi apenas para o Não HDLc. Crianças com o %G e RCE inadequados apresentaram LDLc e Não HDLc maiores (p < 0,001), os quais associaram-se positivamente (p < 0,001) com as frações lipídicas (CT e Não HDLc). O excesso de gordura corporal elevou em 21% a probabilidade de ocorrência de colesterol acima da referência (170 mg/dL). O excesso de gordura corporal associou-se com o perfil lipídico aterogênico (maior Não HDLc), principalmente em meninos.

Abstract We studied the relationship between different anthropometric indexes and plasma lipids. Data were collected from 2014 to 2016 in 854 schoolchildren (6-18 years). Waist circumference (WC), body fat percentage (BFP) by bioimpedance, body mass index (BMI), and waist-to-height ratio (WHtR) were measured. Total cholesterol (TC), HDLc, and triglycerides were measured in fasting blood samples and Non-HDL cholesterol (Non-HDLc) was calculated. Data are presented as mean ± standard deviation, with percentages. Means were compared using the t test or ANOVA followed by Tukey's test. The association between variables was tested by linear regression. The study was approved by the Research Ethics Committee of the Universidade Federal do Espírito Santo. Obese boys had higher TC, non-HDLc, and LDLc than eutrophic boys (p < 0.05). In girls this difference was found only for non-HDLc (p < 0.05). Children with inappropriate BFP and WHtR presented higher LDLc and non-HDLc concentrations (p < 0.001), which showed positive association (p<0.001) with lipid fractions (TC and non-HDLc). Excess body fat increased the probability of cholesterol above the reference value (170 mg/dL) by 21%. Excess body fat was associated with an atherogenic lipid profile (higher non-HDLc), especially in boys.

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Abstract Objective: Given the importance of incorporating simple and low-cost tools into the pediatric clinical setting to provide screening for insulin resistance, the present study sought to investigate whether waist-to-height ratio is comparable to biochemical markers for the discrimination of insulin resistance in children and adolescents. Methods: This cross-sectional study involved students from nine public schools. In total, 296 children and adolescents of both sexes, aged 8 -14 years, composed the sample. Waist-to-height ratio, triglycerides/glucose index, and triglycerides-to-HDL-C ratio were determined according to standard protocols. Insulin resistance was defined as homeostatic model assessment for insulin resistance with cut-off point ≥ 3.16. Results: Age, body mass index, frequency of overweight, waist circumference, waist-to-height ratio, insulin, glucose, homeostatic model assessment for insulin resistance, triglycerides, triglycerides/glucose index, and triglycerides-to-HDL-C were higher among insulin resistant boys and girls. Moderate correlation of all indicators (waist-to-height ratio, triglycerides/glucose index, and triglycerides-to-HDL-C ratio) with homeostatic model assessment for insulin resistance was observed for both sexes. The areas under the receiver operational characteristic curves ware similar between waist-to-height ratio and biochemical markers. Conclusion: The indicators provided similar discriminatory power for insulin resistance. However, taking into account the cost-benefit ratio, we suggest that waist-to-height ratio may be a useful tool to provide screening for insulin resistance in pediatric populations.

Resumo Objetivo: Considerando a importância de incorporar ferramentas simples e de baixo custo no cenário clínico-pediátrico para a triagem de resistência à insulina, o presente estudo buscou investigar se a razão cintura/estatura é comparável a marcadores bioquímicos na discriminação de resistência à insulina em crianças e adolescentes. Métodos: Este estudo transversal envolveu estudantes de nove escolas públicas. No total, 296 crianças e adolescentes, de ambos os sexos, com idades entre 8 e 14 anos, compuseram a amostra. A razão cintura/estatura, o índice triglicerídeos/glicose e a razão triglicerídeos/HDL-C foram determinados de acordo com protocolos padrão. A resistência à insulina foi definida por meio do modelo de avaliação homeostática para resistência insulínica, com ponto de corte ≥ 3.16. Resultados: Idade, índice de massa corporal, frequência de excesso de peso, circunferência da cintura, razão cintura/estatura, insulina, glicemia, modelo de avaliação homeostática para resistência insulínica, triglicerídeos, índice triglicerídeos/glicose e razão triglicerídeos/HDL-C foram maiores entre meninos e meninas com resistência à insulina. Também foram observadas, em ambos os sexos, correlações moderadas de todos os indicadores (razão cintura/estatura, índice triglicerídeos/glicose e razão triglicerídeos/HDL-C) com o modelo de avaliação homeostática para resistência à insulina. As áreas sob as curvas ROC foram semelhantes entre a razão cintura/estatura e os marcadores bioquímicos. Conclusão: Os indicadores forneceram poder discriminatório similar para a resistência à insulina. No entanto, levando em conta o custo-benefício, sugerimos que a razão cintura/estatura pode ser uma ferramenta útil para a triagem de resistência à insulina em populações pediátricas.

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BACKGROUND: We aimed to compare the accuracy of the ponderal index (PI) vs. BMI-for-age z-scores transformed (BMIz) in estimating body fat levels and classifying obesity in children and adolescents from a Brazilian urban population. METHODS: This is a cross-sectional study with 1149 participants (53.2% male), aged 6 to 18 years. Body fat percent (BFP) was obtained by multi-frequency bioelectrical impedance. Non-linear regression analysis provided the accuracy of both BMIz and PI in estimating BFP. False positive rate was obtained from the proportion of individuals placed at or above the 95th percentile for BMIz or PI, whereas their BFP was discordantly below the 95th percentile. RESULTS: PI and BMIz appeared with similar stability from childhood to adolescence for both boys and girls. The portion of the variability in BFP explained by BMIz (R2 = 0.74 and R2 = 0.75) was close to the variability in BFP explained by PI (R2 = 0.73 and R2 = 0.75) for boys and girls, respectively. False positive rate was higher for BMIz compared with PI among boys (21.8% vs. 3.9%) and girls (28.5% vs. 17.5%). CONCLUSIONS: PI is a promising index for replacing BMIz in children and adolescents due to its potential to reduce false diagnosis of obesity.

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Abstract Objective: To assess whether the indicators of weight status body mass index and waist-to-height ratio are similar to body fat percentage to identify obese children and adolescents with unfavorable lipid profile. Methods: This was a cross-sectional study involving 840 children and adolescents (6-18 years). The same individuals were classified as non-obese (<P95) or obese (≥P95) according to body fat percentage and indicators of weight status, body mass index, and waist-to-height ratio. Body fat percentage was obtained by multi-frequency bioelectrical impedance. Linear association between obesity and increased lipid fractions was tested by ANCOVA. Normal distribution curves of non-HDL cholesterol were designed for obese and non-obese. To provide the proportion of obese individuals with elevated non-HDL-c across all indicators, Z-score was calculated. Results: Obese boys presented higher non-HDL cholesterol when compared with those non-obese, classified by body mass index (107 ± 28 vs. 94 ± 25 mg/dL, p = 0.001), waist-to-height ratio (115 ± 29 vs. 94 ± 25 mg/dL, p < 0.001) and body fat percentage (119 ± 33 vs. 94 ± 24 mg/dL, p < 0.001). Differently, obese girls presented with higher non-HDL cholesterol when compared with those non-obese only according to the body fat percentage classification (118 ± 24 vs. 96 ± 26 mg/dL, p = 0.001). A large shift to the right in the distribution curve of non-HDL cholesterol among obese girls compared with non-obese was observed only when body fat percentage was used to discriminate between obese and non-obese. Conclusion: Body fat percentage was better than the indicators of weight status to identify children and adolescents with unfavorable lipid profile, mainly among girls.

Resumo Objetivo: Investigar se os indicadores da condição do peso, índice de massa corporal e razão cintura/estatura são semelhantes ao percentual de gordura corporal para identificação de crianças e adolescentes obesos com perfil lipídico desfavorável. Métodos: Estudo transversal que envolveu 840 crianças e adolescentes (6‐18 anos). Os mesmos indivíduos foram classificados em não obesos (p < 95) ou obesos (p ≥ 95) de acordo com o percentual de gordura corporal e os indicadores da condição do peso, índice de massa corporal e razão cintura/estatura. O percentual de gordura corporal foi obtido por bioimpedância multifrequencial tetrapolar. A associação linear entre obesidade e aumento das frações lipídicas foi tesada por ANCOVA. As curvas de distribuição normal de colesterol não HDL foram construídas para obesos e não obesos. Para fornecer a proporção de indivíduos obesos com colesterol não HDL elevado para todos os indicadores, o escore z foi calculado. Resultados: Os meninos obesos apresentaram maior colesterol não HDL em comparação com não obesos de acordo com a classificação fornecida pelo índice de massa corporal (107 ± 28 em comparação com 94 ± 25 mg/dL, p = 0,001), razão cintura/estatura (115 ± 29 em comparação com 94 ± 25 mg/dL, p < 0,001) e percentual de gordura corporal (119 ± 33 em comparação com 94 ± 24 g/dL, p < 0,001). Diferentemente, as meninas obesas apresentaram maior colesterol não HDL em comparação com as não obesas, somente de acordo com a classificação fornecida pelo percentual de gordura corporal (118 ± 24 em comparação com 96 ± 26 mg/dL, p = 0,001). Um grande deslocamento para a direita na curva de distribuição de colesterol não HDL entre meninas obesas em comparação com não obesas foi observado somente quando o percentual de gordura corporal foi utilizado para discriminar obesas e não obesas. Conclusão: O percentual de gordura corporal é melhor do que os indicadores da condição do peso na identificação de crianças e adolescentes com perfil lipídico desfavorável, principalmente entre meninas.

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OBJECTIVE: To assess whether the indicators of weight status body mass index and waist-to-height ratio are similar to body fat percentage to identify obese children and adolescents with unfavorable lipid profile. METHODS: This was a cross-sectional study involving 840 children and adolescents (6-18 years). The same individuals were classified as non-obese (

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OBJECTIVE: Given the importance of incorporating simple and low-cost tools into the pediatric clinical setting to provide screening for insulin resistance, the present study sought to investigate whether waist-to-height ratio is comparable to biochemical markers for the discrimination of insulin resistance in children and adolescents. METHODS: This cross-sectional study involved students from nine public schools. In total, 296 children and adolescents of both sexes, aged 8-14 years, composed the sample. Waist-to-height ratio, triglycerides/glucose index, and triglycerides-to-HDL-C ratio were determined according to standard protocols. Insulin resistance was defined as homeostatic model assessment for insulin resistance with cut-off point ≥ 3.16. RESULTS: Age, body mass index, frequency of overweight, waist circumference, waist-to-height ratio, insulin, glucose, homeostatic model assessment for insulin resistance, triglycerides, triglycerides/glucose index, and triglycerides-to-HDL-C were higher among insulin resistant boys and girls. Moderate correlation of all indicators (waist-to-height ratio, triglycerides/glucose index, and triglycerides-to-HDL-C ratio) with homeostatic model assessment for insulin resistance was observed for both sexes. The areas under the receiver operational characteristic curves ware similar between waist-to-height ratio and biochemical markers. CONCLUSION: The indicators provided similar discriminatory power for insulin resistance. However, taking into account the cost-benefit ratio, we suggest that waist-to-height ratio may be a useful tool to provide screening for insulin resistance in pediatric populations.

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