RESUMO
OBJECTIVES: To explore the association between adiposity, major depressive disorder and generalized anxiety disorder, and to assess the role of inflammation, diet quality and physical activity in this association. METHODS: We used data from 2,977 individuals from the 1993 Pelotas Cohort (Brazil) who attended the 18- and 22-year follow-ups. We assessed general obesity using body mass index, fat mass index, and abdominal obesity using waist circumference. Major Depressive Disorder and generalized anxiety disorder were assessed using the mini-international neuropsychiatric interview. C-reactive protein and interleukin-6 (IL-6) levels were used as a measure of inflammation; diet quality was estimated using the revised diet quality index, and physical activity was assessed by the International physical activity questionnaire (IPAQ, min/day). The association between adiposity and major depressive disorder and generalized anxiety disorder was assessed using logistic regression, and the natural indirect effect via the mediators was estimated using G-computation. RESULTS: General obesity assessed by body mass index (OR: 2.3; 95% CI:1.13; 4.85), fat mass index (OR: 2.6; 95%CI: 1.37; 4.83), and abdominal obesity (OR: 2.5; 95%CI: 1.18; 5.39) were associated with higher odds of major depressive disorder, whereas major depressive disorder was only associated with obesity assessed by body mass index (OR=1.9; 95% CI: 1.09; 3.46). Obesity and generalized anxiety disorder were not associated. C-reactive protein, diet quality and physical activity did not mediate the effect of obesity on major depressive disorder, and C-reactive protein mediated about 25% of the effect of major depressive disorder on adiposity. CONCLUSIONS: Depression, but not generalized anxiety disorder, is associated with adiposity in both directions, with a stronger evidence for the direction obesity-depression. Inflammation explains part of the effect of major depressive disorder on obesity but not the other way around. Further research should explore other mechanisms that could be involved in the association between obesity and depression.
Assuntos
Adiposidade/fisiologia , Transtornos de Ansiedade/fisiopatologia , Transtorno Depressivo Maior/fisiopatologia , Dieta , Exercício Físico/psicologia , Obesidade/psicologia , Adolescente , Antropometria , Brasil , Proteína C-Reativa/análise , Estudos de Coortes , Exercício Físico/fisiologia , Feminino , Humanos , Interleucina-6/sangue , Estilo de Vida , Modelos Logísticos , Masculino , Obesidade Abdominal/psicologia , Escalas de Graduação Psiquiátrica , Valores de Referência , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVE: To evaluate the effectiveness of a replicable group treatment program for improving social competence after traumatic brain injury (TBI). DESIGN: Multicenter randomized controlled trial comparing 2 methods of conducting a social competency skills program, an interactive group format versus a classroom lecture. SETTING: Community and veteran rehabilitation centers. PARTICIPANTS: Civilian, military, and veteran adults with TBI and social competence difficulties (N=179), at least 6 months postinjury. INTERVENTIONS: The experimental intervention consisted of 13 weekly group interactive sessions (1.5h) with structured and facilitated group interactions to improve social competence, and the control consisted of 13 traditional classroom sessions using the same curriculum with brief supplemental individual sessions but without structured group interaction. MAIN OUTCOME MEASURES: Profile of Pragmatic Impairment in Communication (PPIC), an objective behavioral rating of social communication impairments after TBI. LaTrobe Communication Questionnaire (LCQ), Goal Attainment Scale (GAS), Satisfaction with Life Scale, Posttraumatic Stress Disorder Checklist-C (PCL) civilian version, Brief Symptom Inventory 18 (BSI-18), Scale of Perceived Social Self-Efficacy (PSSE). RESULTS: Social competence goals (GAS) were achieved and maintained for most participants regardless of treatment method. Significant improvements in the primary outcome (PPIC) and 2 of the secondary outcomes (LCQ and BSI) were seen immediately posttreatment and at 3 months posttreatment in the alternative treatment arm only; however, these improvements were not significantly different between the group interactive structured treatment and alternative treatment arms. Similar trends were observed for PSSE and PCL-C. CONCLUSIONS: Social competence skills improved for persons with TBI in both treatment conditions. The group interactive format was not found to be a superior method of treatment delivery in this study.
Assuntos
Lesões Encefálicas Traumáticas/reabilitação , Competência Mental/psicologia , Reabilitação Psiquiátrica/métodos , Psicoterapia de Grupo/métodos , Transtorno de Comunicação Social/reabilitação , Adulto , Lesões Encefálicas Traumáticas/psicologia , Comunicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Militares/psicologia , Centros de Reabilitação , Transtorno de Comunicação Social/psicologia , Habilidades Sociais , Resultado do Tratamento , Veteranos/psicologiaRESUMO
OBJECTIVE: This study aimed to assess the association between adverse childhood experiences (ACEs) and adiposity in adolescents from two cohorts in different socioeconomic contexts. METHODS: Data from the Avon Longitudinal Study of Parents and Children (ALSPAC, United Kingdom) and the 1993 Pelotas Cohort (Brazil) were used. Six ACEs were assessed in both cohorts up to age 15. At 15 years, body mass index (BMI) and waist circumference (WC) were measured, and at 18 years, BMI, fat mass index, and android fat percentage were assessed. RESULTS: Few associations were observed between ACEs and adiposity at 15 years, and they were not consistent across cohorts. For adiposity at age 15 in ALSPAC, physical abuse had a positive association with WC, and domestic violence had a positive association with both WC and BMI. A dose-response relationship between the ACE score and both WC and BMI at 15 years was observed in ALSPAC. In the 1993 Pelotas Cohort, the associations found in crude analysis were no longer evident after adjustment. CONCLUSIONS: This study found some evidence of an association between an ACE score and adiposity in adolescence in a United Kingdom cohort but no evidence of association in a Brazilian cohort. Residual confounding or context-specific relationships could explain the different pattern of associations.
Assuntos
Adiposidade/fisiologia , Acontecimentos que Mudam a Vida , Adolescente , Índice de Massa Corporal , Criança , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Fatores de Risco , Circunferência da CinturaRESUMO
The aim of this study was to explore the association between parental separation during childhood (up to 18 years of age) and cardiometabolic risk factors (body mass index, fat mass index, blood pressure, physical activity, smoking, and alcohol consumption) in late adolescence using a cross-cohort comparison and to explore whether associations differ according to the age at which the parental separation occurred and the presence or absence of parental conflict prior to separation. Data from the Avon Longitudinal Study of Parents and Children (ALSPAC, United Kingdom) (1991-2011) and the 1993 Pelotas Birth Cohort (Brazil) (1993-2011) were used. The associations of parental separation with children's cardiometabolic risk factors were largely null. Higher odds of daily smoking were observed in both cohorts for those adolescents whose parents separated (for ALSPAC, odds ratio = 1.46; for Pelotas Birth Cohort, odds ratio = 1.98). Some additional associations were observed in the Pelotas Birth Cohort but were generally in the opposite direction to our a priori hypothesis: Parental separation was associated with lower blood pressure and fat mass index, and with more physical activity. No consistent differences were observed when analyses were stratified by child's age at parental separation or parental conflict.
Assuntos
Doenças Cardiovasculares/epidemiologia , Divórcio/estatística & dados numéricos , Pais , Adolescente , Fatores Etários , Consumo de Bebidas Alcoólicas/epidemiologia , Pressão Sanguínea , Índice de Massa Corporal , Pesos e Medidas Corporais , Brasil/epidemiologia , Criança , Pré-Escolar , Exercício Físico , Feminino , Humanos , Estudos Longitudinais , Masculino , Fatores de Risco , Fumar/epidemiologia , Fatores Socioeconômicos , Reino Unido/epidemiologiaRESUMO
BACKGROUND: Variations in the distribution of cardiovascular disease and risk factors by socioeconomic status (SES) have been described in affluent societies, yet a better understanding of these patterns is needed for most low- and middle-income countries. OBJECTIVE: This study sought to describe the relationship between cardiovascular risk factors and SES using monthly family income, educational attainment, and assets index, in 4 Peruvian sites. METHODS: Baseline data from an age- and sex-stratified random sample of participants, ages ≥35 years, from 4 Peruvian sites (CRONICAS Cohort Study, 2010) were used. The SES indicators considered were monthly family income (n = 3,220), educational attainment (n = 3,598), and assets index (n = 3,601). Behavioral risk factors included current tobacco use, alcohol drinking, physical activity, daily intake of fruits and vegetables, and no control of salt intake. Cardiometabolic risk factors included obesity, elevated waist circumference, hypertension, insulin resistance, diabetes mellitus, low high-density lipoprotein cholesterol, and high triglyceride levels. RESULTS: In the overall population, 41.6% reported a monthly family income Assuntos
Doenças Cardiovasculares/epidemiologia
, Hipertrigliceridemia/epidemiologia
, Resistência à Insulina
, Obesidade/epidemiologia
, Pobreza/estatística & dados numéricos
, Classe Social
, Adulto
, Idoso
, Consumo de Bebidas Alcoólicas/epidemiologia
, HDL-Colesterol
, Estudos de Coortes
, Diabetes Mellitus/epidemiologia
, Dieta/estatística & dados numéricos
, Dislipidemias/epidemiologia
, Escolaridade
, Exercício Físico
, Feminino
, Humanos
, Hipertensão/epidemiologia
, Renda/estatística & dados numéricos
, Masculino
, Pessoa de Meia-Idade
, Peru/epidemiologia
, Fatores de Risco
, Fumar/epidemiologia
, Circunferência da Cintura
RESUMO
OBJECTIVE: To investigate whether short sleep duration from the first year of life influenced weight at an early age. STUDY DESIGN: During 2004, children born in Pelotas, Brazil, were enrolled in a cohort study. Sleeping habits during the previous 2 weeks were assessed, and the children were weighed and measured at 1-, 2-, and 4-year follow-ups. Overweight and obesity at 4 years were defined according to World Health Organization z-scores for body mass index for age. Short sleep duration was defined as fewer than 10 hours of sleep per night at any follow-up. RESULTS: Out of the 4263 live births, 4231 were recruited. The prevalence of short sleep duration at any follow-up from 1-4 years of age was 10.1%. At 4 years of age, 201 children were obese (5.3%), and 302 (8%) were overweight. Among short sleepers, the prevalence ratio for overweight/obesity after adjusting for maternal and children's characteristics was 1.32 (1.03; 1.70). CONCLUSIONS: Children who slept for fewer than 10 hours per night at any follow-up from 1-4 years of age were more likely to be overweight or obese at 4 years of age, despite their sociodemographic and sleep characteristics.
Assuntos
Obesidade/etiologia , Sobrepeso/etiologia , Privação do Sono/complicações , Índice de Massa Corporal , Brasil , Pré-Escolar , Estudos de Coortes , Feminino , Seguimentos , Humanos , Lactente , Masculino , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Prevalência , Fatores de Risco , Sono , Fatores de TempoRESUMO
Adverse childhood experiences (ACEs) can affect people's health and wellbeing not only at the time the ACE is experienced, but also later in life. The majority of studies on ACEs are carried out in high-income countries and little is known about its prevalence in low and middle-income countries. Thus, the aim of this study was to assess the prevalence of ACEs, associations between ACEs and sociodemographic factors, and the interrelationship between types of ACEs in adolescents of a Brazilian birth cohort. Data from 3,951 adolescents (78.4% of the original cohort) from the 1993 Pelotas Cohort were analyzed. Seven types of ACEs were assessed in those up to 18 years old: physical abuse, sexual abuse, physical neglect, emotional neglect, domestic violence, parental separation and parental death. The most common ACE was parental separation (42%), followed by emotional neglect (19.7%) and domestic violence (10.3%). Approximately 85% of the adolescents experienced at least one ACE, and females reported a higher number of adversities. Several socioeconomic, demographic and family-related characteristics were associated with the occurrence of ACEs, e.g. non-white skin color, low family income, low maternal schooling, absence of mother's partner, maternal smoking, and poor maternal mental health. A strong interrelationship was observed among the ACEs, indicating clustering of risk. These aspects should be considered by health and social care professionals in the prevention and identification of childhood adversities.
Assuntos
Maus-Tratos Infantis/estatística & dados numéricos , Adolescente , Brasil , Estudos de Coortes , Feminino , Humanos , Masculino , Satisfação Pessoal , Prevalência , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: We investigated whether Body Mass Index (BMI) at 11 years old has a direct effect on bone mass at age 18 operating through alterations to bone growth and development, or whether the association is mediated by concurrent BMI, fat mass (FM), and fat free mass (FFM). METHODS: Path analysis was used to explore the association between BMI at age 11 and whole-body bone mineral content (BMC) and bone mineral density (BMD) assessed by dual-energy x-ray absorptiometry (DXA) at age 18 in a prospective birth cohort study comprising 3,307 adolescents; we also evaluated the degree to which this association was mediated by BMI, FM (kg) and FFM (kg) assessed by plethysmography (BOD POD) at age 18. RESULTS: We found a positive association between BMI at age 11 and BMC (males [ß = 179.7 g, 95% CI 161.4; 198.0]; females [ß = 179.9 g, 95% CI 165.3; 194.6]) and BMD (males [ß = 0.030 g/cm2, 95% CI 0.024; 0.035]; females [ß = 0.029 g/cm2, 95% CI 0.025; 0.033]) at age 18. This association was largely mediated by BMI and FFM at age 18 in both female and male adolescents. FM at age 18 was not an important mediator. CONCLUSIONS: Concurrent BMI and FFM were the main mediators of the association between BMC/BMD in late adolescence and BMI in early adolescence.
Assuntos
Tecido Adiposo/fisiologia , Composição Corporal/fisiologia , Índice de Massa Corporal , Densidade Óssea/fisiologia , Absorciometria de Fóton , Adolescente , Brasil , Criança , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Pletismografia , Estudos Prospectivos , Estudos Retrospectivos , Fatores SexuaisRESUMO
OBJECTIVES: To examine independent associations between sleep-disordered breathing (SDB), sleep duration from birth through 6.75 years, and body mass index (BMI) through 15 years of age in a population-based cohort. STUDY DESIGN: The Avon Longitudinal Study of Parents and Children collected parent questionnaire data on child sleep duration and SDB symptoms from birth through 6.75 years and child BMI from the Avon Longitudinal Study of Parents and Children research clinics (n = 1899). For SDB, logistic regression models-minimal, confounder, and confounder + sleep duration adjusted-examined associations with BMI at 7, 10, and 15 years of age. For short sleep duration (≤10th percentile), comparable SDB-adjusted models examined associations with BMI at 15 years of age. RESULTS: Children with the worst SDB symptoms vs asymptomatic children, had increased odds of overweight at 7 (OR = 2.08, 95% CI = 1.04-4.17), 10 (OR = 1.79, 95% CI = 1.02-3.16), and 15 years of age (OR = 2.25, 95% CI = 1.27-3.97) in models adjusted for sleep duration. Similarly, short sleep duration at ≈5-6 years was associated with overweight at 15 years, independent of SDB. Children with short sleep duration at 4.75 years were more likely to be overweight at 15 years in minimally (OR = 2.21, 95% CI = 1.52-3.20), confounder (OR = 1.99, 95% CI = 1.34-2.96), and SDB-adjusted (OR = 2.04, 95% CI = 1.36-3.04) models. CONCLUSIONS: Both SDB and short sleep duration significantly and independently increase children's odds of becoming overweight. Findings underscore the potential importance of early identification and remediation of SDB, along with insufficient sleep, as strategies for reducing childhood obesity.
Assuntos
Índice de Massa Corporal , Sobrepeso/etiologia , Síndromes da Apneia do Sono/complicações , Sono/fisiologia , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Sobrepeso/epidemiologia , Polissonografia , Respiração , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários , Reino Unido/epidemiologiaRESUMO
Socio-economic inequalities in attained height have been reported in many countries. The aim of this study was to explore the age at which maternal education inequalities in child height emerge among children from a middle-income country. Using data from the 2004 Pelotas cohort study from Brazil we modelled individual height growth trajectories in 2106 boys and 1947 girls from birth to 4 years using a linear spline mixed-effects model. We examined the associations of maternal education with birth length and trajectories of growth in length/height, and explored the effect of adjusting for a number of potential confounder or mediator factors. We showed linear and positive associations of maternal education with birth length and length/height growth rates at 0-3 months and 12-29/32 months with very little association at 3-12 months, particularly in boys. By age 4 years the mean height of boys was 101.06 cm (SE = 0.28) in the lowest and 104.20 cm (SE = 0.15) in the highest education category (mean difference 3.14 cm, SE = 0.32, P < 0.001). Among girls the mean height was 100.02 cm (SE = 0.27) and 103.03 cm (SE = 0.15) in the lowest and highest education categories, respectively (mean difference 3.01 cm, SE = 0.31, P < 0.001). For both boys and girls there was on average a 3-cm difference between the extreme education categories. Adjusting for maternal height reduced the observed birth length differences across maternal education categories, but differences in postnatal growth rates persisted. Our data demonstrate an increase in the absolute and relative inequality in height after birth; inequality increases from approximately 0.2 standard deviations of birth length to approximately 0.7 standard deviations of height at age 4, indicating that height inequality, which was already present at birth, widened through differential growth rates to age 2 years.