RESUMO
BACKGROUND: Earlier we reported on growth and adiposity in a cross-sectional study of disadvantaged Brazilian preschoolers. Here we extend the work on these children, using structural equation modelling (SEM) to gather information on the complex relationships between the variables influencing height and adiposity. We hope this information will help improve the design and effectiveness of future interventions for preschoolers. METHODS: In 376 preschoolers aged 3-6 years attending seven philanthropic daycares in Salvador, we used SEM to examine direct and indirect relationships among biological (sex, ethnicity, birth order, maternal height and weight), socio-economic, micronutrient (haemoglobin, serum selenium and zinc), and environmental (helminths, de-worming) variables on height and adiposity, as reflected by Z-scores for height-for-age (HAZ) and body mass index (BMIZ). RESULTS: Of the children, 11 % had HAZ < -1, 15 % had WHZ < -1, and 14 % had BMIZ > 1. Of their mothers, 8 % had short stature, and 50 % were overweight or obese. Based on standardized regression coefficients, significant direct effects (p < 0.05) for HAZ were maternal height (0.39), being white (-0.07), having helminth infection (-0.09), and serum zinc (-0.11). For BMIZ, significant direct effects were maternal weight (0.21), extremely low SES (-0.15), and haemoglobin (0.14). Indirect (p < 0.05) effects for HAZ were sex (being male) (-0.02), helminth infection (-0.01), de-worming treatment (0.01), and serum selenium (-0.02), and for BMIZ were extremely low SES (-0.001), helminth infection (-0.004), and serum selenium (0.02). CONCLUSIONS: Of the multiple factors influencing preschoolers' growth, helminth infection was a modifiable risk factor directly and indirectly affecting HAZ and BMIZ, respectively. Hence the WHO de-worming recommendation should include preschoolers living in at-risk environments as well as school-aged children.
Assuntos
Adiposidade , Estatura , Índice de Massa Corporal , Transtornos do Crescimento/etiologia , Obesidade/etiologia , Classe Social , Populações Vulneráveis , Animais , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Meio Ambiente , Etnicidade , Feminino , Transtornos do Crescimento/sangue , Transtornos do Crescimento/epidemiologia , Helmintos , Hemoglobinas/metabolismo , Humanos , Masculino , Mães , Obesidade/sangue , Obesidade/epidemiologia , Sobrepeso , Fatores de Risco , Oligoelementos/sangueRESUMO
OBJECTIVE: To determine the reliability and stability of sleep (duration and quality) over time in young children using repeated accelerometer estimates of sleep. STUDY DESIGN: One hundred ninety-four children wore Actical accelerometers for 5-day periods (24-hour monitoring) at 3, 4, 5, 5.5, 6.5, and 7 years of age. Sleep variables of interest (duration, onset, offset, latency, efficiency, and wake after sleep onset) were estimated using the Sadeh algorithm within a commercial data reduction program (ActiLife). Children were divided into various groups according to sleep stability, and demographic and behavioral differences were compared across groups by ANOVA. RESULTS: All measures of sleep quantity and quality required 4-7 days of accelerometry to obtain acceptable reliability estimates, except morning wake time (2-4 days), and sleep latency (11-21 days). Average year-to-year correlations were only moderate for most measures (r = 0.41-0.51), but considerably higher than those observed for sleep latency, efficiency, and wake after onset (r = 0.15-0.24). Only 29 children were classified as sleep-stable over the 4 years. These children were less likely to be from ethnic minority groups (P = .017) and had higher levels of day-time physical activity (P = .032). CONCLUSIONS: Sleep patterns in children are not particularly stable, showing considerable variation both within a week and across the years. Few children exhibit stable sleep patterns over time, yet characterization of these children might provide further information regarding how sleep benefits health.
Assuntos
Atividade Motora/fisiologia , Sono/fisiologia , Vigília/fisiologia , Acelerometria , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Valores de Referência , Reprodutibilidade dos Testes , Estudos RetrospectivosRESUMO
Objective: We aimed to examine whether breastfeeding is associated with lower blood cholesterol concentrations in adulthood...
Assuntos
Masculino , Feminino , Humanos , Adulto , Aleitamento Materno , Colesterol , Nutrição da Criança , LDL-ColesterolRESUMO
OBJECTIVE: To examine the micronutrient status of disadvantaged pre-schoolers from Northeast Brazil, following the introduction of pro-poor policies, by assessing the prevalence of anaemia and micronutrient deficiencies and the role of sociodemographic factors, genetic Hb disorders and parasitic infections. DESIGN: In a cross-sectional study, data on sociodemographic status, health, growth, genetic Hb disorders, parasites and nutrient supply from day-care meals were obtained. Fasting blood samples were collected and analysed for Hb, serum ferritin, transferrin receptor, folate, vitamin B12, retinol, Zn and Se. SETTING: Seven philanthropic day-care centres serving urban slums in Salvador, Northeast Brazil. SUBJECTS: Pre-schoolers aged 3-6 years from disadvantaged households. RESULTS: Of the 376 sampled children, 94 % were of black or mixed race; 33 % and 29 % had at least one genetic Hb disorder and intestinal parasite, respectively. Stunting and underweight were ≤5 %; 14 % were overweight. Day-care centres supplied micronutrient-dense meals and snacks each weekday. Less than 10 % of pre-schoolers had anaemia and micronutrient deficiencies. Predictors (P < 0·05) of Hb were α(3·7) thalassaemia, Se and retinol (but not ferritin). Micronutrient predictors (P < 0·05) were: elevated α1-glycoprotein for ferritin, Hb AS and BMI Z-score >1 for transferrin receptor, Zn and elevated α1-glycoprotein for retinol, sex and helminths for Se, helminths for vitamin B12, and Giardia intestinalis infection for serum folate. CONCLUSIONS: Impaired growth, anaemia and micronutrient deficiencies were uncommon among these disadvantaged pre-schoolers attending day care. A range of interventions including provision of micronutrient-dense, fortified day-care meals, deworming and vitamin A supplementation likely contributed to improved micronutrient status, suggesting expanded coverage of these programmes.
Assuntos
Anemia Ferropriva/prevenção & controle , Fenômenos Fisiológicos da Nutrição Infantil , Deficiências Nutricionais/prevenção & controle , Assistência Alimentar , Alimentos Fortificados , Micronutrientes/uso terapêutico , Saúde da População Urbana , Anemia Ferropriva/economia , Anemia Ferropriva/epidemiologia , Anemia Ferropriva/etiologia , Brasil/epidemiologia , Criança , Creches , Desenvolvimento Infantil , Pré-Escolar , Estudos Transversais , Deficiências Nutricionais/economia , Deficiências Nutricionais/epidemiologia , Deficiências Nutricionais/etiologia , Dieta/efeitos adversos , Dieta/economia , Feminino , Serviços de Alimentação/economia , Alimentos Fortificados/economia , Humanos , Masculino , Micronutrientes/administração & dosagem , Micronutrientes/deficiência , Micronutrientes/economia , Estado Nutricional , Pobreza , Prevalência , Fatores Socioeconômicos , Saúde da População Urbana/economiaRESUMO
OBJECTIVES: To determine what factors drive participation in a family-based weight management program for 4- to 8-year-old children following screening for overweight or obesity. STUDY DESIGN: Children (n = 1093) attended a comprehensive screening appointment where parents completed questionnaires on demographics, motivation for healthy lifestyles, feeding practices, and beliefs about child size, prior to feedback about the child's weight. Parents of overweight or obese children (body mass index ≥85th percentile) attended a follow-up interview to assess reactions to feedback and willingness to participate in a 2-year intervention. RESULTS: A total of 271 (24.8%) children were overweight or obese with 197 (72.7%) agreeing to the intervention. Socioeconomic status differed in intervention participants (n = 197) compared with non-participants (n = 74), whereas no differences were observed in parental feeding practices, ineffective parenting practices, or self-determined forms of motivation. However, fewer non-participating parents believed their child to be overweight (23% vs 49%, P < .001) or were concerned about it (16% vs 43%, P < .001), despite children having an average body mass index approximating the 95th percentile. Non-participating parents did not expect their child to be overweight (P = .002) and rated receiving this information as less useful (P = .008) than participating parents. CONCLUSION: Preconceptions about child weight and reactions to feedback determined intervention uptake more than parenting or motivation for health. Many parents agreed to participate in the intervention despite not viewing their child as overweight.
Assuntos
Obesidade/terapia , Cooperação do Paciente/estatística & dados numéricos , Peso Corporal , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Programas de Rastreamento , Motivação , Sobrepeso/terapia , Poder FamiliarRESUMO
Poor growth and intestinal parasitic infections are widespread in disadvantaged urban children. This cross-sectional study assessed factors influencing poor growth and intestinal parasites in 376 children aged three to six years in daycare centers in Salvador, in the Northeast Region of Brazil. Data was obtained from seven daycare centers on child weight, height, socio-economic status, health and intestinal parasites in stool samples. Prevalence of moderate underweight (< -1SD > -2SD), wasting and stunting was 12%, 16% and 6% respectively. Socioeconomic status, birth order, and maternal weight were predictors of poor anthropometric status. Almost 30% of children were infected with more than one intestinal parasite. Helminths (17.8%), notably Trichuris trichiura (12%) and Ascaris lumbricoides (10.5%), and protozoan Giardia duodenalis (13%) were the most common types of parasites detected. One percent of children had hookworm and Cryptosporidium sp. and 25% had non-pathogenic protozoan cysts. Boys from families with very low socio-economic status had lower linear growth and presented a greater risk of helminth infection. Deworming is considered an alternative for reducing the prevalence of intestinal parasitic infections in this age group.
Assuntos
Creches , Desenvolvimento Infantil , Fezes/parasitologia , Enteropatias Parasitárias/epidemiologia , Animais , Estatura , Peso Corporal , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Crescimento , Humanos , Enteropatias Parasitárias/complicações , Enteropatias Parasitárias/parasitologia , Masculino , Prevalência , Fatores de Risco , Fatores Socioeconômicos , População UrbanaRESUMO
Poor growth and intestinal parasitic infections are widespread in disadvantaged urban children. This cross-sectional study assessed factors influencing poor growth and intestinal parasites in 376 children aged three to six years in daycare centers in Salvador, in the Northeast Region of Brazil. Data was obtained from seven daycare centers on child weight, height, socio-economic status, health and intestinal parasites in stool samples. Prevalence of moderate underweight (< -1SD > -2SD), wasting and stunting was 12%, 16% and 6% respectively. Socioeconomic status, birth order, and maternal weight were predictors of poor anthropometric status. Almost 30% of children were infected with more than one intestinal parasite. Helminths (17.8%), notably Trichuris trichiura (12%) and Ascaris lumbricoides (10.5%), and protozoan Giardia duodenalis (13%) were the most common types of parasites detected. One percent of children had hookworm and Cryptosporidium sp. and 25% had non-pathogenic protozoan cysts. Boys from families with very low socio-economic status had lower linear growth and presented a greater risk of helminth infection. Deworming is considered an alternative for reducing the prevalence of intestinal parasitic infections in this age group.
Déficit de crescimento e parasitoses são comuns entre crianças residentes em periferias. Em estudo transversal com 376 pré-escolares (3-6 anos) de creches em Salvador, Nordeste do Brasil, avaliamos fatores predisponentes para déficit de crescimento e parasitose. Obtiveram-se dados em sete creches sobre peso da criança, altura, nível socioeconômico, estado de saúde e parasitos em amostras de fezes. Prevalência de baixo peso (-1 < DP > -2), desnutrição e baixa estatura foram 12%, 16%, e 6%, respectivamente; nível socioeconômico, ordem de nascimento e peso materno foram preditores da antropometria. Aproximadamente 30% estavam infectados com ≥ 1 parasita. Helmintos (17.8%), notavelmente Trichuris trichiura (12%) e Ascaris lumbricoides (10.5%) e protozoário Giardia duodenalis (13%) foram os mais comuns; < 1% tinha ancilostomíase e Cryptosporidium sp.; 25% apresentaram protozoários cistos não patogênicos. Meninos de famílias muito pobres tiveram menor crescimento e maior risco de helmintose. A desparasitação pode ser considerada uma alternativa para a redução da prevalência de parasitoses intestinais nesse grupo etário.
Assuntos
Animais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Creches , Desenvolvimento Infantil , Fezes/parasitologia , Enteropatias Parasitárias/epidemiologia , Estatura , Peso Corporal , Brasil/epidemiologia , Estudos Transversais , Crescimento , Enteropatias Parasitárias/complicações , Enteropatias Parasitárias/parasitologia , Prevalência , Fatores de Risco , Fatores Socioeconômicos , População UrbanaRESUMO
A nationwide representative survey of New Zealand schoolchildren showed a 2.7% incidence of extreme obesity (versus 4% in the United States) but revealed worrying ethnic differences in prevalence. Prevalence percentages (95% CI) were 0.8 (0.4 to 1.9), 5.1 (3.6 to 7.1), and 10.9 (8.9 to 13.3) in New Zealand European, Maori, and Pacific Island groups, respectively. These findings warrant remedial action.
Assuntos
Obesidade Mórbida/etnologia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Etnicidade/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Nova Zelândia/epidemiologia , Prevalência , Classe SocialRESUMO
Prior fracture was associated with increased risk of new fracture in 601 members of a cohort studied between birth and l8 years. Hazard ratios for new fracture in data adjusted for age and sex were l.90 (95%CI l.51-2.39) after first fracture and 3.04 (95% CI 2.23-4.15) after second fracture.