Serum leptin in eutrophic and overweight Venezuelan children and adolescents

Leptin is closely related to obesity and its complications. In order to determine serum levels of this hormone in children and adolescents, and its associations to age, gender, socioeconomic status, nutritional anthropometrical status and dietary intake, 166 children and adolescents (91 normal and 75 obese, aged 2 to 15 years), from low socioeconomic status were assessed. A socioeconomic evaluation (Grafffar-Mendez C method), dietary intake (24 hour recalls), anthropometrical assessment and leptin by ELISA were performed. Normal or eutrophic was defined as weight for height (W/H) or Body mass index (BMI) and fatty area between 10th and 90th percentile. Obesity when indicators were over 90th percentile. Leptin was significantly higher in obese than in normal, without differences by gender or age. Leptin percentile distribution showed 11.53 microg/L and 24.29 microg/L as 90th percentile for normal and obese children, respectively. There was a tendency to inverse correlation among leptin, fat dietary intake and waist-thigh ratio. Excessive fat intake was associated to lower serum leptin. Results suggest that obese children had leptin resistance, independently of age and gender. It is recommended to develop nutritional education programs regarding obesity and dietary intake in order to prevent and control infantile obesity.     

Prevalence of nutritional deficiencies in Mexican adolescent women with early and late prenatal care

The objective was to evaluate the prevalence of specific nutritional deficiencies in a group of pregnant adolescents according to the gestational age when they started to receive prenatal care. A group of 163 pregnant adolescents that attended the Instituto Nacional de Perinatología (Mexico City) for the first time to receive prenatal care was evaluated. An anthropometrical evaluation was performed and a blood sample taken to determine hemoglobin, ferritin, erythrocyte folate and plasma zinc to all cases. The mean age was 15 years (11 to 17 years). The mean gestational age when starting prenatal care was 27 +/- 7 gestation weeks and most of them tended to have low weight (97 +/- 12% expected weight for height and gestational age). Eight of every ten adolescents had anemia and iron deficiency. Late prenatal care (> or = 25 weeks) was associated with the risk of presenting anemia OR 5.11 (CI 95% 2.4-10.7) iron deficiency (OR 3.5; CI 95% 1.7 to 7.1) and zinc deficiency (OR 2.9; CI 95% 1.1 a 7.6). In relation to folate deficiency, the opposite effect was observed (OR 0.10; CI 95% 0.02 a 0.48). Lack of opportune prenatal care was associated with the presence of iron and zinc depletion. Probably iron deficiency contributes to an erythrocyte folate accumulation.     

Physical growth and menarche in Guatemalan adolescents

The relationship between anthropometric measurements and age at menarche was studied in a group of Guatemalan adolescents, from urban and rural areas. The data indicate that median age at menarche is significantly higher in Indian adolescents living in rural areas than in non-Indian, the lowest age at menarche being that of adolescents living in urban areas. The age at menarche is positively associated with anthropometric measurements (weight, arm circumference and height) and body composition (body mass index), suggesting that both physical growth and sexual maturation are interacting processes of the same phenomenon known as the development age.     

The menarche age in teenagers of the Northwest of Mexico

The beginning of sexual maturity in individuals is a measure commonly used as an indicator of a population's quality of life. Among women, one of the most frequently used indicators is the age of menarche. The objectives of this research were to obtain the age of menarche in school age girls from the Northwest of Mexico, and to establish the relationship between the latter with their socioeconomic level, body weight, and height. The sample was taken from 857 girls between 7 and 17 years old from different socioeconomic level sectors. The age of menarche of these girls was determined by the statu quo method. The value found for menarche was 12.06 +/- 0.44 years old. We also found an association of menarche to height (p < 0.01) and to socioeconomic level (p < 0.01). The value for age of menarche in this study was similar to the one reported for other Latin-American populations. Taking into consideration that approximately 70% of the Mexican population has been considered of low income level and that the environmental conditions are not entirely favorable, it is possible that this could be the result of genetic and environmental interactions.     

Factors associated with adiposity in normal weight female adolescents with adequate and high percent body fat: elaborating a risk model

Factors associated with adiposity in normal weight female adolescents with adequate and high percent body fat: elaborating a risk model. This study was carried out to evaluate the factors associated with adiposity in normal weight adolescents presenting appropriate or high percent body fat, who attended the public schools in Vi?osa county-Minas Gerais/Brazil. A total of 118 female adolescents at age range from 14 to 19 years and have already presented the menarche were evaluated. The adolescents were divided into 2 groups: G1 with high percent body fat and G2 with appropriate percent body fat. The following variables were evaluated: anthropometric, body composition, lifestyle and the family history of non-communicable chronic diseases. In subsample, the basal energy consumption was determined by indirect calorimetry. The G1-grouped adolescents showed higher values for most anthropometric and body composition variables (p < 0.001). No differences were observed (p > 0.05) for basal metabolism and metabolism of lean body mass, smoking habit, total energy consumption and protein and lipid as well between groups. When comparing the physical activity level, the G1 adolescents spent more time with 1-level sedentary activities whereas the G2 ones showed higher total caloric consumption with daily activities (p < 0.001). According to risk factors under analysis, the variables related to lifestyle, as distinguishing the use of sweeteners (OR = 13.47), provided higher contribution to excessive adiposity in the normal weight adolescents. The detailed analysis of the body composition as well as the risk factors associated with excessive body fat makes possible the early diagnosis and the development of more appropriate intervention means.     

Metabolic parameters and risk factors associated with abdominal obesity among female adolescents in public schools in the Distrito Federal (Brazil)

This study aimed to estimate the prevalence of abdominal obesity and investigate their association with parameters markers of metabolic syndrome (MS) and its risk factors in female adolescents. It is a cross-sectional study with 150 adolescents from 10 public schools in the Federal District, Brazil. The presence of abdominal obesity was considered by measuring waist circumference above the 80th percentile, according to Taylor et al. (2000). The associated factors included sociodemographic characteristics, health status of adolescents and their parents, physical activity, eating habits, blood pressure and biochemical profile. The abdominal obesity prevalence ratio (PR) was estimated by Poisson regression model, with 95% CI. Among the adolescents studied (age= 15.6 +/- 0.8 years; BMI = 21.0 +/- 3.0 kg/m2), prevalence of abdominal obesity was 20%, and this condition was not associated with sociodemographic variables, physical activity and diet. However, abdominal obesity was significantly associated with intake of less than 4 meals a day (PR = 2.27; IC95% 1.27-4.10), previous obesity (PR = 2.36; IC95% 1.31-4.01), history of parental chronic disease (PR = 3.55; IC 95% 1.63-7.75), fasting insulin = 15 uUi/mL (PR = 3.05; IC 95% 1.36-6.82) e HDL-c > 40 mg/dL (PR = 0.39; IC95% 0.23-0.67). In this population, modifiable factors, family history and determinants of MS, such as insulin and HDL-c were associated with abdominal obesity, which points to the need for effective health promotion among adolescents.     

Dietary evaluation of pregnant adolescents during first, second and third trimester

In order to identify risk of inadequate intake of calories and nutrients during pregnancy, 75 pregnant adolescents (14 to 18 years old) apparently healthy, from low socioeconomic level, in their first prenatal control (12 weeks) were studied by two 24 hour recalls and a food frequency questionnaire at each trimester. Nutritional status was assessed by body mass index (pregestation weight/height) and classified according to American Medicine Institute reference. Paired t-test, frequency distribution and ANOVA were used for statistical analysis. Low weight was found in 34.6% of adolescent at the first visit and 5.3% were overweight. Even though, caloric intake was below recommendation, significant increases were observed between first and second trimester for energy, carbohydrates, niacin and zinc (p < 0.001) and for fat, proteins, riboflavin, thiamin, vitamin C, calcium and iron (p < 0.05). From second to third trimester, differences (p < 0.05) were significant only for vitamin A. Between first and third trimester, differences were significant (p < 0.05) for energy, proteins, carbohydrates, niacin, riboflavin, zinc and for thiamin, vitamin A and calcium (p < 0.05). A high proportion of pregnant adolescent did not reach recommendations for energy, folate, calcium and zinc. Food intake pattern did not change significantly among trimesters. Mean total weight gain was 9.2 kg and 0.412 +/- 0.4 g/week. Newborn's mean weight was 3.221 +/- 418 grams. It is concluded that adolescents are at high nutritional risk and deficiency of dietary intake should be followed. Attention should be addressed from the preconceptional period to postpartum in order to improve maternal and fetal conditions.     

Iron and vitamin A deficiencies and prevalence of anemia in boys and girls between 6 to 24 months of age in Chaco,Argentina

To determine the prevalence of anemia, and iron (ID) and vitamin A deficiencies aiming at their prevention, 414 children between 6 and 24 months of age, were randomly selected from the whole province of Chaco. A sociodemographic survey was implemented, and hemoglobin (Hb), plasma ferritin and retinol were measured. Anemia prevalence (Hb < 110 g/L) was 66.4%, without differences between age groups, and included 18% with Hb < 90 g/L. These cases were significantly less in children 6-8 month of age (5.1%) than in the others (approximately equal to 20%) (P: 0.007). Mean Hb was also higher in 6-8 months old children and was associated with lower prevalence of ID (ferritin < 12 micrograms/L) (p < 0.000) but not with age (p = 0.8865). ID already present, however, in 36.6% of children in this age group, reached a prevalence of 72.9% in children older than 18 months. Anemia prevalence was significantly higher in males, in children whose birth weight was < 3000 g, in those who had never taken iron supplements and among the poor, both structural and by income. Retinol values < 20 micrograms/dl occurred only in 5.1% of children. Iron nutrition prior to, during pregnancy and in children during the first 2 years of life must be improved by joining strategies based on community empowerment aimed at improving dietary iron, assuring effective preventive supplementation and promoting the opportune umbilical cord ligation.     

Changes in lipid profile in obese children and adolescents

Alterations in plasmatic lipid profile are known to be risk factors for atherosclerotic disease and have been associated with obesity. This research was designed in order to study the incidence of these alterations in obese children and adolescents according to two different reference patterns. Analyses of seric levels of Total Cholesterol (CT) and fractions and of Triglycerides (TG) were done. The sample included 74 obese children and adolescents with average age equal to 11 years and 10 months for boys and 10 years and 9 months for girls and with mean weight/height ratio (W/H) equal to 151 and 149% for boys and for girls, respectively. Plasmatic lipid values obtained were classified according to the American Heart Position Statement Circulation (AHPSC) and to Kwiterovich reference patterns. It was observed that patients with abnormal seric HDL-cholesterol (HDL) levels had a significantly greater (W/H) then the other group. It was also noticed that a greater number of individuals presented abnormal or borderline plasmatic lipid levels (91.9%), specially HDL (93.6%) and TG (67.6%), according to Kwiterovich than AHPSC. Obesity showed to be an important factor in determining lipid profile values and should be included as a variable to indicate screening of these lipoproteins in childhood and adolescence.     

Circulating Levels of Ferritin,RDW, PTLs as Predictive Biomarkers of Postoperative Atrial Fibrillation Risk after Cardiac Surgery in Extracorporeal Circulation

Postoperative atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery in conventional extracorporeal circulation (CECC), with an incidence of 15–50%. The POAF pathophysiology is not known, and no blood biomarkers exist. However, an association between increased ferritin levels and increased AF risk, has been demonstrated. Based on such evidence, here, we evaluated the effectiveness of ferritin and other haematological parameters as POAF risk biomarkers in patients subjected to cardiac surgery. We enrolled 105 patients (mean age = 70.1 ± 7.1 years; 70 men and 35 females) with diverse heart pathologies and who were subjected to cardiothoracic surgery. Their blood samples were collected and used to determine hematological parameters. Electrocardiographic and echocardiographic parameters were also evaluated. The data obtained demonstrated significantly higher levels of serum ferritin, red cell distribution width (RDW), and platelets (PLTs) in POAF patients. However, the serum ferritin resulted to be the independent factor associated with the onset POAF risk. Thus, we detected the ferritin cut-off value, which, when ≥148.5 ng/mL, identifies the subjects at the highest POAF risk, and with abnormal ECG atrial parameters, such as PW indices, and altered structural heart disease variables. Serum ferritin, RDW, and PTLs represent predictive biomarkers of POAF after cardiothoracic surgery in CECC; particularly, serum ferritin combined with anormal PW indices and structural heart disease variables can represent an optimal tool for predicting not only POAF, but also the eventual stroke onset.     

Abdominal obesity epidemiology amongst adult women resident in Southern Brazil

The objective of this study was to investigate the risk factors associated with abdominal obesity in women. A cross-sectional population based study was carried out on 981 women aged 20 to 60 years living in Southern Brazil. Abdominal adiposity was assessed by waist circumference (WC) = 88 cm. Poisson regression models were used to obtain prevalence ratios (PR) and their confidence intervals. The abdominal obesity prevalence was 23.3% (IC95%: 20.7-26.0). The main factors associated with the outcome were: having low education level, being unemployed, being more than 40 years old, having family obesity history, and being married. Adjusted analyses showed increased obesity prevalence in hypertensive women (Prevalence Ratio--PR = 2.06; CI95%: 1.58-2.69) and those having higher number of children (PR = 1.17; CI95% 1.00-1.37). Later menarche, at 12-13 years and at 14 years of age, protected against obesity comparing to women with earlier menarche at 8-11 years, respectively, 31% and 46% of protection. The understanding of how the abdominal obesity is distributed among the population allows effective planning and action implementation towards the reduction rates of this nutritional and public health problem.     

Risk factors for growth retardation in children of low economic and social level in São Paulo, Brazil

Aiming to analyze the mild to moderate growth retardation associate factors in children at school age, a case control study was conducted with 153 pairs of seven and eight years old children from public schools of the outskirts of the city. The cases were defined as children with a height for age(H/A) between -1 and -2 Z score, according to NCHS/WHO standards, and matched with a H/A +/- 0.5 Z-score children of same age, gender, school, classroom and class time, as controls. The height was measured at school according to WHO rules by trained professionals, and household visits were carried out to obtain environmental and socio-economic data. Initially the data was analyzed by the univariate conditional method and then, the statistically significant variables were included in a model of multivariate logistic regression analysis. As a result, the risk factors remaining at the end of the multivariate analyses, by Odds Ratio and it's 95% Confidence Interval were respectively:--mother's height: for each decrease of one standard deviation the OR increased 1.84(CI: 1.35 to 2.49); inadequate feeding pattern: OR = 2.12; CI: 1.17 to 3.83, very low socio-economic level: OR = 9.2; CI: 3.35 to 25.13, low birth weight: OR = 2.59; CI: 1.44 to 4.63 and smoking during pregnancy: OR = 1.75; CI: 0.98 to 3.12. These results highlight the environment as a determinant factor for growth performance during the first years of the child's life. Despite this, the significant OR for Mother's height allows the assumption that besides the environment, the parent's height has to be considered as one of the determinants of height deficit, even for the low socioeconomic level.     

Changes in body composition in lactating adolescent mothers

We assessed changes in body composition in lactating adolescent mothers living under unfavorable socioeconomic and sanitary conditions. A total of 17 healthy primiparous adolescents under 17 years of age attending the Maternity Hospital of the city of La Plata, Argentina, were followed at 4 time points (15 days and 3, 6 and 12 months postpartum) to assess, a) dietary intake, b) practice of physical activity, c) nutritional condition (weight, height, body mass index [BMI] according to age, and body composition by the sum of skinfold measurements), d) characteristics of lactation, and e) growth parameters of the child. The mean age of adolescents was 15.06 +/- 0.66 years (mean menarchal age, 11.59 +/- 0.80 years). All adolescents breastfed up to 12 months postpartum, and maternal milk covered above 80% the baby intake (mean 7.06 +/- 2.54 breast feeds/day). While the daily intake of nutrients by adolescent mothers was constant up to 6 months postpartum, there was a modest decrease in that of proteins, carbohydrates and lipids 15 days and 12 months postpartum. The decrease in energetic intake during the same period was significant (p < 0.05). The practice of physical activity was classified as moderate during the follow-up period. Whereas mean basal percent of fat body mass (FBM) was 29.85 +/- 2.87, and decreased significantly at 6 (27.2% +/- 3.9%; p = 0.02) and 12 (26.1% +/- 3.9%; p = 0.002) months postpartum, changes in lean body mass (LBM) were not significant. In conclusion, lactating adolescents maintained LBM, whereas weight, FBM and BMI decreased markedly from 3 months postpartum.     

Relationship between calcium intake and body mass index in adolescents

Epidemiologic and experimental data support thee possibility that dietary calcium intake plays a role in human body weight regulation. The aim of the present study was to evaluate calcium intake and its relationship with body mass index (BMI) in adolescents. Weight, height, 3-day food record and a food frequency questionnaire were collected among all adolescents participants at the Outpatient Clinic for Adolescents at the Federal University of Sao Paulo between 2001 and 2003. The statistical analysis comprised Chi-square, Student's T-test, Pearson correlation and linear regression. One-hundred and twenty-one adolescents were studied (62.8% female), with a mean age of 14.9 +/- 2.2 years old. Mean energy and calcium intakes were 1729.9 +/- 557.8 kcal/day and 598.2 +/- 287.9 mg/day respectively, with no significant statistical differences between sex or age. Almost ninety-eight percent of adolescents presented a mean calcium intake lower than proposed values. Calcium intake adjusted for energy presented a significant negative correlation with body weight (r=-0.194, p=0.03) and BMI (r=-0.185, p=0.04). Furthermore, adolescents in the lowest quartile of calcium intake presented higher BMI (29.7 +/- 7.4 kg/m2) than adolescents in the highest calcium quartile. These results indicated a dietary calcium intake lower than recommendations for this life stage, and a contribution of this mineral in the body mass index.     

Nutritional recovery of mild and moderately malnourished children under two different treatment approaches (ambulatory versus day-care)

This retrospective analysis was conducted between May 1997 and May 2000 at the Centro de Atención Nutricional Infantil de Antímano, CANIA, in Caracas, Venezuela to assess the efficacy of two treatments (ambulatory versus day-care) of mild and moderate malnourished children. Inclusion criteria were: children under 10 years old with mild and moderate malnourishment, who attended a minimum of 3 control visits during a period of 12 months. One hundred fourteen malnourished children were included: fifty seven in ambulatory treatment and fifty seven in day-care treatment paired per nutritional diagnosis, gender and age (thirty nine mild and eighteen moderate malnourished children). The nutritional recovery criterion was weight for height above tenth percentile. No relation was found between treatment approaches and nutritional recovery at 3 and 6 months of treatment. In the group of mild malnourished children, the percentage of recovered patients at 3 months of treatment, that kept their recovered condition at 6 months was 83% (15/18) in the ambulatory treatment and 82% (18/22) in the day-care treatment Age of children, associated disease, acute morbidity, dietetic risk and mother's education and age were not associated with nutritional recovery at 6 months of treatment (p > 0.05). The day-care approach resulted as effective as ambulatory in mild malnourished children. In moderate malnourished new studies will need to be conducted with greater number of patients.     

Maternal fruit and vegetable or vitamin C consumption during pregnancy is associated with fetal growth and infant growth up to 6 months: results from the Korean Mothers and Children’s Environmental Health (MOCEH) cohort study

Background

Based on data obtained from pregnant women who participated in the Mothers and Children’s Environmental Health (MOCEH) study in South Korea, we aimed to determine whether maternal intake of fruits and vegetables or vitamin C is associated with fetal and infant growth.

Methods

A total of 1138 Korean pregnant women at 12–28 weeks gestation with their infants were recruited as study participants for the MOCEH. Intake of fruits and vegetables or vitamin C during pregnancy was assessed by a 1-day 24-h recall method. Fetal biometry was determined by ultrasonography at late pregnancy. Infant weight and length were measured at birth and 6 months.

Results

A multiple regression analysis after adjusting for covariates showed that maternal intake of fruits and vegetables was positively associated with the biparietal diameter of the fetus and infant’s weight from birth to 6 months. Also, maternal vitamin C intake was positively associated with the abdominal circumference of the fetus and infant birth length. In addition, there was a significant inverse relationship between consumption of fruits and vegetables (below the median compared to above the median of ≥519 g/d) and the risk of low growth (<25th percentile) of biparietal diameter (odds ratio (OR): 2.220; 95% confidence interval (CI): 1.153–4.274) and birth weight (OR: 1.434; 95% CI: 1.001–2.056). A significant inverse relationship also existed between vitamin C consumption (below vs above the estimated average requirement (EAR) of ≥85 mg/d) and the risk of low growth (<25th percentile) of birth weight (OR: 1.470; 95% CI: 1.011–2.139), weight from birth to 6 months (OR: 1.520; 95% CI: 1.066–2.165), and length at birth (OR: 1.579; 95% CI: 1.104–2.258).

Conclusions

An increased intake of fruits and vegetables or vitamin C at mid-pregnancy is associated with increased fetal growth and infant growth up to 6 months of age.

     

Body mass index in a group of Venezuelan pregnant women and its relationship with the newborns' anthropometry

To assess the relationship between maternal body mass index (BMI) at early gestation and the newborns' anthropometry, 105 mother-infant dyads from a public Maternity Hospital in Valencia Venezuela, were studied during 1998-2000. Weight and height of adult women between 10 and 15 weeks of gestation were used to calculate BMI according to Atalah's reference (Low weight, Normal, Over weight). Term newborns were assessed using gestational age calculated according to the Capurro method. Their weight, height, and head circumference were recorded, and were characterized using a Venezuelan reference. Newborns whose birth weight (BW) was pound 10th percentile were considered "small for gestational age" (SGA), and those with BW (3) 90th percentile as "large for gestational age" (LGA). One-way ANOVA and Tukey's Post Hoc test were used for group comparisons. There were 41.9% of "low weight" mothers, and 13.4% of SGA newborns. There were differences in the newborns' weight and height according to "Low weight" maternal BMI with "Normal" and "Over weight" maternal BMI (p < 0.05). A high prevalence of nutritional deficit was observed from the beginning of the gestational period, as well as a relationship between maternal BMI and the newborn's anthropometry.     

Validity of the energy/protein index in the detection of overweight in low income Venezuelan preschoolers

The validity of the energy/protein index (EPI) in the detection of overweight was assessed in 163 low income children (four to six years old) from Valencia, Venezuela. Weight, height, arm circumference, and skinfolds were taken. Weight for height (W/H), limb fat area (LFA), and EPI were calculated. All subjects with W/H < or =p10 were considered deficient, with W/H between >p10 and < or =p90 normal, and with W/H and LFA >p90 in excess. Percentile distribution of EPI for age and gender was calculated, regarding below the norm all subjects < or =p10, normal those > p10 and p90, and above the norm those >p90. Validity was assessed through sensibility, specificity, and likelihood ratio. Student's t test and ANOVA were used for group comparisons (p < 0.05). According to the nutritional diagnosis, 27.60% of the children were deficient, 66.88% normal, and 15.52% in excess. According to the EPI, 7.36% of the sample was considered below the norm, 82.20% normal, and 10.44% above the norm. The EPI decreased with age in boys, and in the 6 years old group was significantly higher for girls. Lastly, an EPI above the norm is eleven times more likely to occur in a subject considered in excess than in subjects considered normal. For deficiency, the tests did not meet the expected values.