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De Sanctis V, Soliman A, Alaaraj N, Ahmed S, Alyafei F, Hamed N. Early and Long-term Consequences of Nutritional Stunting: From Childhood to Adulthood. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021168. [PMID: 33682846 PMCID: PMC7975963 DOI: 10.23750/abm.v92i1.11346] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 01/30/2023]
Abstract
Linear growth failure (stunting) in childhood is the most prevalent form of undernutrition globally. The debate continues as to whether children who become stunted before age 24 months can catch up in growth and cognitive functions later in their lives. The potentially irreparable physical and neurocognitive damage that accompanies stunted growth is a major obstacle to human development. This review aims at evaluation and summarizing the published research covering the different aspects of stunting from childhood to adulthood.
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Affiliation(s)
| | - Ashraf Soliman
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
| | - Nada Alaaraj
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
| | - Shayma Ahmed
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
| | - Fawziya Alyafei
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
| | - Noor Hamed
- Department of Pediatrics, Division of Endocrinology, Hamad General Hospital, Doha, Qatar.
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2
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Qiu Q, Meng X, Li Y, Liu X, Teng F, Wang Y, Zang X, Wang Y, Liang J. Evaluation of the associations of body height with blood pressure and early-stage atherosclerosis in Chinese adults. J Clin Hypertens (Greenwich) 2020; 22:1018-1024. [PMID: 32442361 DOI: 10.1111/jch.13870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 01/12/2023]
Abstract
Body height has been recently related to the risk of coronary heart disease and metabolic risk factors. However, data are scarce regarding the relationship between body height and early-stage atherosclerotic changes, especially in Chinese individuals. In this study, we aimed to comprehensively examine the associations of body height with early-stage atherosclerosis and blood pressure in Chinese adults. Carotid-femoral pulse wave velocity (cfPWV), carotid-radial pulse wave velocity (crPWV), carotid artery-dorsalis pedis pulse wave velocity (cdPWV), and body height were measured in 5098 men and women. All samples were obtained from a community-based health examination survey in central China. After adjusting for sex, age, weight, fasting glucose level, lipid level, creatinine, and heart rate, low body heights were significantly associated with higher cfPWV, crPWV, and blood pressure (all P for trend <.01), whereas no significant association was found between body height and cdPWV. In addition, we found a significant interaction between prehypertension status and body height in relation to cfPWV, after adjusting for covariates (P for interaction = .0024). The associations were stronger in participants with prehypertension than in those with normal blood pressure. Compared to the group with the tallest stature and normal blood pressure, individuals in the group with the shortest stature and prehypertension had nearly a 2.5 m/s higher cfPWV. These results indicate that short body height was associated with an increased risk of early-stage atherosclerosis in Chinese adults, independent of traditional cardiometabolic risk factors. Prehypertension might modify the association between body height and cfPWV.
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Affiliation(s)
- Qinqin Qiu
- Department of Endocrinology and Central Laboratory, Xuzhou Central Hospital, Xuzhou Institute of Medical Sciences, Xuzhou Institute of Diabetes, Xuzhou, China.,The Clinical School of Xuzhou Medical University, The Affiliated Xuzhou Central Hospital of Nanjing University of Chinese Medicine, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, China
| | | | - Yanjun Li
- Department of Orthopedic, Xuzhou Central Hospital, Xuzhou Institute of Medical Sciences, Xuzhou Institute of Diabetes, Xuzhou, China
| | - Xuekui Liu
- Department of Endocrinology and Central Laboratory, Xuzhou Central Hospital, Xuzhou Institute of Medical Sciences, Xuzhou Institute of Diabetes, Xuzhou, China.,The Clinical School of Xuzhou Medical University, The Affiliated Xuzhou Central Hospital of Nanjing University of Chinese Medicine, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, China
| | - Fei Teng
- Department of Endocrinology and Central Laboratory, Xuzhou Central Hospital, Xuzhou Institute of Medical Sciences, Xuzhou Institute of Diabetes, Xuzhou, China.,The Clinical School of Xuzhou Medical University, The Affiliated Xuzhou Central Hospital of Nanjing University of Chinese Medicine, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, China
| | - Yu Wang
- Department of Endocrinology and Central Laboratory, Xuzhou Central Hospital, Xuzhou Institute of Medical Sciences, Xuzhou Institute of Diabetes, Xuzhou, China.,The Clinical School of Xuzhou Medical University, The Affiliated Xuzhou Central Hospital of Nanjing University of Chinese Medicine, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, China
| | - Xiu Zang
- Department of Endocrinology and Central Laboratory, Xuzhou Central Hospital, Xuzhou Institute of Medical Sciences, Xuzhou Institute of Diabetes, Xuzhou, China.,The Clinical School of Xuzhou Medical University, The Affiliated Xuzhou Central Hospital of Nanjing University of Chinese Medicine, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, China
| | - Yun Wang
- Xuzhou Medical University, Xuzhou, China
| | - Jun Liang
- Department of Endocrinology and Central Laboratory, Xuzhou Central Hospital, Xuzhou Institute of Medical Sciences, Xuzhou Institute of Diabetes, Xuzhou, China.,The Clinical School of Xuzhou Medical University, The Affiliated Xuzhou Central Hospital of Nanjing University of Chinese Medicine, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, China
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Martins VJB, Sesso R, Clemente APG, Fernandes MBF, Sawaya AL. Albuminuria, renal function and blood pressure in undernourished children and recovered from undernutrition. Pediatr Nephrol 2017; 32:1555-1563. [PMID: 28233099 DOI: 10.1007/s00467-017-3602-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objective of this study was to investigate some biomarkers of renal function and blood pressure in children who had recovered from undernutrition. METHODS This was cross-sectional, comparative study in which a convenience sample of children of both genders (n = 126; age range 6-16 years) treated at the Centre for Nutritional Recovery and Education (São Paulo, Brazil) was used. These children were classified into four groups for analysis: (1) children who were well nourished (control group; n = 50), (2) those showing stunted growth (stunted group; n = 22), (3) those who were underweight (underweight group; n = 23) and (4) those who had recovered from undernutrition (recovered group; n = 31). RESULTS No between-group differences were found for mean levels of albuminuria, serum creatinine and cystatin C, and similar mean estimates of glomerular filtration rate (eGFR; using either creatinine, cystatin C or both). Almost 14% of the stunted group, 4% of the underweight group and 3% of the recovered group had albuminuria of >30 mg/g creatinine (chi-square p = 0.034); none of the control children showed albuminuria of >30 mg/g creatinine. Mean systolic (SBP) and diastolic blood pressure (DBP) adjusted for age and gender of the children in the stunted [SBP (95% confidence interval): 92 (88-96) mmHg; DBP: 47 (44-49) mmHg] and recovered [SBP: 93 (90-96) mmHg; DBP: 49 (47-51) mmHg] groups were significantly lower than those of the controls [SBP: 98 (95-100) mmHg, P = 0.027; DBP: 53 (52-55) mmHg, P = 0.001]. After additional adjustment for height, mean DBP remained significantly lower in the recovered group compared with the control group [49 (46-51) vs. 53 (51-55) mmHg, respectively; P = 0.018). Logistic regression analysis showed that the stunted group had a 8.4-fold higher chance of developing albuminuria (>10 mg/g creatinine) than the control children (P = 0.006). CONCLUSIONS No alterations in renal function were found in underweight children and those who had recovered from undernutrition, whereas children with stunted growth presented with a greater risk for albuminuria. A lower DBP was found in children with stunted growth and those who had recovered from undernutrition.
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Affiliation(s)
- Vinicius J B Martins
- Department of Physiology and Pathology, Federal University of Paraíba, Centro de Ciências da Saúde, Campus I, Cidade Universitária, 58051-900, João Pessoa, PB, Brazil.
| | - Ricardo Sesso
- Department of Medicine, Federal University of São Paulo, Rua Botucatu, 740, 04023-900, São Paulo, SP, Brazil
| | - Ana P G Clemente
- Nutrition College, Federal University of Alagoas, Campus A. C. Simões, Avenida Lourival Melo Mota, s/n, Cidade Universitária, 57072-900, Maceió, AL, Brazil
| | - Mariana B F Fernandes
- Department of Physiology, Federal University of São Paulo, Rua Botucatu, 862, Edifício de Ciências Biomédicas, 2° andar, 04023-060, São Paulo, SP, Brazil
| | - Ana L Sawaya
- Department of Physiology, Federal University of São Paulo, Rua Botucatu, 862, Edifício de Ciências Biomédicas, 2° andar, 04023-060, São Paulo, SP, Brazil
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Grillo LP, Gigante DP, Horta BL, de Barros FCF. Childhood stunting and the metabolic syndrome components in young adults from a Brazilian birth cohort study. Eur J Clin Nutr 2016; 70:548-53. [PMID: 26733042 PMCID: PMC4858756 DOI: 10.1038/ejcn.2015.220] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 11/02/2015] [Accepted: 11/18/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND/OBJECTIVES The aim of this study was to investigate the association between stunting in the second year of life and metabolic syndrome components in early adulthood among subjects who have been prospectively followed-up since birth, in a city in Southern Brazil. SUBJECTS/METHODS In 1984, we attempted to follow-up the entire cohort; the subjects were examined and their mothers interviewed. Stunting was defined by a length-for-age Z-score 2 s.d. or more below the mean, in accordance with the World Health Organization reference. Between 2004 and 2005, we again tried to follow the entire cohort; during this period the subjects were evaluated for the following metabolic syndrome components: high-density lipoprotein (HDL) cholesterol, triglycerides, random blood glucose, waist circumference and systolic and diastolic blood pressure. Family income at the time of the baby's birth, asset index, mother's education, mother's smoking during pregnancy and duration of breastfeeding were considered possible confounders. Linear regression was used in the unadjusted and adjusted analyses. RESULTS Among men, stunting was inversely associated with triglycerides (β=-11.90, confidence interval (CI)=-22.33 to -1.48) and waist circumference (β=-4.29, CI=-5.62 to -2.97), whereas for women stunting was negatively related to HDL-cholesterol (β=-4.50, CI=-6.47 to -2.52), triglycerides (β=-9.61, CI=-17.66 to -1.56) and waist circumference (β=-1.14, CI=-4.22 to -1.02). However, after controlling for confounding variables, these associations vanished. CONCLUSIONS The findings suggest that stunting in childhood is not associated with metabolic syndrome components in young adults.
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Affiliation(s)
- L P Grillo
- Departament of Nutrition, Vale of Itajaí University, Itajaí, Santa Catarina, Brazil
- Epidemiological Research Center, Epidemiology Postgraduate Program, Federal University of Pelotas, Rio Grande do Sul, Brazil
| | - D P Gigante
- Epidemiological Research Center, Epidemiology Postgraduate Program, Federal University of Pelotas, Rio Grande do Sul, Brazil
- Departament of Nutrition, Federal University of Pelotas, Rio Grande do Sul, Brazil
| | - B L Horta
- Epidemiological Research Center, Epidemiology Postgraduate Program, Federal University of Pelotas, Rio Grande do Sul, Brazil
| | - F C F de Barros
- Epidemiological Research Center, Epidemiology Postgraduate Program, Federal University of Pelotas, Rio Grande do Sul, Brazil
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López-Jaramillo P, Sánchez RA, Diaz M, Cobos L, Bryce A, Parra-Carrillo JZ, Lizcano F, Lanas F, Sinay I, Sierra ID, Peñaherrera E, Bendersky M, Schmid H, Botero R, Urina M, Lara J, Foss MC, Márquez G, Harrap S, Ramírez AJ, Zanchetti A. [Latin American consensus on hypertension in patients with diabetes type 2 and metabolic syndrome]. ACTA ACUST UNITED AC 2015; 58:205-25. [PMID: 24863082 DOI: 10.1590/0004-2730000003019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 03/06/2014] [Indexed: 12/30/2022]
Abstract
The present document has been prepared by a group of experts, members of cardiology, endocrinology, internal medicine, nephrology and diabetes societies of Latin American countries, to serve as a guide to physicians taking care of patients with diabetes, hypertension and comorbidities or complications of both conditions. Although the concept of metabolic syndrome is currently disputed, the higher prevalence in Latin America of that cluster of metabolic alterations has suggested that metabolic syndrome is a useful nosography entity in the context of Latin American medicine. Therefore, in the present document, particular attention is paid to this syndrome in order to alert physicians on a particular high-risk population, usually underestimated and undertreated. These recommendations result from presentations and debates by discussion panels during a 2-day conference held in Bucaramanga, in October 2012, and all the participants have approved the final conclusions. The authors acknowledge that the publication and diffusion of guidelines do not suffice to achieve the recommended changes in diagnostic or therapeutic strategies, and plan suitable interventions overcoming knowledge, attitude and behavioural barriers, preventing both physicians and patients from effectively adhering to guideline recommendations.
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Affiliation(s)
- Patricio López-Jaramillo
- Fundación Oftalmológica de Santander FOSCAL, Universidad de Santander UDES, Bucaramanga, Colômbia
| | - Ramiro A Sánchez
- Unidad de Metabolismo e Hipertensión Arterial, Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina
| | | | | | | | | | - Fernando Lizcano
- Asociación Colombiana de Endocrinología, Universidad de la Sabana, Bogotá, Colômbia
| | | | - Isaac Sinay
- Instituto Cardiológico de Buenos Aires, Buenos aires, Argentina
| | - Iván D Sierra
- Asociación Latinoamericana de Diabetes, Bogotá, Colômbia
| | | | | | - Helena Schmid
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | | | - Manuel Urina
- Sociedad Colombiana de Cardiología, Bogotá, Colômbia
| | - Joffre Lara
- Sociedad Ecuatoriana de Aterosclerosis, Guayaquil, Equador
| | | | | | | | - Agustín J Ramírez
- Unidad de Metabolismo e Hipertensión Arterial, Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina
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6
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Lower waist circumference in mildly‐stunted adolescents is associated with elevated insulin concentration. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2014. [DOI: 10.1016/j.jpedp.2014.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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7
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Clemente APG, Santos CDDL, Martins VJB, Albuquerque MP, Fachim MB, Sawaya AL. Lower waist circumference in mildly-stunted adolescents is associated with elevated insulin concentration. J Pediatr (Rio J) 2014; 90:479-85. [PMID: 24973467 DOI: 10.1016/j.jped.2014.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 12/20/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE Augmented waist circumference (WC) is associated with non-communicable diseases and could represent a valuable marker in screening for metabolic dysfunctions in subjects with insufficient linear growth. The objective of the present study was to determine whether biochemical and hemodynamic parameters and waist circumference vary between mildly-stunted and non-stunted adolescents from impoverished communities of São Paulo, Brazil. METHODS The cross-sectional study involved 206 subjects, aged between 9 and 19 years and living in impoverished areas of São Paulo, Brazil. The sample population was divided according to height-for-age Z-score (HAZ) into stunted (-1 > HAZ ≥ -2) and non-stunted (HAZ ≥ -1) groups, and was sub-divided according to gender. Logistic regression analysis was employed to compare individuals with elevated (> 75th percentile) insulin concentrations. The receiver operating characteristic curves were constructed to determine WC cut-off points that could be used to identify stunted and non-stunted individuals with elevated insulin concentrations. RESULTS WC cut-off points of 58.25cm and 67.2cm allowed for correct classification of 90.7% of stunted and 88.7% of non-stunted individuals in the studied population. While the sensitivity of the model was high for stunted and non-stunted subjects (98.8% and 97.2%, respectively), the specificity was modest (57.1% and 41.2%, respectively). CONCLUSION The results presented herein suggest that an increase in plasma insulin is one of the primary metabolic modifications in stunted individuals, and that this alteration could be identified at a lower WC cut-off point than in non-stunted counterparts.
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Affiliation(s)
| | | | - Vinicius J B Martins
- Programa de Pós-Graduação em Endocrinologia Clínica, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Maria Paula Albuquerque
- Programa de Pós-Graduação em Endocrinologia Clínica, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Mariana B Fachim
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Ana Lydia Sawaya
- Departamento de Fisiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Epigenetics, the missing link in hypertension. Life Sci 2014; 129:22-6. [PMID: 25128856 DOI: 10.1016/j.lfs.2014.08.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/15/2014] [Accepted: 08/01/2014] [Indexed: 12/11/2022]
Abstract
Epigenetics refers to functional alterations in gene expression or phenotype without any change of the underlying DNA sequence. It is the study of the potential of a cell or organism to express different traits through functional regulation of its gene transcription. Though it is met as a necessary process in biology, epigenetics may often play a crucial part in the development of specific pathologic conditions, including cardiovascular diseases and hypertension.
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9
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López-Jaramillo P, Camacho PA, Forero-Naranjo L. The role of environment and epigenetics in hypertension. Expert Rev Cardiovasc Ther 2014; 11:1455-7. [PMID: 24160576 DOI: 10.1586/14779072.2013.846217] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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10
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López-Jaramillo P, Sánchez RA, Díaz M, Cobos L, Bryce A, Parra-Carrillo JZ, Lizcano F, Lanas F, Sinay I, Sierra ID, Peñaherrera E, Benderky M, Schmid H, Botero R, Urina M, Lara J, Foos MC, Márquez G, Harrap S, Ramírez AJ, Zanchetti A. Consenso latinoamericano de hipertensión en pacientes con diabetes tipo 2 y síndrome metabólico. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2014; 26:85-103. [DOI: 10.1016/j.arteri.2013.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 11/26/2013] [Indexed: 12/14/2022]
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Fernandes MTB, Ferraro AA, Pires A, Santos E, Schvartsman C. Early-life weight and weight gain as predictors of obesity in Brazilian adolescents. Clinics (Sao Paulo) 2013; 68:1408-12. [PMID: 24270951 PMCID: PMC3812563 DOI: 10.6061/clinics/2013(11)04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 05/27/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To test whether weight and the weight gain rate during different age periods are associated with being overweight/obese at 10 years of age. METHODS A nested case-control study was performed in a clinical historic cohort that was selected based on medical records from the Albert Einstein Hospital Social Program in São Paulo, Brazil. A sample of 378 eutrophic and overweight/obese children was analyzed. RESULTS After adjusting for birth weight and gestational age, the likelihood of being overweight/obese at 10 years of age was 4.04-fold greater when progressing from one quartile of weight gain to the immediately superior quartile in the first semester of life and 3.24-fold greater when this occurred from 2-5 years of age. A one-quartile change in weight gain in the first semester was associated with a 0.5 z-score increase in BMI at age 10. A robust independent effect of weight at age 5 confirmed that earlier weight gain was an important predictor. CONCLUSIONS The amount of weight gain during the first 6 months of life and between 2 and 5 years of age and weight at age 5 were important predictors of overweight/obesity at 10 years of age.
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12
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Latin American consensus on hypertension in patients with diabetes type 2 and metabolic syndrome. J Hypertens 2013; 31:223-38. [PMID: 23282894 DOI: 10.1097/hjh.0b013e32835c5444] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The present document has been prepared by a group of experts, members of cardiology, endocrinology and diabetes societies of Latin American countries, to serve as a guide to physicians taking care of patients with diabetes, hypertension and comorbidities or complications of both conditions. Although the concept of 'metabolic syndrome' is currently disputed, the higher prevalence in Latin America of that cluster of metabolic alterations has suggested that 'metabolic syndrome' is a useful nosographic entity in the context of Latin American medicine. Therefore, in the present document, particular attention is paid to this syndrome in order to alert physicians on a particularly high-risk population, usually underestimated and undertreated. These recommendations result from presentations and debates by discussion panels during a 2-day conference held in Bucaramanga, in October 2012, and all the participants have approved the final conclusions. The authors acknowledge that the publication and diffusion of guidelines do not suffice to achieve the recommended changes in diagnostic or therapeutic strategies, and plan suitable interventions overcoming knowledge, attitude and behavioural barriers, preventing both physicians and patients from effectively adhering to guideline recommendations.
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13
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Inflammation and hypertension: are there regional differences? Int J Hypertens 2013; 2013:492094. [PMID: 23573414 PMCID: PMC3618944 DOI: 10.1155/2013/492094] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 02/19/2013] [Indexed: 12/16/2022] Open
Abstract
Hypertension is a chronic disease with global prevalence and incidence rapidly increasing in low and medium income countries. The surveillance of cardiovascular risk factors, such as hypertension, is a global health priority in order to estimate the burden and trends, to appropriately direct resources, and to measure the effect of interventions. We propose here that the adoption of Western lifestyles in low and middle incomes countries has dramatically increased the prevalence of abdominal obesity, which is the main source of proinflammatory cytokines, and that the vascular systemic inflammation produced by adipose tissue contributes to the development of hypertension. The concentration of proinflammatory cytokines is higher in the Latin American population than that reported in developed countries, suggesting a higher susceptibility to develop systemic low-degree inflammation at a given level of abdominal obesity. These particularities are important to be considered when planning resources for health care programs. Moreover, studying these singularities may provide a better understanding of the causes of the burden of cardiovascular risk factors and the remarkable variability in the prevalence of these medical conditions within and between countries.
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Nutritional status and its relationship with blood pressure among children and adolescents in South China. Eur J Pediatr 2012; 171:1073-9. [PMID: 22311167 DOI: 10.1007/s00431-012-1684-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 01/24/2012] [Indexed: 10/14/2022]
Abstract
The present study measures the nutritional status and the blood pressure to assess their relationship in a group of children and adolescents in the Hainan province, China. A total of 5,456 students aged 7 to 18 years were recruited from 10 public schools in Hainan province of South China during the period March 2009 to December 2009. Height, weight, systolic blood pressure, and diastolic blood pressure were measured by health-care professionals. Body mass index (BMI) was calculated and used to define thinness, overweight, and obesity according to the existing standards. Prevalence of thinness, overweight, obesity, pre-hypertension, and hypertension was computed, and logistical regression model was used to examine the association of BMI with elevated blood pressure. A high prevalence of thinness was observed in male and female children and adolescents (34.0% and 34.3%, respectively). The percentage of overweight and obesity was 2.7% and 1.3%, respectively. Pre-hypertension and hypertension were detected in 3.9% and 3.3% children and adolescents, respectively. Multivariate logistical regression analysis showed that obesity was positively associated with both pre-hypertension and hypertension, with adjusted odds ratio of 1.44 (95% confidence interval (CI) = 1.08-1.92, P = 0.014) and 2.00 (95%CI = 1.53-2.60, P < 0.001) compared to normal weight students. Overweight was also associated with pre-hypertension and hypertension. However, no significant association between thinness and pre-hypertension and hypertension was found. In conclusion, this study showed that thinness, especially mild thinness, was a major public health problem among children and adolescents in Hainan province of South China. Overweight and obesity were strongly associated with pre-hypertension and hypertension among studied students.
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Brito VC, Maux DADSX, Oliveira BDRD, Costa RDCS, Silva CRSE, Paes ST, Moraes SRAD. Impacto da desnutrição e do treinamento aeróbico moderado sobre a estrutura da parede arterial de ratos em processo de envelhecimento. REV BRAS MED ESPORTE 2011. [DOI: 10.1590/s1517-86922011000400014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Foram avaliadas as repercussões tardias da desnutrição multicarencial imposta no período de aleitamento e os possíveis efeitos e/ou alterações tanto do processo de envelhecimento como do treinamento físico aeróbio moderado sobre o diâmetro luminal e a área da túnica média da parede das artérias carótida comum esquerda, aorta horizontal e aorta torácica de ratos em processo de envelhecimento. Vinte e quatro ratos machos, Wistar, foram separados de acordo com a dieta e o treinamento físico em: GNS - nutrido sedentário, GNT - nutrido treinado, GDS - desnutrido sedentário e GDT - desnutrido treinado. Aos 10 meses, o GNT e o GDT foram submetidos ao treinamento, em meio aquático, durante oito semanas. Em seguida, os ratos foram anestesiados, sacrificados e, posteriormente, foram coletados fragmentos arteriais para o processamento histológico. A área da túnica média foi mensurada através da diferença entre as áreas externa e interna da parede arterial e o diâmetro luminal foi mensurado a partir da média de dois diâmetros medidos a partir de quatro pontos marcados na camada interna do vaso. A área da túnica média apresentou redução na aorta horizontal quando comparamos os grupos GNS x GDS (p = 0,015) e um aumento da artéria carótida comum esquerda entre os grupos GNT e GNS (p < 0,001). A aorta torácica apresentou um aumento do diâmetro luminal ao compararmos o GDS com o GDT (p= 0,041). Tanto a desnutrição multicarencial induziu alterações parciais na parede aorta horizontal, como também o treinamento físico foi capaz de promover mudanças na área da túnica média da artéria carótida comum esquerda e no diâmetro luminal da aorta torácica.
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Martins VJB, Toledo Florêncio TMM, Grillo LP, Franco MDCP, Martins PA, Clemente APG, Santos CDL, Vieira MDFA, Sawaya AL. Long-lasting effects of undernutrition. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2011; 8:1817-46. [PMID: 21776204 PMCID: PMC3137999 DOI: 10.3390/ijerph8061817] [Citation(s) in RCA: 206] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 05/12/2011] [Accepted: 05/19/2011] [Indexed: 12/15/2022]
Abstract
Undernutrition is one of the most important public health problems, affecting more than 900 million individuals around the World. It is responsible for the highest mortality rate in children and has long-lasting physiologic effects, including an increased susceptibility to fat accumulation mostly in the central region of the body, lower fat oxidation, lower resting and postprandial energy expenditure, insulin resistance in adulthood, hypertension, dyslipidaemia and a reduced capacity for manual work, among other impairments. Marked changes in the function of the autonomic nervous system have been described in undernourished experimental animals. Some of these effects seem to be epigenetic, passing on to the next generation. Undernutrition in children has been linked to poor mental development and school achievement as well as behavioural abnormalities. However, there is still a debate in the literature regarding whether some of these effects are permanent or reversible. Stunted children who had experienced catch-up growth had verbal vocabulary and quantitative test scores that did not differ from children who were not stunted. Children treated before 6 years of age in day-hospitals and who recovered in weight and height have normal body compositions, bone mineral densities and insulin production and sensitivity.
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Affiliation(s)
- Vinicius J. B. Martins
- Department of Physiology, Federal University of São Paulo, Rua Botucatu, 862, Edifício de Ciências Biomédicas, 2°andar CEP 04023-060 São Paulo, SP, Brazil; E-Mails: (M.C.P.F.); (A.P.G.C.); (C.D.L.S); (A.L.S.)
| | - Telma M. M. Toledo Florêncio
- Department of Nutrition, Federal University of Alagoas, Rua Hélio Pradines, 225/301 Ponta Verde, CEP 57035-220 Maceió, Alagoas, Brazil; E-Mail:
| | - Luciane P. Grillo
- Professional Masters Program in Health and Work Management, Vale of Itajaí University, Rua Uruguai 458, Bloco 25 B, Sala 402, Centro, CEP 88302-202 Itajaí, SC, Brazil; E-Mail:
| | - Maria do Carmo P. Franco
- Department of Physiology, Federal University of São Paulo, Rua Botucatu, 862, Edifício de Ciências Biomédicas, 2°andar CEP 04023-060 São Paulo, SP, Brazil; E-Mails: (M.C.P.F.); (A.P.G.C.); (C.D.L.S); (A.L.S.)
| | - Paula A. Martins
- Department of Health Sciences, Federal University of São Paulo, Av. Ana Costa, 95 Vila Matias CEP 11060-001, Santos, São Paulo, Brazil; E-Mail:
| | - Ana Paula G. Clemente
- Department of Physiology, Federal University of São Paulo, Rua Botucatu, 862, Edifício de Ciências Biomédicas, 2°andar CEP 04023-060 São Paulo, SP, Brazil; E-Mails: (M.C.P.F.); (A.P.G.C.); (C.D.L.S); (A.L.S.)
| | - Carla D. L. Santos
- Department of Physiology, Federal University of São Paulo, Rua Botucatu, 862, Edifício de Ciências Biomédicas, 2°andar CEP 04023-060 São Paulo, SP, Brazil; E-Mails: (M.C.P.F.); (A.P.G.C.); (C.D.L.S); (A.L.S.)
| | - Maria de Fatima A. Vieira
- Nutrition College, Federal University of Pelotas, Campus Universitário, CP 354, Pelotas, RS, Brazil; E-Mail:
| | - Ana Lydia Sawaya
- Department of Physiology, Federal University of São Paulo, Rua Botucatu, 862, Edifício de Ciências Biomédicas, 2°andar CEP 04023-060 São Paulo, SP, Brazil; E-Mails: (M.C.P.F.); (A.P.G.C.); (C.D.L.S); (A.L.S.)
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Krzyzaniak A, Krzywińska-Wiewiorowska M, Stawińska-Witoszyńska B, Kaczmarek M, Krzych L, Kowalska M, Szilágyi-Pagowska I, Palczewska I, Karch A, Jośko J, Ostrowska-Nawarycz L, Nawarycz T. Blood pressure references for Polish children and adolescents. Eur J Pediatr 2009; 168:1335-42. [PMID: 19214567 DOI: 10.1007/s00431-009-0931-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Accepted: 01/20/2009] [Indexed: 10/21/2022]
Abstract
The objective of this study was to develop age- and gender-specific reference ranges for blood pressure in a large national database on blood pressure levels throughout childhood and adolescence in young Poles. A prospective cross-sectional study was performed in 2002-2005 in the representative sampling sites, selected randomly from the entire Poland. Altogether, 6,447 school pupils, aged 7-18 years, were involved in the study of which 3,176 were boys and 3,271 were girls. Statistical analysis was performed using STATISTICA for Windows 7.1. The normal range of blood pressure, determined by age and the category of body height percentiles, revealed percentiles values which might serve as reference values to identify cases of high normal blood pressure (the mean blood pressure between 90th and 95th percentiles for age and gender) and hypertension (the mean blood pressure equals or exceeds the 95th percentiles on at least three occasions).
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Affiliation(s)
- Alicja Krzyzaniak
- Department of Epidemiology, Poznan University of Medical Sciences, Dabrowskiego 79, 60-529 Poznan, Poland
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Maux DADSX, Araújo TND, Viana MT, Paes ST, Andrade MDA, Moraes SRAD. Influência do treino fisico moderado sobre a estrutura da parede arterial de ratos submetidos à desnutrição proteica gestacional e neonatal. REV BRAS MED ESPORTE 2009. [DOI: 10.1590/s1517-86922009000600002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Avaliamos o efeito do treinamento físico moderado (TFM) associado à reposição nutricional na parede das artérias carótida comum esquerda e aorta horizontal em 24 ratos Wistar machos adultos jovens, submetidos à desnutição proteica nas fases gestacional e neonatal. Os animais foram divididos em grupos Nutrido (N, n = 12, caseína 17%) e Desnutrido (D, n = 12, caseína 8%). Após o desmame, todos os animais receberam dieta padrão (Labina®) e aos 60 dias de vida, os dois grupos foram subdivididos em quatro com seis animais cada: Nutrido Não Treinado (NNT), Nutrido Treinado (NT), Reposição Não Treinado (RNT) e Reposição Treinado (RT). O TFM foi realizado em esteira durante oito semanas, cinco dias por semana, 60 minutos por dia. A histomorfometria de ambas as artérias foi realizada com o programa Scion Image for Windows (Beta 4.0.2). A espessura das paredes das artérias foi obtida a partir da média de aferição de quatro pontos diferentes (0°, 90°, 180°, 270°) e o diâmetro do lúmen dos vasos, a partir da média de aferição de dois valores, partindo de quatro pontos diametralmente opostos. Para a comparação entre os grupos utilizou-se o teste t de Student com os dados apresentados em média ± desvio padrão. A espessura média das artérias carótida comum esquerda (µm) e aorta horizontal (mm) foi menor no grupo RNT (32,51 ± 5,54; 0,11 ± 0,02, respectivamente), comparado com o NNT (40,91 ± 3,56; 0,15 ± 0,01). O diâmetro (µm) da artéria carótida comum esquerda foi maior nos animais RT (724 ± 44,64) do que nos RNT (630,73 ± 79,67). Conclui-se que o TFM associado à reposição nutricional não foi capaz de recuperar as alterações estruturais provocadas pela desnutrição na parede das artérias carótida comum esquerda e aorta horizontal.
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Santos CDDL, Clemente APG, Martins PA, Sawaya AL. Influência do déficit de estatura nos desvios nutricionais em adolescentes e pré-adolescentes. REV NUTR 2009. [DOI: 10.1590/s1415-52732009000200001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Avaliar a influência do déficit estatural nos desvios nutricionais em pré-adolescentes e adolescentes de baixa renda. MÉTODOS: Calculou-se o Índice de Massa Corporal a partir do peso e da estatura de alunos da rede pública entre 4 e 8ª séries. Foram utilizadas as tabelas do National Center for Health Statistics de 2000 para crianças e adolescentes e foi considerado excesso de peso Índice de Massa Corporal/Idade>P85 e déficit de peso Índice de Massa Corporal/Idade <P5. Déficit estatural foi classificado quando estatura/idade foi menor que -1 desvio-padrão. Foram comparadas as proporções de baixo peso e excesso de peso nos grupos com e sem déficit estatural, de acordo com sexo e faixa etária. RESULTADOS: Foram avaliados 3 766 jovens sendo 50,4% do sexo feminino. A média de idade foi de 12,8, desvio-padrão de 2,0 anos, sem diferença significante entre os grupos. No grupo com déficit de estatura, observou-se que o excesso de peso é mais prevalente entre os mais velhos. Naqueles sem déficit de estatura a distribuição por idades foi semelhante para as três classificações de Índice de Massa Corporal/Idade. A distribuição por sexo mostra que o excesso de peso no grupo com déficit de estatura foi mais acentuada entre as meninas (76,1%) enquanto que no grupo com estatura normal a diferença foi mínima entre os sexos (4,4%). CONCLUSÃO: Na presença do déficit de estatura, o excesso de peso foi mais prevalente nos maiores de 12 anos e entre o sexo feminino. Os meninos sem déficit de estatura mostraram uma proporção maior de excesso de peso em relação aos com déficit de estatura.
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Febba A, Sesso R, Barreto GP, Liboni CS, Franco MCP, Casarini DE. Stunting growth: association of the blood pressure levels and ACE activity in early childhood. Pediatr Nephrol 2009; 24:379-86. [PMID: 18791745 DOI: 10.1007/s00467-008-0980-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 08/03/2008] [Accepted: 08/05/2008] [Indexed: 11/24/2022]
Abstract
Angiotensin converting enzyme (ACE) converts angiotensin I to angiotensin II and inactive bradykinin. Several studies carried out in our laboratory have consistently identified three isoforms of ACE, at 65, 90 and 190 kDa, with the 90-kDa isoform being a possible genetic marker of hypertension. Based on these observations and the fact that nutritional stunting can be associated with hypertension, we have investigated the expression and activity of ACE in stunted children and its association with blood pressure (BP) levels and nutritional state. Sixty children aged 2-7 years were selected for this study. A urine sample was collected from each child. Angiotensin converting enzyme activity was evaluated using two different substrates, and ACE expression was detected by Western blotting. Our results show that nutritional stunting is associated with high ACE activity in childhood and that adjustment by gender does not modify the strength of this association. A greater percentage of stunted children had increased BP levels, and this clinical parameter was inversely correlated with anthropometric indicators. A greater urinary protein expression of the three ACE isoforms was observed in the group of children with growth stunting. Our findings suggest that the reported high risk of hypertension in stunted adolescents and adults are, at least partly, associated with abnormalities in the renin-angiotensin system.
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Affiliation(s)
- Andréia Febba
- Division of Nephrology, Federal University of São Paulo, R. Botucatu, 740, São Paulo, SP, Brazil, 04023-900
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Martins IS, Oliveira DCD, Marinho SP, Araújo EACD. Hipertensão em segmentos sociais pauperizados da região do Vale do Paraíba São Paulo. CIENCIA & SAUDE COLETIVA 2008; 13:477-86. [DOI: 10.1590/s1413-81232008000200023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Accepted: 04/13/2007] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste trabalho foi verificar as relações entre fatores socioeconômicos, ambientais e biológicos com a hipertensão, segundo gênero. A população estudada foi formada por adultos residentes em dois municípios do Vale do Paraíba (SP), uma das regiões mais pobres do estado de São Paulo. Foi composta por 274 (39,8%) homens e 415 (60,2 %) mulheres. O estudo foi realizado por meio de um modelo de regressão logística hierarquizada, aplicado separadamente para homens e mulheres. Foram estimados os odds ratios ajustados (ORaj), com intervalo de confiança de 95% e a = 0,05. Para os homens, os seguintes fatores de risco estiveram associados à hipertensão: viver na zona rural (ORaj=2,00; p=0,01); etilismo (ORaj= 1,90; p=0,03) e idade acima de 40 anos (ORaj=3,10; p<0,0001). Famílias numerosas, com mais de seis pessoas exerceram efeito protetor (ORaj=0,46; p=0,02). Para mulheres, os fatores de risco associados foram: ausência de escolaridade (ORaj= 2,37; p=0,0003); sedentarismo (ORaj=1,71; p=0,04); obesidade acompanhada de baixa estatura (ORaj= 4,66; p <0,0001) e idade acima de 40 anos ( ORaj=5,29; p=0,01). A obesidade isolada não se associou à hipertensão, nos níveis pressóricos iguais ou maiores do que os correspondentes ao estágio II do padrão de referência.
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Savitha MR, Krishnamurthy B, Fatthepur SSR, Yashwanth Kumar AM, Khan MA. Essential hypertension in early and mid-adolescence. Indian J Pediatr 2007; 74:1007-11. [PMID: 18057681 DOI: 10.1007/s12098-007-0185-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To detect prevalence of essential hypertension in early and mid adolescents and to identify various risk factors. METHODS Blood pressure was recorded in 503 apparently normal school students in 10 to 16 yr age group as per standard guidelines. Detailed clinical examination was done in all cases. A detailed questionnaire was sent to parents. RESULTS 6.16% of adolescents had high blood pressure at the end of fourth screening. Both systolic and diastolic hypertensions were documented. Increased body mass index and reduced consumption of vegetables and fruits were found to be statistically significant risk factors for hypertension. CONCLUSION Multiple blood pressure recordings are essential for accurate diagnosis of hypertension. There is a high prevalence of essential hypertension amongst adolescents in Mysore city with modifiable risk factors for hypertension.
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Affiliation(s)
- M R Savitha
- Department of Pediatrics, Government Medical College, Mysore, India.
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Loss IDO, Fernandes LG, Martins CDD, Cardoso LM, Silva ME, Dias-da-Silva VJ, Moraes MFD, Chianca DA. Baroreflex dysfunction in rats submitted to protein restriction. Life Sci 2007; 81:944-50. [PMID: 17822720 DOI: 10.1016/j.lfs.2007.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Revised: 07/16/2007] [Accepted: 08/03/2007] [Indexed: 11/23/2022]
Abstract
Earlier studies from the authors' laboratory showed that malnourishment induces alterations in the cardiovascular homeostasis increasing the basal mean arterial pressure and heart rate. In this study, the authors evaluated whether the sympathetic and parasympathetic efferent activities contribute to changes in the cardiovascular homeostasis through altered modulation of the arterial baroreflex of malnourished rats. After weaning, male Fischer rats were given 15% (Normal Protein--NP) or 6% (Low Protein--LP) protein diet for 35 d. The baroreflex gain and latency were evaluated before and after selective autonomic blockades in control and malnourished rats. It was observed that malnourishment affected the baroreflex gain in response to activation and deactivation of the arterial baroreflex. Moreover, malnourished rats showed increased baroreflex latency as compared to that of control rats. Regarding the autonomic efferent activity directed to the heart, the data showed increased sympathetic and decreased parasympathetic efferent activities in malnourished rats, and such alterations could be related to the observed changes in the arterial baroreflex gain as well as in the basal mean arterial pressure and heart rate.
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Affiliation(s)
- Igor de O Loss
- Department of Biological Sciences, DECBI-NUPEB, Federal University of Ouro Preto, 35400-000, Ouro Preto, MG, Brazil
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Martins PA, Hoffman DJ, Fernandes MTB, Nascimento CR, Roberts SB, Sesso R, Sawaya AL. Stunted children gain less lean body mass and more fat mass than their non-stunted counterparts: a prospective study. Br J Nutr 2007; 92:819-25. [PMID: 15533271 DOI: 10.1079/bjn20041274] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of the present study was to analyse the changes in body composition of stunted children during a follow-up period and to test the hypothesis of a tendency to accumulate body fat as a consequence of undernutrition early in life. We selected fifty boys and girls aged 11 to 15, who were residents of slums in São Paulo, Brazil. Twenty were stunted (S) and thirty had normal stature (NS). The children's nutritional status and body composition were assessed through anthropometry and dual-energy X-ray absorptiometry, at the beginning of the present study and after 3 years, and changes in lean mass (LM and LM%) and fat mass (FM and FM%) were calculated. Stunted boys accumulated more body fat (FM%: S=1·62%, NS=−3·40%;P=0·003) and gained less lean mass (LM%: S=−1·46, NS=3·21%;P=0·004). Stunted girls gained less lean mass (S=7·87 kg, NS=11·96 kg;P=0·032) and had significantly higher values of FM% at follow-up when compared with their baseline values (P=0·008), whereas non-stunted girls had a non-significant difference in FM% over time (P=0·386). These findings are important to understand the factors involved in the increased prevalence of overweight and obesity among poor populations, which appear to be associated with hunger during infancy and/or childhood.
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Affiliation(s)
- P A Martins
- Department of Physiology, Federal University of São Paulo, CEP 04023-060, Brazil
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Sawaya AL, Sesso R, Florêncio TMDMT, Fernandes MTB, Martins PA. Association between chronic undernutrition and hypertension. MATERNAL AND CHILD NUTRITION 2006; 1:155-63. [PMID: 16881895 PMCID: PMC6860942 DOI: 10.1111/j.1740-8709.2005.00033.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In developing countries nutritional deficit during prenatal and continuing in post-natal life is very common. This condition leads to stunting and important metabolic changes. Over 30% of children in the world are stunted. The metabolic resultants of nutritional deficit during growth are classically known to aim at energy conservation. This review summarizes data from Brazil, a developing country undergoing the double burden of obesity and undernutrition, especially among the poor, and suggests that stunting or chronic undernutrition increases the risk of obesity and hypertension later in life. Around 60 million people are under the poverty line in Brazil. In São Paulo, the richest city of the country, 20% of the population live in slums and in Maceió, the capital of one of the poorest states, this percentage reaches 50%. Undernutrition in this population is around 20% among children, with high frequency of infections, anemia, and parasitic infestations, associated with poor sanitation. Among stunted adolescents, we found a high prevalence of hypertension (21%) that is a considerably higher estimate compared to non-stunted adolescents (less than 10%). The prevalence of hypertension in undernourished pre-school children, or in those who recovered from undernutrition, was higher than that in controls (29%, 20% and 2%, respectively, P < 0.001). Among stunted adults eating no more than 66% of the requirements (adjusted for stature), overweight/obesity was 35% in women and 25% in men. The prevalence of hypertension was 44% among stunted women and 18% among stunted men. Fifty per cent of stunted and obese women had hypertension. These data reinforce the important association between undernutrition and hypertension from childhood through adulthood. Health policies for preventing and combating childhood undernutrition should have an impact on the morbidity and mortality related to hypertension during adulthood.
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Affiliation(s)
- Ana L Sawaya
- Department of Physiology, Universidade Federal de São Paulo, Rua Botucatu 862, 2o andar, São Paulo, SP, Brazil.
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Martins PA, Sawaya AL. Evidence for impaired insulin production and higher sensitivity in stunted children living in slums. Br J Nutr 2006; 95:996-1001. [PMID: 16611392 DOI: 10.1079/bjn20061754] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The objective of the present study was to investigate the changes in glucose and insulin metabolism in nutritionally stunted children that can be involved in the appearance of chronic diseases in adulthood. For this purpose, sixty-one children were selected, thirty-five boys and twenty-six girls, residents of slums in São Paulo, Brazil. The children were classified according to the height-for-age as stunted (<or=-1.5 Z-score; n 21) or non-stunted (>-1.5 Z-score; n 40). The glucose and insulin plasma levels were determined and, from these values, the indexes that evaluate the pancreatic beta-cell function (homeostasis model assessment (HOMA-B)) and insulin sensitivity (HOMA-S) were assessed. Stunted children showed lower values of fasting insulin than those of the non-stunted group (boys: 29.7 (SD 14.9) v. 50.4 (SD 29.2) pmol/l, P=0.019; girls: 34.4 (SD 12.6) v. 62.3 (SD 28.7) pmol/l, P=0.016) but the glucose levels were similar (boys: 4.6 (SD 0.3) v. 4.5 (SD 0.3) mmol/l; girls: 4.2 (SD 0.3) v. 4.4 (SD 0.3) mmol/l). Stunted children showed lower HOMA-B values (boys: 83 (SD 22) % v. 115 (SD 36) %, P=0.011; girls: 107 (SD 23) % v. 144 (SD 46) %, P=0.045) and higher HOMA-S values (boys: 196 (SD 92) % v. 120 (SD 62) %, P=0.014; girls: 159 (SD 67) % v. 98 (SD 57) %, P=0.016). The results show a decreased activity of beta-cell function and increased insulin sensitivity in stunted children. The decreased beta-cell function of this group may strongly predict type 2 diabetes.
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Affiliation(s)
- P A Martins
- Department of Physiology, Federal University of São Paulo, São Paulo, Brazil.
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Angelopoulos PD, Milionis HJ, Moschonis G, Manios Y. Relations between obesity and hypertension: preliminary data from a cross-sectional study in primary schoolchildren: The children study. Eur J Clin Nutr 2006; 60:1226-34. [PMID: 16708067 DOI: 10.1038/sj.ejcn.1602442] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To record the prevalence of overweight, obesity and hypertension in primary schoolchildren living in one of the poorest regions in Europe and furthermore to identify certain behavioural, lifestyle and physiological parameters associated with body mass index (BMI) and blood pressure (BP). DESIGN Cross-sectional study. SETTING Nineteen primary schools within the county of Ioannina, Greece. SUBJECTS AND METHODS Demographic, dietary and physical activity data as well as anthropometrical, BP and cardiorespiratory fitness measurements were obtained from a representative sample of 312 school children (153 boys and 159 girls) attending 5th grade. Inclusion of subjects in the study was voluntary. One-way analysis of variance and multiple linear regression analysis were mainly applied for the evaluation of the tested hypotheses. RESULTS The prevalence of overweight and obesity was 29.4 and 11.8% for boys and 39.0 and 7.5% for girls. The prevalence of systolic and diastolic hypertension was 28.1 and 7.8% for boys and 26.4 and 17.0% for girls. Furthermore, BMI and BP (systolic and diastolic) were positively related to frequency of fast food meals (rho: + 0.28, P = 0.033, rho: + 1.09, P = 0.03 and rho: +0.86, P = 0.014, respectively) but negatively to leisure time physical activity (rho: -5.55, P = 0.005, rho: -3.32 x 10(-2), P < 0.001 and rho: -2.08 x 10(-2), P < 0.001, respectively). CONCLUSIONS The current study revealed an increased prevalence of overweight, obesity and hypertension among schoolchildren in Ioannina, indicating the need for early preventive measures in one of the less privileged regions of Europe.
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Affiliation(s)
- P D Angelopoulos
- Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece
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