Obesity and abdominal fatness associated with undernutrition early in life in a survey in Rio de Janeiro

Maternal depressiveness and infant growth outcomes: Findings from the MAASTHI cohort study in India

OBJECTIVE

The study aims to examine the association between depressiveness in mothers on infant obesity and stunting at one year of age.

METHODS

We enrolled 4829 pregnant women, followed them up at public health facilities in Bengaluru for one year after birth. We collected information on women's sociodemographic characteristics, obstetric history, depressive symptoms during pregnancy and delivery within 48 h. We took infant anthropometric measurements at birth and one year. We used chi-square tests, and calculated an unadjusted odds ratio using univariate logistic regression. We used multivariate logistic regression to examine the association between maternal depressiveness, childhood adiposity, and stunting.

RESULTS

We found that the prevalence of depressiveness was 31.8% in mothers who delivered in public health facilities in Bengaluru. Infants born to mothers with depressiveness at birth had 3.9 times higher odds of having larger waist circumference than infants born to mothers with no depressiveness (AOR: 3.96, 95% Confidence Interval: 1.24,12.58) and 1.9 times higher odds of having a larger sum of skinfold thickness (AOR: 1.99, 95% CI: 1.18,3.38). Additionally, we found that infants born to mothers with depressiveness at birth had 1.7 times higher odds of stunting than infants born to mothers with no depressiveness (AOR: 1.72; 95%CI: 1.22,2.43) after adjusting for confounders.

CONCLUSION

Our study highlights a high prevalence of depressiveness among mothers seeking antenatal care at a public hospital is associated with an increased risk of infant adiposity and stunting at one year. Further research is needed to understand the underlying mechanisms and identify effective interventions.

Peripheral histamine and neonatal growth performance in swine

Identification of plasma and/or serum markers at birth that will predict animal performance may be useful for identifying animals susceptible to poor growth. Metabolomic analysis of plasma from newborn swine was used to identified potential metabolite differences between 8 pairs of littermates with similar birth weights but whose ADG differed by >50 g/d so that, at weaning (21 d), littermates differed in BW by 1.62 kg (P < 0.01). Plasma analysis failed to identify metabolic pathways impacted by growth, most likely because of the small sample population. Interestingly, despite comparative analysis of 576 metabolites between these slow-growing and normal-growing littermates, the relative abundance of only 36 metabolites differed between the pairs. Most of these metabolites could be eliminated as potential markers because of the difficulty with the extraction and rapid measurement of their plasma/serum concentrations. Histamine differed from most of these potential metabolite markers in that commercial sandwich ELISAs are readily available. Using an ELISA, we verified the metabolomic data, demonstrating that plasma histamine concentrations were 150% higher in slow-growing than normal growing littermates of similar birth weight (P < 0.05). Subsequently, a separate data set was obtained using swine from a different geographical location and genetic background and also showed that elevated histamine (ng/mL) at birth is associated with increased preweaning growth rate (P = 0.009, r = 0.306, n = 9 litters). Together, the data indicate that perinatal histamine concentrations may serve as a tool to identify potentially slower growing pigs and as a serum biomarker for predicting litter growth rate.

Preventing weight-related problems among adolescent girls: A cluster randomized trial comparing the Brazilian 'New Moves' program versus observation

PURPOSE

To conduct a cluster randomized controlled trial comparing the Brazilian version of the New Moves program (NMP) versus observation among Brazilian adolescent girls.

METHODS

Ten schools were randomly allocated to the Brazilian NMP or the observation arm. Study participants included 12-14-year-old girls. Recruitment occurred between February 2014 and March 2015. The NMP included sports, nutritional support, motivational interviews, collective lunch, and parental information materials. Our main outcome was the Body Shape Questionnaire (BSQ). Secondary outcomes included the Rosenberg Self-Esteem Scale and the Unhealthy Weight-Control Behaviors Index, as well as body mass index. Study results were evaluated through generalized estimating equations.

RESULTS

A total of 270 adolescents participated in the study. At baseline, mean age was 13.4 years, and average BMI was 21.4. The intervention did not result in any statistically significant differences between the NMP and the observation arm, including BSQ (predicted means of 64.33 - IC 95% 59.2-69.47 vs. 62.02 - IC 95% 56.63-67.4), respectively) and our secondary outcomes. Adherence was low during the intervention (32.9%) and maintenance (19.1%) phases of the program.

CONCLUSION

The New Moves program did not lead to significant changes in our measured outcomes. Future studies should investigate whether changes might occur when comprehensive behavioral programs are sustained over longer periods while also being customized to local population characteristics.

[Abdominal obesity: a critical review of the measurement techniques and cutoff points of anthropometric indicators adopted in Brazil]

The scope of this article is to assess the suitability of the measurement techniques and the cutoff points of anthropometric indicators of abdominal obesity adopted in Brazil, and summarize the results. This involves a review of the literature published from 1990 to 2010 and indexed in the MEDLINE, LILACS and SciELO databases. The inclusion criteria for articles were: original research articles with abstracts available of experimental or observational design conducted in Brazil, in English, Spanish or Portuguese; articles about assessment of abdominal obesity with the use of anthropometric indicators of central distribution. Eighteen articles characterized according to author and publication year, study site, study type, sample size, age, sex, anthropometric indicators, measurement techniques, cutoff points and main results were selected. A divergence was found between studies in terms of standardized technical procedures and cutoff points. The results of this review recommend the standardized use of the validated measurement techniques and cutoff points in order to facilitate comparison of the results of the epidemiological studies into abdominal obesity and their adequate use in clinical practice.

Childhood stunting and the metabolic syndrome components in young adults from a Brazilian birth cohort study

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.

Excess weight and disability among the elderly in Argentina

The aim of this paper is to analyze the relationship between excess weight and the condition of disability among elderly people in Argentina and to assess the extent to which a protective factor could be operating that reduces or mitigates the effect of overweight on the loss of functional skills in people over 64 years of age. In order to do so, microdata from Argentina's 2009 National Survey of Risk Factors [Encuesta Nacional de Factores de Riesgo] was utilized. To measure the association among overweight, obesity and disability status, as well as the interaction of weight status and age, logistic regression models were estimated. The results indicate that although overweight and obesity have a positive net effect on the occurrence of disabilities, this effect is lower among people 64 years of age and older. This result could be suggesting that among older people a protective factor is at work that, while not reversing the direct relationship between excess weight and disability, seems to attenuate it.

Early-life conditions and older adult health in low- and middle-income countries: a review

Population aging and subsequent projected large increases in chronic conditions will be important health concerns in low- and middle-income countries. Although evidence is accumulating, little is known regarding the impact of poor early-life conditions on older adult (50 years and older) health in these settings. A systematic review of 1141 empirical studies was conducted to identify population-based and community studies in low- and middle-income countries, which examined associations between early-life conditions and older adult health. The resulting review of 20 studies revealed strong associations between (1) in utero/early infancy exposures (independent of other early life and adult conditions) and adult heart disease and diabetes; (2) poor nutrition during childhood and difficulties in adult cognition and diabetes; (3) specific childhood illnesses such as rheumatic fever and malaria and adult heart disease and mortality; (4) poor childhood health and adult functionality/disability and chronic diseases; (5) poor childhood socioeconomic status (SES) and adult mortality, functionality/disability and cognition; and (6) parental survival during childhood and adult functionality/disability and cognition. In several instances, associations remained strong even after controlling for adult SES and lifestyle. Although exact mechanisms cannot be identified, these studies reinforce to some extent the importance of early-life environment on health at older ages. Given the paucity of cohort data from the developing world to examine hypotheses of early-life conditions and older adult health, population-based studies are relevant in providing a broad perspective on the origins of adult health.

Is overweight in stunted preschool children in Cameroon related to reductions in fat oxidation, resting energy expenditure and physical activity?

BACKGROUND

Recent studies suggest that early modifications in metabolic pathways and behaviour, leading to energy conservation and reduced linear growth, could represent adaptations to nutritional constraints during foetal life and infancy. Impaired fat oxidation, low resting energy expenditure and reduced physical activity, resulting from these adaptations, could facilitate fat storage and development of overweight in growth-retarded children that consume more energy-dense food. This study aims at assessing whether: (1) dual-burden preschool children (simultaneously stunted and overweight) of Yaounde (Cameroon) have low birth-weight (indicator of foetal undernutrition) and reductions in fat oxidation, resting energy expenditure (REE) and physical activity, (2) fat oxidation, REE and physical activity are associated with foetal growth.

METHODOLOGY/PRINCIPAL FINDINGS

162 children (24-72 months) were considered: 22 stunted-overweight (SO), 40 stunted (S), 41 overweight (O), and 59 non stunted-non overweight (NSNO). Nutritional status and body composition were assessed using anthropometry and multifrequency bioimpedance analysis. Fasting respiratory quotient (RQ) and REE were measured by indirect calorimetry. Physical activity was determined using accelerometers, food questionnaires were used for diet assessment and birth-weight was noted. Mean RQs and REE (weight adjusted) did not differ between stunted children (SO and S) and non-stunted children (O and NSNO). SO and S children spent more time in sedentary activities than O children (p = 0.01 and p = 0.02, respectively) and less time in moderate-to-vigorous activities than NSNO children (p = 0.05 and p = 0.04, respectively). SO children's diet was less diverse (p = 0.01) with less animal products (p = 0.006). Multiple linear regressions model revealed that birth-weight is predictive of RQ (β = 0.237, p<0.01, R(2) = 0.08).

CONCLUSIONS/SIGNIFICANCE

This study showed that growth retardation in stunted-overweight children could be associated with postnatal nutritional deficiencies. Overweight in stunted children could be associated with reduced physical activity in the context of nutrition transition. High birth-weight was a predictor of reduced lipid oxidation, a risk factor of fat deposition.

[Metabolic syndrome and short stature in adults from the metropolitan area of São Paulo city (SP, Brazil)]

The undernutrition has been appointed as a risk factor to cause chronic diseases in later life. The objective of this study was to investigate the prevalence of metabolic syndrome and its relationship to short stature, as evidence of stunting in early life in adults. It is a cross-sectional study of adult population (age 20 to 64 years old) living in the metropolitan area of São Paulo city (SP, Brazil). The sample comprehended a total of 287 individuals, 214 (74.6%) were women and 73 (25.4%) were men. The anthropometric, clinical and biochemical data were collected through the physical exam and the fast blood after 8 hours. The standard prevalence for sex and age to metabolic syndrome was 34.0% and the short stature was 29.0%. In multiple logistic regression analyses the metabolic syndrome showed to be associated to short stature adjusted by sex, age, education, income, smoking, alcohol consumption, family history of coronary disease, hypertension, diabetes and body mass index. In this study was demonstrated association between metabolic syndrome and short stature in adults.

Relationship between short stature and obesity in Brazil: a multilevel analysis

To ascertain the association of BMI and obesity with short stature, a cross-sectional telephone survey was conducted in 2006, using a multilevel approach, adjusting for individual- and city-level measures of socio-economic status. The study probabilistic sample consisted of 54 369 adults (>18 years) living in households with access to telephone lines in each urban area of the twenty-six Brazilian state capitals and federal district. Odds of being currently obese and obese at age 20 years were compared between short stature individuals (5th percentile) and those with normal stature. After controlling for individual- and city-level sociodemographic characteristics and behaviours, high BMI was strongly associated with short stature individuals (P = 0·001). Among short stature women the adjusted OR of being obese was 3·0 (95 % CI 2·2, 4·2) compared with those with stature greater than the 5th percentile. Among men this adjusted OR was 2·0 (95 % CI 1·5, 2·6). When comparisons were made for BMI at age 20 years the OR were even larger (6 for men and 8 for women). Despite the growing body of evidence that environmental factors such as poor food choices and physical inactivity are the main determinants of the worldwide obesity epidemic, the greater difference in BMI and prevalence of obesity in the Brazilian capitals was explained mainly by individual factors. We found a strong association between obesity and short stature after adjustment for diet, physical activity, and many environmental factors. Intra- and inter-generational consequences of undernutrition are an alternative explanation for the regional disparities in obesity in Brazil.

Maternal protein restriction during early lactation induces GLUT4 translocation and mTOR/Akt activation in adipocytes of adult rats

Epidemiological and experimental studies have demonstrated that early postnatal nutrition has been associated with long-term effects on glucose homeostasis in adulthood. Recently, our group demonstrated that undernutrition during early lactation affects the expression and activation of key proteins of the insulin signaling cascade in rat skeletal muscle during postnatal development. To elucidate the molecular mechanisms by which undernutrition during early life leads to changes in insulin sensitivity in peripheral tissues, we investigated the insulin signaling in adipose tissue. Adipocytes were isolated from epididymal fat pads of adult male rats that were the offspring of dams fed either a normal or a protein-free diet during the first 10 days of lactation. The cells were incubated with 100 nM insulin before the assays for immunoblotting analysis, 2-deoxyglucose uptake, immunocytochemistry for GLUT4, and/or actin filaments. Following insulin stimulation, adipocytes isolated from undernourished rats presented reduced tyrosine phosphorylation of IR and IRS-1 and increased basal phosphorylation of IRS-2, Akt, and mTOR compared with controls. Basal glucose uptake was increased in adipocytes from the undernourished group, and the treatment with LY294002 induced only a partial inhibition both in basal and in insulin-stimulated glucose uptake, suggesting an involvement of phosphoinositide 3-kinase activity. These alterations were accompanied by higher GLUT4 content in the plasma membrane and alterations in the actin cytoskeleton dynamics. These data suggest that early postnatal undernutrition impairs insulin sensitivity in adulthood by promoting changes in critical steps of insulin signaling in adipose tissue, which may contribute to permanent changes in glucose homeostasis.

Stunting: its relation to overweight, global or localized adiposity and risk factors for chronic non-communicable diseases

This article discloses and discusses recent findings that have associated stunting - which still represents the most prevalent deviation from normal body measurements among children living in developing countries - with overweight and higher adiposity, mainly in the central region of the body, and their clinical and physio-pathological consequences. Although there is need for further studies to clarify these associations, there is a tendency for the weight/height index and body fat topography to behave differently in short and normal stature individuals, mainly in females. This review, therefore, alerts health professionals this characteristic, given that this anthropometric profile may be linked to the widespread occurrence of chronic non-communicable diseases and/or to risk factors for these conditions and that stunting is still a reality in developing countries.

Short stature, abdominal obesity, insulin resistance and alterations in lipid profile in very low-income women living in Maceió, north-eastern Brazil

OBJECTIVE

To test the hypothesis that short stature is associated with abdominal obesity, insulin resistance and lipid profile changes.

METHODS

Anthropometric data were collected from 237 women (18-60 years old), residents of a shantytown in Maceió. Biochemical profiles of 60 individuals drawn from this population were determined.

RESULTS

Total and low-density lipoprotein (LDL) cholesterol levels and insulin resistance rose with increasing waist : hip circumference ratio, particularly in women. Short, overweight individuals exhibited larger biochemical alterations than overweight individuals of average stature.

CONCLUSION

Short stature, when associated with overweight, is a risk factor for increased insulin resistance and alterations in lipid profile.

Stunted children gain less lean body mass and more fat mass than their non-stunted counterparts: a prospective study

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.

Proporcionalidade corporal na avaliação antropométrica de adolescentes pós-menarca

OBJETIVO: Verificar o comportamento da proporcionalidade corporal em adolescentes pós-menarca e sua influência na avaliação antropométrica desses indivíduos, com ênfase na relação peso/estatura. MÉTODOS: Avaliaram-se 80 adolescentes de uma escola pública de Alfenas, Minas Gerais, com pelo menos 12 meses pós-menarca. As medidas antropométricas foram realizadas conforme procedimentos padronizados. A proporcionalidade corporal foi avaliada pelo Índice de Cormic. A população foi dividida em grupos de estudo (Índice de Cormic > mediana) e controle (Índice de Cormic < mediana). Os grupos foram comparados em relação às idades cronológica e ginecológica, peso, estatura, estatura tronco-cefálica, comprimento de pernas, índice de massa corporal e indicadores de adiposidade global e localizada. RESULTADOS: Os grupos estudados eram homogêneos em relação ao desenvolvimento físico, visto que as médias das idades cronológica e ginecológica não diferiram estatisticamente. A média e o desvio-padrão do Índice de Cormic corresponderam a 0,52 e 0,013, respectivamente. Os grupos não diferiram em relação à estatura (p=0,23), porém o grupos de estudo apresentou valores de estatura tronco-cefálica significantemente superiores em relação ao grupo controle (p<0,01). Proporção significantemente superior (67,6%) do grupo de estudo apresentou índice de massa corporal > mediana, em comparação ao grupo controle (37,2%). Quanto aos indicadores de adiposidade global ou localizada, não foram observadas diferenças estatísticas entre os grupos. CONCLUSÃO: As diferenças na proporcionalidade corporal não se relacionaram com a estatura. Altos valores de Índice de Cormic parecem estar associados a elevado índice de massa corporal, mas não à composição corporal e à topografia da gordura corporal. Questiona-se, assim, a utilização exclusiva do índice de massa corporal para avaliação antropométrica em serviços de saúde, visto que pode gerar resultados inexatos em populações com comprometimento na proporcionalidade corporal.

Association between chronic undernutrition and hypertension

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.

Measuring the full economic costs of diet, physical activity and obesity-related chronic diseases

Most studies that have focused on the costs of obesity have ignored the direct effects of obesity-related patterns of diet and physical activity. This study reviews the full effects of each component--poor dietary and physical activity patterns and obesity--on morbidity, mortality and productivity. The direct healthcare costs are based on a review of the effects of these factors on key diseases and the related medical care costs of each disease. The indirect costs on reduced disability, mortality and sickness during the period of active labour force participation prior to retirement are also examined. A case study is prepared for China to provide some guidance in the utilization of this review for economic analysis of obesity. The case study shows that the indirect costs are often far more important than the direct medical care costs. The Chinese case study found that the indirect effects of obesity and obesity-related dietary and physical activity patterns range between 3.58% and 8.73% of gross national product (GNP) in 2000 and 2025 respectively.

Adaptive changes in thyroid function of female rats fed a high-fat and low-protein diet during gestation and lactation

The percent of lipids in the western diet has been continuously increasing in the last decades and is associated with a decrease in the proportion of protein intake. Recently, we demonstrated that protein malnutrition during lactation is associated with lower body weight and thyroid hypofunction in female rats and their offspring. Our objective in the present study was to determine if a high-fat and low-protein diet was associated with similar changes. Three-month-old female Wistar rats were randomly assigned to one of the following groups with 8 animals each: high-fat and low-protein (40% lipid, 5% protein, and 55% carbohydrate of the total energy content) from the 3rd week of gestation to the end of lactation; control group--standard diet (11% lipid, 23% protein, and 66% carbohydrate of the total energy content). Food consumption and body weight were monitored daily. Serum thyrotropin and thyroid hormone concentrations were determined by specific radioimmunoassay at the end of lactation. Animals receiving high-fat and low-protein diet had a significantly lower body weight (13.9% at weaning, P < 0.05) and serum albumin (25%, P < 0.05) and thyrotropin (26.2%, P < 0.01) concentrations, and a higher serum triiodothyronine concentration (74%, P < 0.005) and 131I-thyroid uptake (77%, P < 0.005). These data show that a high-fat and low-protein diet can promote maternal thyroid hyperfunction that differs from the thyroid hypofunction observed in dams fed a low-protein diet, a phenomenon that can be of adaptive importance for pup nurturing.

The emerging epidemic of obesity in developing countries

Thirty years ago international nutritionists were focussing on childhood malnutrition, the 'protein gap' and how to feed the world's burgeoning population, and medical services in the developing world were concentrated on the fight against infectious diseases. Today the World Health Organization (WHO) finds itself needing to deal with the new pandemic of obesity and its accompanying non-communicable diseases (NCDs) while the challenge of childhood malnutrition has far from disappeared, TB and malaria rates are escalating, and the scourge of AIDS has emerged. This has created a 'double burden' of disease that threatens to overwhelm the health services of many resource-poor countries. WHO warns that the greater future burden of obesity and diabetes will affect developing countries, and the projected numbers of new cases of diabetes run into the hundreds of millions within the next 2 decades. The obesity pandemic originated in the US and crossed to Europe and the world's other rich nations before, remarkably, it penetrated even the world's poorest countries especially in their urban areas. The pandemic is transmitted through the vectors of subsidized agriculture and multinational companies providing cheap, highly refined fats, oils, and carbohydrates, labour-saving mechanized devices, affordable motorized transport, and the seductions of sedentary pastimes such as television. This paper briefly reviews these macro-environmental trends as well as considering some of the socio-behavioural influences on weight gain in traditional societies. It concludes, pessimistically, that the pandemic will continue to spread for the foreseeable future, and that, apart from educational campaigns, the governments and health services of poor countries will have few effective public health levers with which they can try to arrest the trend.

Waist circumference and waist-to-hip ratio as predictors of serum concentration of lipids in Brazilian men

OBJECTIVE

It is unknown whether waist circumference can predict a lipid profile beyond that predicted by body fatness alone, after adjustment for important confounding variables such as smoking, alcohol intake, and physical activity. The purpose of this non-clinical, healthy-subject study was to test this hypothesis.

METHODS

Data refer to 416 men, ages 20 to 58 y with a body mass index between 18.5 and 29.9 kg/m(2), who were blood donors living in a Brazilian city. Alcohol consumption, smoking, and physical activity were evaluated by interview; body fat was measured by electrical bioimpedance, and weight, height, and waist and hip circumferences were measured by trained anthropometrists. Multiple linear regression analysis was performed to quantify the association between measurements of fat distribution (waist circumference and waist-to-hip ratio) and the ratio of total cholesterol to high-density lipoprotein cholesterol and triacylglycerols independently of measurements of fatness and potentially confounding factors.

RESULTS

Waist circumference was strongly correlated with percentage of body fat (r = 0.90), whereas waist-to-hip ratio was less correlated (r = 0.55). After adjustment for age, percentage of body fat, smoking, alcohol intake, and physical activity, waist circumference was not significantly related to the ratio of total cholesterol high-density lipoprotein cholesterol, whereas the waist-to-hip ratio was strongly associated among the youngest subjects (beta = 3.51, P = 0.005).

CONCLUSION

Although several studies have analyzed the association between serum lipids with anthropometric markers, few, including the present one, support waist circumference as a good predictor of lipid profile.

Hipertensão, obesidade abdominal e baixa estatura: aspectos da transição nutricional em uma população favelada

OBJETIVO: Investigar, em mulheres de muito baixa renda, a prevalência e a associação entre a baixa estatura, o sobrepeso, a obesidade abdominal e a hipertensão arterial, discutindo os achados, segundo o processo de transição nutricional e a hipótese da programação fetal (hipótese Barker). MÉTODOS: Foram estudadas 223 mulheres de 18 a 65 anos, por meio dos seguintes indicadores: índice de massa corporal (kg/m²) >25 para sobrepeso + obesidade ou <18,5 para magreza; razão cintura-quadril > 0,8 para obesidade abdominal; pressão arterial sistólica e/ou diastólica >140/90mmHg para hipertensão; percentil 25 (1º quartil) para baixa estatura. RESULTADOS: A prevalência de sobrepeso + obesidade (35,9%) foi superior à de magreza (9,4%). A pressão diastólica associou-se com o índice de massa corporal (r=0,37; IC 95%: 0,01 <r² <0,26) e com a razão cintura-quadril (r=0,35; IC 95%: 0,01 <r² <0,25). Comparando-se os 1º e 4º quartis de estatura, encontraram-se os seguintes resultados, respectivamente, para a prevalência de hipertensão: 23,3% e 8,9% (odds ratio=3,08; p=0,03); para sobrepeso + obesidade: 41,7% e 35,7% (p=0,51); para o índice de massa corporal médio: 24,6 e 23,7 (p=0,27); para a média da razão cintura-quadril: 0,87 e 0,85 (p=0,04). CONCLUSÃO: A prevalência de sobrepeso/obesidade foi menor do que a de desnutrição. A baixa estatura, um indicador de desnutrição no início da vida, foi um importante fator de risco para a hipertensão arterial e para a obesidade abdominal. Apesar da miséria, a população parece estar passando pelo processo de transição nutricional. Os mecanismos resultantes da adaptação metabólica à desnutrição imposta no início da vida, parecem desempenhar importante papel na determinação desses achados.

Relationship between sitting-height-to-stature ratio and adiposity in Brazilian women

Inadequate anthropometric dimensions, such as short leg length or high sitting-height-to-stature ratio (SHSR) in adults, can be considered indices of adverse environmental conditions in early life. Our objective was to describe the association between SHSR, a variable of prepubertal environment, and levels of adiposity in a group of Brazilian women. Six hundred and sixty-nine women aged 20-55 years were studied through a cross-sectional design. Detailed anthropometric measurements were obtained according to standardized procedures. Body mass index (BMI) > or = 30 kg/m2, percent body fat (% BF) measured through bioelectrical impedance >30, and the third tertile of six skinfold sums (SKF sum) were treated as dependent variables. High SHSR was defined as values > or = mean + 1 SD. Data analysis was performed using nonconditional hierarchical multivariate logistic regression, estimating adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for the three dependent variables. Thirty-two percent of women who had high SHSR had low stature, compared with 13.8% in the group with normal SHSR (P < 0.000). After adjustment for age, schooling, total family income, parity, and age of menarche, high SHSR was still associated with BMI > or = 30 kg/m2 (OR, 2.46; 95% CI, 1.31-4.60), % BF >30 (OR, 2.07; 95% CI, 1.11-3.61), and SKF sum (OR, 2.11; 95% CI, 1.33-3.35). These results support the hypothesis that high SHSR, a variable of prepubertal adverse environmental conditions, is independently associated with adiposity in this group of Brazilian women. Responsible factors for high SHSR, other than genetics, should be investigated.

Early postnatal growth in preterm infants and cord blood leptin

Although circulating leptin and insulin concentration is linked to intrauterine growth, fetal development and birth weight in full-term infants, there has been no enquiry into the influence of cord blood insulin and leptin for catch-up growth in preterm infants. The study evaluated the association of cord blood leptin with growth and weight gain of 96 premature babies during 6 months (corrected age). The temporal changes of anthropometric indexes over this period were calculated by repeated random regression (PROC MIXED) using SAS. Cord blood leptin was negatively associated with the rate of change in BMI (p=0.01) and length (p<0.001), from birth until 64 postnatal weeks. Insulin was positively associated with the change rate in BMI (p=0.03); however, this disappeared when adjusted for birth weight. For the first time, the association between lower leptin levels with greater catch up growth is shown for both BMI and length among preterm children. In conclusion, leptin levels at birth, but not insulin levels, predict growth rates.

Long-term Effects of Early Malnutrition on Body Weight Regulation

Malnutrition is still highly prevalent in developing countries. Studies have shown an increase in the number of obese individuals in very poor urban communities. This review shows a co-existence between malnutrition and obesity in households of slums in Brazil and a higher prevalence of stunted/overweight or obese individuals (30%) in comparison with stunted/underweight (16%). These conditions are associated with important metabolic changes. Results from stunted children showed higher susceptibility to the effects of higher fats diets, lower fat oxidation, higher central fat, and higher body fat gain. A model to explain how early malnutrition alters energy balance in adults is outlined. In the presence of a relative food intake insufficiency, a higher cortisol:insulin ratio, associated with lower levels of IGF-1 will lead to lower muscle gain and linear growth, impaired lypolysis and fat oxidation. When these hormonal changes are combined with a higher fat/carbohydrate and/or marked decreased in physical activity, obesity with short stature will occur.

[Factors associated with dietary patterns in the urban Brazilian population]

This study evaluated factors associated with dietary patterns in the Brazilian population based on the Living Standards Survey conducted in the Northeast and Southeast regions of the country. Multi-stage probability sampling was employed to select the households, and for the present analysis 5,121 adults aged 20 to 50 years were included. Pregnant women and individuals reporting chronic health conditions were excluded. Through principal component analysis, two major family dietary patterns were identified: a mixed pattern, in which all groups and foods have approximately the same factor loading, and a second pattern based main1y on rice and beans, which was called a traditional diet. Weight and height were measured in the households, and food intake was based on a 21-item semi-quantitative family questionnaire. The Northeast (as compared to the Southeast) was negatively associated with the mixed pattern. Body mass index was positively associated with the mixed pattern, whereas leisure physical activity and Black skin color were negatively associated with the mixed pattern. Schooling and income levels explained most of the dietary variance, but after adjusting for education and income, region of residence remained significantly associated and was the third most important explanatory variable.

[Socio-demographic and lifestyle factors associated with abdominal fat distribution in adults: a population-based survey in Southern Brazil]

This article describes the anthropometric distribution of abdominal fat in the urban adult population in Pelotas, Rio Grande do Sul, Brazil, and the influence of independent variables on this distribution. In a cross-sectional population-based study, 3,464 adults from 20 to 69 years of age were selected in a multistage systematic sampling. They were interviewed and had their largest abdominal circumference measured. Means were compared using one-way ANOVA, while multiple linear regression models were employed to adjust for confounding. According to the study, older white married men with higher family incomes were more likely to have the highest mean abdominal circumferences (p < 0.001). Women at greatest risk for abdominal fat were older married mothers with a history of 4 or more pregnancies and less schooling (p < 0.001). Former smokers had the highest mean abdominal circumferences in both males and females, while other lifestyle factors such as alcohol consumption and physical activity showed no association with the outcome after adjusting for confounding.

Obesity trends and determinant factors in Latin America

Obesity rates have increased markedly in Latin America, especially during the last 10-15 years, becoming a public health problem in most countries. Prevalence of obesity among preschool children remains low, while among schoolchildren it has increased considerably. Prevalence is high in the adult population, especially among women with less schooling. In developed populations, obesity occurs more frequently among the poor; the opposite occurs in less developed societies, where in households undergoing nutritional transition, underweight can coexist with obesity. The most important determinant factors involved in the increasing obesity prevalence are fetal and infant nutritional conditions (stunting), education and socioeconomic conditions, dietary changes (especially increased total energy intake), and physical inactivity. Because chronic diseases are the main causes of death in the Region and obesity is one of the main risk factors for these diseases, policies to improve economic and educational levels with the implementation of health promotion and prevention should be a priority in every country.

Food consumed does not account for the higher prevalence of obesity among stunted adults in a very-low-income population in the Northeast of Brazil (Maceió, Alagoas)

OBJECTIVE

To study the food pattern of stunted and nonstunted, obese and nonobese individuals in a very-low-income population.

DESIGN

A household survey.

SETTING

Slum set up by the 'Homeless Movement', city of Maceió (Alagoas), Brazil.

SUBJECTS AND METHODS

A total of 532 adults classified by sex, stature (Z</= and Z > -2s.d. of the NCHS curves), and body mass index (BMI) were compared using the following variables: waist circumference, waist-hip circumference ratio (W/H), percentage body fat (skinfold thickness and bioelectrical impedance), and food intake (24-h recall).

RESULTS

The prevalence of stunting was 22.6%. In all, 30% of the stunted subjects were overweight or obese, compared with 23% for the nonstunted individuals (P<0.05). In women, logistic regression analysis showed a strong association among weight, abdominal fat, and stunting (r=0.81). No significant differences were observed in the values of W/H or in the qualitative menu of the different categories. Energy intake was below the RDA figures (about 63%). There was similarity among the groups regarding the proportion of macronutrients, except for the fact that stunted obese women ingested less fat and protein than nonstunted obese women. Stunted obese individuals consumed less energy (5962 kJ) than the population as a whole (6213 kJ), an amount far lower than their average needs, which were calculated on the basis of their shorter stature (8109 kJ).

CONCLUSION

The observed energy consumption seems compatible with the panorama of undernutrition present in the population, but it does not explain the high prevalence of obesity detected.

Prevalências de sobrepeso e obesidade em adolescentes masculinos, no Nordeste do Brasil, 1980-2000

O estudo teve como objetivo determinar as prevalências de sobrepeso e de obesidade em adolescentes masculinos residentes nos estados do Nordeste do Brasil, nos últimos vinte anos (1980 a 2000), e compará-las, para ter uma indicação de tendência. Utilizou-se, como fonte de informações, o Banco de Dados do Exército Brasileiro, além dos dados de 316.925 adolescentes com 18 anos de idade. Sobrepeso foi definido como índice de massa corporal (IMC) entre 25kg/m² e 29,9kg/m², e obesidade como IMC > 30kg/m². Verificou-se uma curva ascensional, mostrando que a tendência secular nos últimos vinte anos foi crescente, tanto para o sobrepeso, quanto para a obesidade. Essa tendência ascendente das prevalências de sobrepeso/obesidade foi observada em todos os Estados, e, embora sejam menores do que as encontradas nos países desenvolvidos, a velocidade de ascensão é preocupante.

Combined effect of short stature and socioeconomic status on body mass index and weight gain during reproductive age in Brazilian women

Short stature, a marker for undernutrition early in life, has been associated with obesity in Brazilian women, but not in men. We tested the hypothesis that weight gain during the reproductive years could explain this gender difference. A national two-stage household survey of mothers with one or more children under five years of age was conducted in Brazil in 1996. The subjects were women aged 20 to 45 years (N = 2297), with last delivery seven months or more prior to the interview. The regions of the country were divided into rural, North/Northeast (urban underdeveloped) and South/Southeast/Midwest (urban developed). The dependent variables were current body mass index (BMI) measured, BMI prior to childbearing (reported), and BMI change. Socioeconomic variables included mother's years of education and family purchasing power score. A secondary analysis was restricted to primiparous women. The prevalence of current overweight and overweight prior to childbearing (BMI > or = 25 kg/m2) was higher among shorter women (<1.50 m) compared to normal stature women only in the urban developed region (P < 0.05). After adjustment for socioeconomic variables, age, parity, BMI prior to childbearing, and age at first birth, current BMI was 2.39 units higher (P = 0.008) for short stature women living in the urban developed area compared with short stature women living in the urban underdeveloped area. For both multiparous and primiparous women, BMI gain compared to the value prior to childbearing was significantly higher among short stature women living in the urban developed region (P <= 0.04). These results provide clear evidence that short stature was associated with a higher BMI and with an increased risk of weight gain/retention with pregnancy in the developed areas of Brazil, but not in the underdeveloped ones.

Height of young men

We analysed the height of young men in Belgium, using 613 257 records of medical examinations made prior to their conscription into the army (about 68% of the male population concerned). All analyses showed very significant associations. Height differed according to the region (-1.24cm in Wallonia, French-speaking and poorer) compared to Flanders (Dutch-speaking and richer), when "age-class" and year are taken into account. The smallest men lived in Hainaut (a deprived area), the tallest ones in Walloon Brabant (wealthy green suburbs of the capital). Height increased across time (+1.11cm, 1978-1990) and with "age-class" (+2.66cm, 18-26years), controlling for other factors. The increase in Brussels stops in 1983, probably due to other socio-demographic evolutions.

Dietary patterns and their associations with obesity in the Brazilian city of Rio de Janeiro

OBJECTIVE

To evaluate the dietary patterns of adults living in the city of Rio de Janeiro, Brazil and their associations with body mass index (BMI).

RESEARCH METHODS AND PROCEDURES

A survey was conducted in 1996 in a probabilistic sample of 2040 households. Weight and height were measured and food intake was based on an 80-item semi-quantitative food frequency questionnaire. Dietary patterns were identified through factor analysis.

RESULTS

More than one-third of the adult population (20 to 60 years old) was overweight (BMI = 25 to 29.9 kg/m(2)), and 12% were obese (BMI >or= 30 kg/m(2)). Three major dietary patterns were identified: mixed pattern when all food groups and items had about the same factor loading, except for rice and beans; one pattern that relies mainly on rice and beans, which was called a traditional diet; and a third pattern, termed a Western diet, where fat (butter and margarine) and added sugar (sodas) showed the highest positive loading and rice and beans were strong negative components. Among men, the Western diet also included deep-fried snacks and milk products with high positive values. The traditional diet was associated with lower risk of overweight/obesity in logistic models adjusted for dieting, age, leisure physical activity, and occupation (13% reduction in men and 14% reduction in women comparing the traditional and Western diets).

DISCUSSION

Factors contributing to the effects of the Brazilian traditional diet may include low-energy density, high-dietary fiber content, incorporation of low glycemic index foods such as beans, or a relatively low food variety.