Media influence on the body image of children and adolescents

To study the media messages portrayed to children, 925 students, from 9 to up to 14 years of age, completed “The Sociocultural Influences Questionnaire.” The media section is the focus of this paper, and the responses from three questions were selected to examine the media's influence to be slimmer, increase weight, or increase muscle size. While the girls and boys exhibited different levels of agreement with each media influence, both genders disagreed that media messages were implying they should gain weight. This is in agreement with the belief that the media perpetuates the ideal of thinness and there is a negative stigma associated with being overweight.

Experiences of care and adjustment to change in caregivers of children with autoimmune encephalitis: an interpretative phenomenological analysis

Background: Autoimmune encephalitis (AE) occurs in response to an antibody-mediated central nervous system disease and can lead to significant neurodisability. Prior research on family adjustment has described a reciprocal relationship between caregiver functioning, distress and clinical outcome in parents and children with encephalitis. There has been no previous research exploring the experiences of caregivers with a child with AE. Aims: To explore the perspectives of parents and/or caregivers with a child diagnosed with AE regarding (i) their own adjustment from hospital admission to post-discharge, and (ii) their experiences of care and service provision. Methods: A purposive sampling approach was used. Five parents of children with AE participated in a semi-structured interview exploring their experiences of caring for their child and service provision during acute care and post-discharge. Interpretative Phenomenological Analysis (IPA) was used to analyse the transcripts. Main findings and conclusions: Four shared super-ordinate themes with related subthemes emerged: (a) uncertainty, (b) managing our recovery, (c) changes in my child, (d) experiences of service provision. Participants reported emotional distress, often underpinned by recurrent experiences of uncertainty, and ‘loss’ of the previous child, and mediated by coping strategies and social support. While an overall positive experience of inpatient services was reported, parents often perceived post-discharge services as lacking in co-ordination, communication and formal follow-up, resulting in unmet support needs. Implications and recommendations for services, practitioners and future research are discussed.

Body composition and its relationship to metabolic risk factors in Asian children

Obesity is a major public health problem in both developed and developing countries. The body mass index (BMI) is the most common index used to define obesity. The universal application of the same BMI classification across different ethnic groups is being challenged due to the inability of the index to differentiate fat mass (FM) and fat�]free mass (FFM) and the recognized ethnic differences in body composition. A better understanding of the body composition of Asian children from different backgrounds would help to better understand the obesity�]related health risks of people in this region. Moreover, the limitations of the BMI underscore the necessity to use where possible, more accurate measures of body fat assessment in research and clinical settings in addition to BMI, particularly in relation to the monitoring of prevention and treatment efforts. The aim of the first study was to determine the ethnic difference in the relationship between BMI and percent body fat (%BF) in pre�]pubertal Asian children from China, Lebanon, Malaysia, the Philippines, and Thailand. A total of 1039 children aged 8�]10 y were recruited using a non�]random purposive sampling approach aiming to encompass a wide BMI range from the five countries. Percent body fat (%BF) was determined using the deuterium dilution technique to quantify total body water (TBW) and subsequently derive proportions of FM and FFM. The study highlighted the sex and ethnic differences between BMI and %BF in Asian children from different countries. Girls had approximately 4.0% higher %BF compared with boys at a given BMI. Filipino boys tended to have a lower %BF than their Chinese, Lebanese, Malay and Thai counterparts at the same age and BMI level (corrected mean %BF was 25.7�}0.8%, 27.4�}0.4%, 27.1�}0.6%, 27.7�}0.5%, 28.1�}0.5% for Filipino, Chinese, Lebanese, Malay and Thai boys, respectively), although they differed significantly from Thai and Malay boys. Thai girls had approximately 2.0% higher %BF values than Chinese, Lebanese, Filipino and Malay counterparts (however no significant difference was seen among the four ethnic groups) at a given BMI (corrected mean %BF was 31.1�}0.5%, 28.6�}0.4%, 29.2�}0.6%, 29.5�}0.6%, 29.5�}0.5% for Thai, Chinese, Lebanese, Malay and Filipino girls, respectively). However, the ethnic difference in BMI�]%BF relationship varied by BMI. Compared with Caucasians, Asian children had a BMI 3�]6 units lower for a given %BF. More than one third of obese Asian children in the study were not identified using the WHO classification and more than half were not identified using the International Obesity Task Force (IOTF) classification. However, use of the Chinese classification increased the sensitivity by 19.7%, 18.1%, 2.3%, 2.3%, and 11.3% for Chinese, Lebanese, Malay, Filipino and Thai girls, respectively. A further aim of the first study was to determine the ethnic difference in body fat distribution in pre�]pubertal Asian children from China, Lebanon, Malaysia, and Thailand. The skin fold thicknesses, height, weight, waist circumference (WC) and total adiposity (as determined by deuterium dilution technique) of 922 children from the four countries was assessed. Chinese boys and girls had a similar trunk�]to�]extremity skin fold thickness ratio to Thai counterparts and both groups had higher ratios than the Malays and Lebanese at a given total FM. At a given BMI, both Chinese and Thai boys and girls had a higher WC than Malays and Lebanese (corrected mean WC was 68.1�}0.2 cm, 67.8�}0.3 cm, 65.8�}0.4 cm, 64.1�}0.3 cm for Chinese, Thai, Lebanese and Malay boys, respectively; 64.2�}0.2 cm, 65.0�}0.3 cm, 62.9�}0.4 cm, 60.6�}0.3 cm for Chinese, Thai, Lebanese and Malay girls, respectively). Chinese boys and girls had lower trunk fat adjusted subscapular/suprailiac skinfold ratio compared with Lebanese and Malay counterparts. The second study aimed to develop and cross�]validate bioelectrical impedance analysis (BIA) prediction equations of TBW and FFM for Asian pre�]pubertal children from China, Lebanon, Malaysia, the Philippines, and Thailand. Data on height, weight, age, gender, resistance and reactance measured by BIA were collected from 948 Asian children (492 boys and 456 girls) aged 8�]10 y from the five countries. The deuterium dilution technique was used as the criterion method for the estimation of TBW and FFM. The BIA equations were developed from the validation group (630 children randomly selected from the total sample) using stepwise multiple regression analysis and cross�]validated in a separate group (318 children) using the Bland�]Altman approach. Age, gender and ethnicity influenced the relationship between the resistance index (RI = height2/resistance), TBW and FFM. The BIA prediction equation for the estimation of TBW was: TBW (kg) = 0.231�~Height2 (cm)/resistance (ƒ¶) + 0.066�~Height (cm) + 0.188�~Weight (kg) + 0.128�~Age (yr) + 0.500�~Sex (male=1, female=0) . 0.316�~Ethnicity (Thai ethnicity=1, others=0) �] 4.574, and for the estimation of FFM: FFM (kg) = 0.299�~Height2 (cm)/resistance (ƒ¶) + 0.086�~Height (cm) + 0.245�~Weight (kg) + 0.260�~Age (yr) + 0.901�~Sex (male=1, female=0) �] 0.415�~Ethnicity (Thai ethnicity=1, others=0) �] 6.952. The R2 was 88.0% (root mean square error, RSME = 1.3 kg), 88.3% (RSME = 1.7 kg) for TBW and FFM equation, respectively. No significant difference between measured and predicted TBW and between measured and predicted FFM for the whole cross�]validation sample was found (bias = �]0.1�}1.4 kg, pure error = 1.4�}2.0 kg for TBW and bias = �]0.2�}1.9 kg, pure error = 1.8�}2.6 kg for FFM). However, the prediction equation for estimation of TBW/FFM tended to overestimate TBW/FFM at lower levels while underestimate at higher levels of TBW/FFM. Accuracy of the general equation for TBW and FFM compared favorably with both BMI�]specific and ethnic�]specific equations. There were significant differences between predicted TBW and FFM from external BIA equations derived from Caucasian populations and measured values in Asian children. There were three specific aims of the third study. The first was to explore the relationship between obesity and metabolic syndrome and abnormalities in Chinese children. A total of 608 boys and 800 girls aged 6�]12 y were recruited from four cities in China. Three definitions of pediatric metabolic syndrome and abnormalities were used, including the International Diabetes Federation (IDF) and National Cholesterol Education Program (NCEP) definition for adults modified by Cook et al. and de Ferranti et al. The prevalence of metabolic syndrome varied with different definitions, was highest using the de Ferranti definition (5.4%, 24.6% and 42.0%, respectively for normal�]weight, overweight and obese children), followed by the Cook definition (1.5%, 8.1%, and 25.1%, respectively), and the IDF definition (0.5%, 1.8% and 8.3%, respectively). Overweight and obese children had a higher risk of developing the metabolic syndrome compared to normal�]weight children (odds ratio varied with different definitions from 3.958 to 6.866 for overweight children, and 12.640�]26.007 for obese children). Overweight and obesity also increased the risk of developing metabolic abnormalities. Central obesity and high triglycerides (TG) were the most common while hyperglycemia was the least frequent in Chinese children regardless of different definitions. The second purpose was to determine the best obesity index for the prediction of cardiovascular (CV) risk factor clustering across a 2�]y follow�]up among BMI, %BF, WC and waist�]to�]height ratio (WHtR) in Chinese children. Height, weight, WC, %BF as determined by BIA, blood pressure, TG, high�]density lipoprotein cholesterol (HDL�]C), and fasting glucose were collected at baseline and 2 years later in 292 boys and 277 girls aged 8�]10 y. The results showed the percentage of children who remained overweight/obese defined on the basis of BMI, WC, WHtR and %BF was 89.7%, 93.5%, 84.5%, and 80.4%, respectively after 2 years. Obesity indices at baseline significantly correlated with TG, HDL�]C, and blood pressure at both baseline and 2 years later with a similar strength of correlations. BMI at baseline explained the greatest variance of later blood pressure. WC at baseline explained the greatest variance of later HDL�]C and glucose, while WHtR at baseline was the main predictor of later TG. Receiver�]operating characteristic (ROC) analysis explored the ability of the four indices to identify the later presence of CV risk. The overweight/obese children defined on the basis of BMI, WC, WHtR or %BF were more likely to develop CV risk 2 years later with relative risk (RR) scores of 3.670, 3.762, 2.767, and 2.804, respectively. The final purpose of the third study was to develop age�] and gender�]specific percentiles of WC and WHtR and cut�]off points of WC and WHtR for the prediction of CV risk in Chinese children. Smoothed percentile curves of WC and WHtR were produced in 2830 boys and 2699 girls aged 6�]12 y randomly selected from southern and northern China using the LMS method. The optimal age�] and gender�]specific thresholds of WC and WHtR for the prediction of cardiovascular risk factors clustering were derived in a sub�]sample (n=1845) by ROC analysis. Age�] and gender�]specific WC and WHtR percentiles were constructed. The WC thresholds were at the 90th and 84th percentiles for Chinese boys and girls, respectively, with sensitivity and specificity ranging from 67.2% to 83.3%. The WHtR thresholds were at the 91st and 94th percentiles for Chinese boys and girls, respectively, with sensitivity and specificity ranging from 78.6% to 88.9%. The cut�]offs of both WC and WHtR were age�] and gender�]dependent. In conclusion, the current thesis quantifies the ethnic differences in the BMI�]%BF relationship and body fat distribution between Asian children from different origins and confirms the necessity to consider ethnic differences in body composition when developing BMI and other obesity index criteria for obesity in Asian children. Moreover, ethnicity is also important in BIA prediction equations. In addition, WC and WHtR percentiles and thresholds for the prediction of CV risk in Chinese children differ from other populations. Although there was no advantage of WC or WHtR over BMI or %BF in the prediction of CV risk, obese children had a higher risk of developing the metabolic syndrome and abnormalities than normal�]weight children regardless of the obesity index used.

Randomised clinical trial of a family-based lifestyle intervention for childhood obesity involving parents as the exclusive agents of change

Parent-centred interventions for childhood obesity aim to improve parents' skills and confidence in managing children's dietary and activity patterns, and in promoting a healthy lifestyle in their family. However, few studies assess changes in parenting over the course of treatment. This study describes the evaluation of a lifestyle-specific parenting program (Group Lifestyle Triple P) on multiple child and parent outcomes. One-hundred-and-one families with overweight and obese 4- to 11-year-old children participated in an intervention or waitlist control condition. The 12-week intervention was associated with significant reductions in child BMI z score and weight-related problem behaviour. At the end of the intervention, parents reported increased confidence in managing children's weight-related behaviour, and less frequent use of inconsistent or coercive parenting practices. All short-term intervention effects were maintained at one-year follow-up assessment, with additional improvements in child body size. The results support the efficacy of Group Lifestyle Triple P and suggest that parenting influences treatment outcomes. Further research is needed to evaluate the long-term effectiveness of the intervention and to elucidate the mechanisms of change. © 2010 Elsevier Ltd.

Validity of currently used cutoff values of body mass index as a measure of obesity in Sri Lankan children

The aim of the study was to determine the reliability of body mass index based (BMI) cutoff values in diagnosing obesity among Sri Lankan children. Height, weight, waist circumference (WC) and hip circumference (HC) in 282 children were measured. Total body water was determined by deuterium dilution and fat mass (FM) derived using age and gender specific constants. A percentage FM of 30% for girls and 25% for boys were considered as cutoff levels for obesity. Two hundred and eighty two children (M/F: 158/124) were studied and 99 (80%) girls and 72 (45.5%) boys were obese based on % body fat. Eight (6.4%) girls and nine (5.7%) boys were obese based on International Obesity Task Force (IOTF) cutoff values. Percentage FM and WC centile charts were able to diagnose a significant proportion of children as true obese children. The FM and BMI were closely associated in both girls (r = 0.82, p < 0.001) and boys (r = 0.87, p < 0.001). Percentage FM and BMI had a very low but significant association; girls (r = 0.32, p < 0.001) and boys (r = 0.68, p < 0.001). FM had a significant association with WC and HC. BMI based cutoff values had a specificity of 100% but a very low sensitivity, varying between 8% and 23.6%. BMI is a poor indicator of the percentage fat and the commonly used cutoff values were not sensitive to detect cases of childhood obesity in Sri Lankan children.

Associations between BMI and home, school and route environmental exposures estimated using GPS and GIS: do we see evidence of selective daily mobility bias in children?

BACKGROUND: This study examined whether objective measures of food, physical activity and built environment exposures, in home and non-home settings, contribute to children's body weight. Further, comparing GPS and GIS measures of environmental exposures along routes to and from school, we tested for evidence of selective daily mobility bias when using GPS data. METHODS: This study is a cross-sectional analysis, using objective assessments of body weight in relation to multiple environmental exposures. Data presented are from a sample of 94 school-aged children, aged 5-11 years. Children's heights and weights were measured by trained researchers, and used to calculate BMI z-scores. Participants wore a GPS device for one full week. Environmental exposures were estimated within home and school neighbourhoods, and along GIS (modelled) and GPS (actual) routes from home to school. We directly compared associations between BMI and GIS-modelled versus GPS-derived environmental exposures. The study was conducted in Mebane and Mount Airy, North Carolina, USA, in 2011. RESULTS: In adjusted regression models, greater school walkability was associated with significantly lower mean BMI. Greater home walkability was associated with increased BMI, as was greater school access to green space. Adjusted associations between BMI and route exposure characteristics were null. The use of GPS-actual route exposures did not appear to confound associations between environmental exposures and BMI in this sample. CONCLUSIONS: This study found few associations between environmental exposures in home, school and commuting domains and body weight in children. However, walkability of the school neighbourhood may be important. Of the other significant associations observed, some were in unexpected directions. Importantly, we found no evidence of selective daily mobility bias in this sample, although our study design is in need of replication in a free-living adult sample.

Investigating the association between motor proficiency and body satisfaction in grade 5 children

The inverse relationships between motor proficiency and overweight, and between overweight and body satisfaction have been well documented. However, the association between motor proficiency and body satisfaction has been largely neglected in the literature. Knowledge of the influence that low motor proficiency may have on body satisfaction is essential if the full burden that those children with poor motor abilities face is to be fully recognized, as low body satisfaction has been linked to an increased risk for low self-esteem, depression, and disordered eating. The cohort investigated in this report included 1907 (971 males, 936 female) Grade 5 students from the Physical Health Activity Study Team (PHAST) project in the Niagara Region of Southern Ontario. Children were grouped as overweight or healthy weight (using BMI cut offs for age and gender), and as low motor proficiency or normal motor proficiency (cut-off set at lowest 10% Bruininks Oseretsky Test of Motor Proficiency-short form (BOTMPsf). It was apparent from analyses of variance (ANOVAs) by gender that boys demonstrated significantly higher motor proficiency scores. As a result separate multiple logistic regressions by gender were used to determine the relationship between body satisfaction, BMI, and motor proficiency. There was a significant relationship between BMI and body satisfaction for both genders (p<0.01) and for males a significant relationship between motor proficiency and body satisfaction (p<0.03). Overweight females were less likely to be satisfied with their bodies with an odds ratio (OR) of 0.33 (CI: 0.23-0.47). The same trend was found in overweight males (OR: 0.42, CI: 0.29-0.59). Males with low motor proficiency were significantly less satisfied with their bodies (OR: 0.53, CI: 0.29-0.97). Males with poor motor proficiency were at greater risk for low body satisfaction regardless of their overweight status. Overweight is known to be prevalent among children with low motor proficiency and, these results indicate that low body satisfaction is also a significant concern. These findings confirm that attention needs to be paid to perceptions of body satisfaction among children with low motor proficiency. This is particularly true for boys, as their bodies may fail them in two common societal expectations, shape and skill and for whom their risk of low body satisfaction is heightened by their poor motor proficiency.

Body mass index values for newborns according to gestational age

Objective: The combination of twho anthropometric parameters has been more appropriate to assess body composition and proportions in children, with special attention to the Body Mass Index (BMI), as it relates weight and length. However the BMI values for the neonatal period have not been determined yet. This study shows the BMI for newborns at different gestational ages represented in a normal smoothed percentile curve. Methods: Retrospective study including 2,406 appropriate for gestational age newborns following the Alexander et al curve (1996) from 29 to 42 weeks of gestational age. Weight and lenght were measured following standard procedures. For the construction aof a normal smoothed percentile curve, the 3(rd) 5(th), 10(th), 25(th), 5(th), 75(th), 90(th) and 95(th) percentiles were determined and a statistical procedure based on the mathematical model ""sinosuoidal fit"" was applied to establish a curve that estimates biological growth parameters. Results: The Body Mass Index values for gestational age in all percentiles shows a steady increase up to 38 weeks, levels off up to the 40(th) week, followed by a slight decrease to the 42(nd) week in both genders. Conclusion: The results show a direct correlation between gestational age and Body Mass Index for both genders in the nine percentiles, and can provide a useful reference to assess intra-uterine proportional growth.

Does cigarette smoking modify the association between change in body mass index during young adulthood and risk of coronary mortality during middle-age in men? Twenty-five year follow-up results from the Chicago Western Electric Study

Many persons in the U.S. gain weight during young adulthood, and the prevalence of obesity has been increasing among young adults. Although obesity and physical inactivity are generally recognized as risk factors for coronary heart disease (CHD), the magnitude of their effect on risk may have been seriously underestimated due to failure to adequately handle the problem of cigarette smoking. Since cigarette smoking causes weight loss, physically inactive cigarette smokers may remain relatively lean because they smoke cigarettes. We hypothesize cigarette smoking modifies the association between weight gain during young adulthood and risk of coronary heart disease during middle age, and that the true effect of weight gain during young adulthood on risk of CHD can be assessed only in persons who have not smoked cigarettes. Specifically, we hypothesize that weight gain during young adulthood is positively associated with risk of CHD during middle-age in nonsmokers but that the association is much smaller or absent entirely among cigarette smokers. The purpose of this study was to test this hypothesis. The population for analysis was comprised of 1,934 middle-aged, employed men whose average age at the baseline examination was 48.7 years. Information collected at the baseline examinations in 1958 and 1959 included recalled weight at age 20, present weight, height, smoking status, and other CHD risk factors. To decrease the effect of intraindividual variation, the mean values of the 1958 and 1959 baseline examinations were used in analyses. Change in body mass index ($\Delta$BMI) during young adulthood was the primary exposure variable and was measured as BMI at baseline (kg/m$\sp2)$ minus BMI at age 20 (kg/m$\sp2).$ Proportional hazards regression analysis was used to generate relative risks of CHD mortality by category of $\Delta$BMI and cigarette smoking status after adjustment for age, family history of CVD, major organ system disease, BMI at age 20, and number of cigarettes smoked per day. Adjustment was not performed for systolic blood pressure or total serum cholesterol as these were regarded as intervening variables. Vital status was known for all men on the 25th anniversary of their baseline examinations. 705 deaths (including 319 CHD deaths) occurred over 40,136 person-years of experience. $\Delta$BMI was positively associated with risk of CHD mortality in never-smokers, but not in ever-smokers (p for interaction = 0.067). For never-smokers with $\Delta$BMI of stable, low gain, moderate gain, and high gain, adjusted relative risks were 1.00, 1.62, 1.61, and 2.78, respectively (p for trend = 0.010). For ever-smokers, with $\Delta$BMI of stable, low gain, moderate gain, and high gain, adjusted relative risks were 1.00, 0.74, 1.07, and 1.06, respectively (p for trend = 0.422). These results support the research hypothesis that cigarette smoking modifies the association between weight gain and CHD mortality. Current estimates of the magnitude of effect of obesity and physical inactivity on risk of coronary mortality may have been seriously underestimated due to inadequate handling of cigarette smoking. ^

Postural balance under normal and altered sensory conditions in normal-weight and overweight children

Background Little or no research has been done in the overweight child on the relative contribution of multisensory information to maintain postural stability. Therefore, the purpose of this study was to investigate postural balance control under normal and experimentally altered sensory conditions in normal-weight versus overweight children. Methods Sixty children were stratified into a younger (7–9 yr) and an older age group (10–12 yr). Participants were also classified as normal-weight (n = 22) or overweight (n = 38), according to the international BMI cut-off points for children. Postural stability was assessed during quiet bilateral stance in four sensory conditions (eyes open or closed, normal or reduced plantar sensation), using a Kistler force plate to quantify COP dynamics. Coefficients of variation were calculated as well to describe intra-individual variability. Findings Removal of vision resulted in systematically higher amounts of postural sway, but no significant BMI group differences were demonstrated across sensory conditions. However, under normal conditions lower plantar cutaneous sensation was associated with higher COP velocities and maximal excursion of the COP in the medial-lateral direction for the overweight group. Regardless of condition, higher variability was shown in the overweight children within the 7–9 yr old subgroup for postural sway velocity, and more specifically medial–lateral velocity. Interpretation In spite of these subtle differences, results did not establish any clear underlying sensory organization impairments that may affect standing balance performance in overweight children compared to normal-weight peers. Consequently, it is believed that other factors account for overweight children's functional balance deficiencies.

Efeito da exposição ao tabagismo e da mobilidade social sobre o crescimento e ganho de peso do nascimento à adolescência em uma coorte de base populacional de Cuiabá-MT

Esta tese é composta por três artigos que permitiram avaliar o efeito da exposição ao tabagismo durante a gestação e no início da infância sobre o crescimento linear e ganho de peso do nascimento à adolescência, além de verificar o efeito do nível socioeconômico no início da infância e da mobilidade social sobre a adiposidade até a adolescência. Foram utilizados para este fim os dados de uma coorte de crianças nascidas entre 1994 e 1999 na cidade de Cuiabá-MT. Essas crianças fizeram parte de um estudo de base populacional realizado na cidade de Cuiabá, entre 1999 e 2000, com 2405 crianças (0 a 5 anos) e foram selecionadas aleatoriamente em unidades básicas de saúde quando da vacinação. As mães foram entrevistadas após a vacinação, quando foram obtidos dados relativos à exposição ao tabagismo gestacional, tabagismo passivo, nível socioeconômico das famílias e dados antropométricos. Entre 2009 e 2011, após aproximadamente 11 anos, essas crianças foram localizadas por meio do Censo Escolar e então 1716 adolescentes entre 10 e 17 anos de idade (71,4% da população) foram reavaliados nas escolas da rede pública e privada de Cuiabá, de 18 municípios do estado e outras 5 capitais do país. A análise por modelos lineares de efeitos mistos permitiu verificar a mudança de estatura e Índice de Massa Corporal (IMC) entre o nascimento e a adolescência. O primeiro e o segundo artigo desta tese avaliaram o efeito da exposição ao tabagismo materno durante a gestação e no início da infância sobre o crescimento linear e o IMC entre o nascimento e a adolescência. Crianças expostas ao tabagismo materno durante a gestação e no início da infância apresentaram menor estatura desde o nascimento até a adolescência quando comparadas às crianças não expostas. Quanto à adiposidade, entre o nascimento e a infância a mudança do IMC foi similar entre as crianças expostas e não expostas ao tabagismo materno, porém, entre a infância e a adolescência, aquelas expostas apenas durante a gestação mostraram maior ganho de IMC. Em conjunto, os dados corroboram o efeito deletério do tabagismo sobre o crescimento, efeito já bastante estudado, mas também indicam que avaliar e comparar exposição gestacional com pós-gestacional é importante, dado que seus efeitos parecem ser diferentes. O terceiro artigo avaliou o efeito do nível socioeconômico no início da infância e da mobilidade social entre a infância e a adolescência sobre o IMC do nascimento à adolescência. Para avaliar o nível socioeconômico, as famílias foram classificadas em nível econômico alto, médio e baixo, a partir do Critério de Classificação Econômica Brasil. Foi observada expressiva mobilidade social na população, principalmente entre os de menor nível econômico. Houve maior aumento do IMC entre o nascimento e a adolescência entre aqueles de maior nível econômico na infância e aqueles que permaneceram nas classes mais elevadas, indicando que a posição inicial foi o maior determinante das mudanças observadas no IMC.

Estudo do perfil clínico, metabólico, hormonal e inflamatório de crianças pré-púberes nascidas com baixo peso e sua relação com a prematuridade, retardo do crescimento intrauterino e ganho ponderal pós-natal

O baixo peso ao nascer (BPN) possui grande impacto na mortalidade neonatal, assim como no desenvolvimento de complicações futuras, como obesidade, hipertensão arterial sistêmica e resistência insulínica, condições relacionadas à doença cardiovascular aterosclerótica, principal causa de morbimortalidade no mundo. O objetivo desta pesquisa foi estudar o perfil clínico, metabólico, hormonal e inflamatório relacionado à doença cardiovascular em crianças pré-púberes de BPN, bem como avaliar a influência do BPN, prematuridade e restrição do crescimento intrauterino nas variáveis de interesse. Realizou-se estudo transversal com 58 crianças de dois a sete anos de BPN, sendo 32 prematuros adequados para idade gestacional (AIG), 17 prematuros pequenos para idade gestacional (PIG), 9 a termo PIG e 38 crianças de peso ao nascer adequado, nascidas no Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de janeiro, oriundas do Ambulatório de Pediatria Geral deste mesmo hospital. Frequências de perfil lipídico alterado, assim como medianas das variações no Z escore de peso e estatura do nascimento até o momento do estudo, do Z escore de índice de massa corporal (ZIMC), da circunferência da cintura, da pressão arterial sistólica e diastólica, do colesterol total, da lipoproteína de baixa densidade, da lipoproteína de baixa densidade, do triglicerídeo, da glicose, insulina, do Homeostasis Assessment for Insulin Resistance (HOMA-IR), da leptina, da adiponectina, da interleucina 6 e da proteína C reativa foram comparadas entre os dois grupos. No grupo de BPN, avaliou-se a correlação entre estas mesmas variáveis e peso de nascimento, idade gestacional, Z escores de peso e comprimento de nascimento e variações no Z escore de peso e comprimento até o primeiro ano, e até o momento do estudo, com ajuste para idade e sexo. O grupo de BPN apresentou maiores variações nos Z escore de peso (p-valor 0,0002) e estatura (p-valor 0,003) até o momento do estudo e menores níveis de adiponectina (p-valor 0,027). Não houve correlação entre as variáveis associadas ao risco cardiovascular e o grau de baixo peso, prematuridade ou crescimento intrauterino retardado. Os níveis de ZIMC (p-valor 0,0001), circunferência da cintura (p-valor 0,0008), pressão arterial diastólica (p-valor 0,046), insulina (p-valor 0,02), HOMA-IR (p-valor 0,016) e leptina (p-valor= 0,0008) se correlacionaram com a variação no Z escore de peso no primeiro ano. O ZIMC (p-valor 0,042) também se correlacionou com a variação do Z escore de comprimento no primeiro ano. Houve ainda correlação entre o ZIMC (p-valor 0,0001), circunferência da cintura (p-valor 0,0001), pressão arterial sistólica (p-valor 0,022), pressão arterial diastólica (p-valor 0,003), insulina (p-valor 0,007), HOMA-IR (p-valor 0,005) e leptina (p-valor 0,0001) com a variação no Z escore de peso até o momento do estudo. Os achados mostram que este grupo de crianças pré-púberes com BPN ainda não diferem do grupo de crianças nascidas com peso adequado exceto pelos níveis de adiponectina, sabidamente um protetor cardiovascular. Em relação às análises de correlação, nem o peso ao nascer, tampouco a prematuridade ou CIUR, influenciaram as variáveis de interesse. No entanto, fatores pós-natais como o ganho pondero-estatural se correlacionaram com o ZIMC, circunferência da cintura, pressão arterial sistólica e diastólica, insulina, HOMA-IR e leptina. Mais estudos são necessários para avaliar se os achados configuram risco cardiovascular aumentado neste grupo de pacientes.

World Hunger, Malnutrition and Brain Development of Children

Hunger is still a major problem faced by people in the world especially in some areas in developing countries, and this condition is a cause of undernutrition. Insufficient nutrition during the early stages of life may adversely influence brain development. It was observed from my own research conducted in Bogor, Indonesia, that children with severe acute malnutrition (SAM, body mass index or BMI for age z score < -3) (N=54) had significantly (p<0.05) lower memory ability score (46.22±1.38) compared to normal children (BMI for age z score -2 ≤ z ≤ 1) (N=91) (51.56±1.24). Further, children with Moderate Acute Malnutrition (MAM, BMI for age z score -3 ≤ z <-2) tended to (p<0.1) have lower memory ability (50.08±1.58) than the normal children. On the other hand, overnutrition among children also might impair the brain function. The study revealed that children who are overweight (BMI for age z score 1 < z ≤ 2) (N=8) significantly (p<0.05) had lower memory ability score (46.13±4.50) compared to the normal children. This study also revealed that obese children (BMI for age z score > 2) (N=6) tended to (p<0.1) have lower memory ability score (50.33±5.64) than the normal children. It is therefore very important to maintain children at a normal BMI, not being undernourished (SAM and MAM categories) on one side and not being overnourished (overweight and obesity categories) on the other side in order to optimise their brain development. This could be achieved through providing children with an adequate and balanced nutrient supply via food.

Body sway and sensory motor coupling adaptation in children: Effects of distance manipulation

The purpose of this investigation was to examine coupling between visual information and body sway in children and young adults at various distances from a moving room front wall. Sixty children (from 4 to 14 years old) and 10 young adults stood upright inside a moving room that was oscillated at .2 and .5 Hz, at distances of .25, .5, 1, and 1.5 m from a front wall. Visual information induced body sway in all participants in all conditions. Young children swayed more than older participants, whether the moving room was oscillated or not. Coupling between visual information and body sway became stronger and the room movement influence became weaker with age. Up to the age of 10, coupling strength between visual information and body sway and the room movement influence were distance dependent. Postural control development appears to be dependent on how children reweight the contribution of varying sensory cues available in environment in order to control body sway. (C) 2007 Wiley Periodicals, Inc.

A prevalência de sobrepeso e obesidade em escolares e a influência nas alterações posturais do aparelho locomotor

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