Biomedical subjects

C G Victora

Publications and source records attributed to C G Victora.

At least 19 recordsLinked to original sources

PubMed2006

Hb A1c in relation to intrauterine growth among male adolescents in southern Brazil.

The fetal origins hypothesis states that nutritional deprivation in utero affects fetal development and contributes to the incidence of diseases associated with the metabolic syndrome in later life. This study investigated whether haemoglobin (Hb) A(1c), an indicator of blood glucose, varied among healthy male adolescents according to their fetal growth rate, in a middle-income setting. Participants were men aged 18 years, belonging to the 1982 Pelotas birth cohort. Complete data, including gestational age and Hb A(1c) at age 18 years, were available for 197 individuals. There was an inverse association between mean Hb A(1c) and birthweight for the gestational age, but not birthweight alone. The association remained significant after adjustment for family income and mother's education, as well as for body mass index at 18 years (P for trend=0.01 and 0.03, respectively).

Adolescent↗

PubMed2006

Effects of socioeconomic change from birth to early adulthood on height and overweight.

BACKGROUND: In this work we explored the association of height and overweight with change in socioeconomic position between birth and 19 years of age. METHODS: A birth cohort has been followed-up in Pelotas, Brazil, since 1982. All 5914 hospital births were enrolled in the study just after delivery. In 2001, 27% of the cohort subjects were sought, and 1031 (69% of the survivors) were interviewed. Weight and height were obtained for women; men had been examined 6 months earlier. Information on family income in 1982 and 2001 was used to classify the sample into tertiles, the lowest classified as 'poor' and the other two as 'non-poor'. Four trajectories resulted: always poor, never poor, poor at birth/non-poor at 19, and non-poor at birth/poor at 19-which were compared in terms of mean height and prevalence of overweight. RESULTS: Height showed a similar behaviour for men and women, with the never poor presenting the highest mean, followed by those who were non-poor at birth and later became poor. Those who were poor at birth, regardless of later status, were shortest. Overweight was approximately twice as common among men who were never poor in relation to the others. Among women, those who were always poor presented the highest prevalence of overweight. In this case, social determination seems to be complex and may involve aspects of lifestyle and behaviour acting differently for each gender. CONCLUSION: Socioeconomic trajectories affected both height and overweight, the effect on the latter being different for each gender.

Birth Weight↗

PubMed2006

Breastfeeding and overweight in childhood: evidence from the Pelotas 1993 birth cohort study.

OBJECTIVES: The effect of breastfeeding duration on the prevalence of overweight and on mean weight for height z-score (WHZ) was evaluated in Brazilian children. DESIGN: Prospective population-based birth cohort study. SUBJECTS: In total, 1,273 children aged 4 years, corresponding to a follow-up rate of 87.2%. MEASUREMENTS: Three explanatory variables were studied: duration of any breastfeeding, duration of exclusive or predominant breastfeeding, and ever breastfeeding. Weight and height were measured using a digital electronic scale and a portable stadiometer. Overweight was defined as WHZ >2 using the National Center for Health Statistics reference curve. RESULTS: Overweight prevalence at the age of 4 years was 10.2% (95% CI 8.4; 11.8). The lowest prevalence (6.5%) was observed among children breastfed for >11 months. Among those breastfed for less than 3 months, the prevalence of overweight was approximately 9.5%. Mean WHZ ranged from 0.38 among children breastfed for less than 1 month to 0.62 among those breastfed for 9-11.9 months. No linear trends were detected in the association between breastfeeding and anthropometric indicators. None of the three breastfeeding variables was significantly associated with the prevalence of overweight or mean WHZ in multivariable analyses. No interactions were detected between breastfeeding and the variables sex, birth weight, socioeconomic status, skin color and pregestational in body mass index. CONCLUSION: Our results do not support the hypothesis that breastfeeding promotion would reduce overweight or obesity in this population. Existing evidence on many other benefits of breastfeeding for the mother and the child supports its continued promotion, protection and support.

Adult↗

PubMed2006

Are health interventions implemented where they are most needed? District uptake of the integrated management of childhood illness strategy in Brazil, Peru and the United Republic of Tanzania.

OBJECTIVE: To describe geographical patterns of implementation of the Integrated Management of Childhood Illness (IMCI) strategy in three countries and to assess whether the strategy was implemented in areas with the most pressing child health needs. METHODS: We conducted interviews with key informants at the national and district levels in Brazil, Peru and the United Republic of Tanzania, and an ecological study of factors associated with health worker training in IMCI. Explanatory factors included district population, distance from the capital, human development index, other socioeconomic indicators and baseline mortality rates in children younger than five years. FINDINGS: In line with recommendations by WHO, early implementation districts were characterized by proximity to the capital and suitable training sites, presence of motivated health managers and a functioning health system. In the expansion phase, IMCI tended to be adopted by other districts with similar characteristics. In Brazil, uptake by poor and small municipalities and those further away from the state capital was significantly lower. In Peru, there was no association with distance from Lima, and a non-significant trend for IMCI adoption by small and poor departments. In the United Republic of Tanzania, the only statistically significant finding was a lower uptake by remote districts. Implementation was not associated with baseline mortality levels in any country studied. CONCLUSION: Whereas clear and reasonable guidelines are provided for selection of early use districts, no criteria for promoting IMCI expansion had been issued, and areas of greatest need were not prioritized. Equity analyses based on the geographical deployment of new programmes and strategies can contribute to assessing whether they are reaching those who need them most.

Brazil↗

PubMed2005

[Evaluating children health conditions in a small community: the study of Itapirapuã, Ribeira Valley, SP].

A household survey for evaluating the mortality, morbidity, nutritional status and health services utilization of children aged under five years was carried out in a rural village in Ribeira, São Paulo State. Most children belonged to families of rural laborers earning less than 80 US dollars per month and living under inadequate environmental conditions. The infant mortality rate was equal to 83 per thousand and 35% of the children were affected by moderate or severe stunting, rates which are well above those for the State. The main reasons for clinic attendances and hospital admissions were acute respiratory infections and diarrhea. The median duration of breastfeeding was 14.4 months, the highest reported for Brazil. Only 40% of the mothers had received antenatal care, and 56% delivered in a hospital - of whom 35% had a caesarean section. Vaccine coverage reached 65% of children aged 12 months or more. This survey revealed an enclave of high morbidity and mortality within Brazil's richest state. It also showed that with a limited budget and within a short time it is possible to obtain valuable information for planning child survival strategies.

English Abstract↗

PubMed2005

2H2O turnover method as a means to detect bias in estimations of intake of nonbreast milk liquids in breast-fed infants.

OBJECTIVE: Firstly, to compare food, and macronutrient intake as obtained from a single 24-h recall and a frequency questionnaire (FQ) covering a 14-day period in breast-fed infants aged 4 months of age. Secondly, nonbreast milk water intake (NB-WI, ml/day) was used as an estimation of energy and macronutrient intake, and NB-WI as calculated from FQ (NB-WIFQ) was compared with NB-WI as measured using the dose-to-the-mother 2H2O turnover method (NB-WIDO) covering the same 14-day period. DESIGN: Cross-sectional. SETTING: Community-based study in urban Pelotas, Southern Brazil. SUBJECTS: In all, 67 breast-fed infants aged 4 months of age recruited at birth. MAIN OUTCOME MEASURES: (1) Bias in estimations of food and macronutrient intake of the 24-h recall relative to FQ; (2) Bias in NB-WIFQ relative to NB-WIDO. RESULTS: In infants with an energy intakeFQ from complementary foods above the 50th percentile (1.03 kcal/day), estimations of water, tea, juice, and milk intake were not different between 24-h recall and FQ (n=34). Nor were estimations of energy and macronutrient intake (protein, fat, and carbohydrates) different between the two methods, and bias was nonsignificant. NB-WIDO was divided into quintiles and compared with NB-WI(FQ). The first two quintiles included negative values for NB-WIDO as a result of random errors of the 2H2O turnover method. Subsequently, bias of NB-WIFQ relative to NB-WIDO was positive in the 1st (P=0.001) and 2nd quintile (P=0.638), respectively. Bias was negative for the three highest quintiles, and within this group, underestimation by FQ was significant for the 3rd and 4th quintile (-57.4%, P=0.019; -43.7%, P=0.019). CONCLUSIONS: Firstly, at the age of 4 months FQ covering a 14-day period provides similar results on food and macronutrient intake as compared to a single 24-h recall for estimations of complementary liquid foods. Secondly, NB-WIFQ appeared to be a good proxy for macronutrient and energy intake in breast-fed infants receiving other liquids. In infants with NB-WIDO>0, the method provides a useful tool for the detection of bias from FQ, and results indicate an underestimation from FQ relative to the 2H2O turnover method. This exercise could be applied wherever the 2H2O turnover method is used in combination with conventional food consumption techniques for measuring intake of nonbreast milk liquids of breast-fed infants in whom solid foods have not yet been introduced. It would help interpreting estimations of macronutrient intake, and could be relevant to studies of dietary intake of infants and its relationship with growth and health.

Breast Feeding↗

PubMed2005

Indices of whole-body and central adiposity for evaluating the metabolic load of obesity.

BACKGROUND: To assess the relative metabolic load or risk imposed by fatness, fat mass (FM) is commonly expressed as a proportion of weight (% fat), while central adiposity is assessed using the ratio of triceps (TRI) to subscapular (SUBS) skinfolds. The statistical validity of these indices, defined as independence of the index from its denominator, has received inadequate evaluation. OBJECTIVE: To critically examine commonly used obesity indices, and to propose more appropriate approaches. DESIGN: Cross-sectional studies. SUBJECTS: In total, 148 infants; 2195 adult men aged 18 y. METHODS: log-log regression analysis was used to explore the relationships between FM and weight (WT) or fat-free mass (FFM) (adults), and between TRI and SUBS (infants and adults). RESULTS: The simple indices FM/WT, FM/FFM, TRI/SUBS and SUBS/TRI remained related to their denominators, showing their rankings of individuals to be biased by size or fatness. The appropriate power (p) by which to raise the denominator was determined from regression analyses, and differed from unity in all cases. Both skinfold ratios showed a nonlinear relationship with their denominators. CONCLUSION: Simple indices for evaluating whole-body or central adiposity are statistically flawed, and remain influenced by size or fatness of the subject. The index FM/WT is conceptually flawed because FM appears in both numerator and denominator, and the index FM/FFM(p) is preferable. Skinfold ratios are also problematic, and to evaluate central adiposity SUBS alone, or SUBS/FFM(p), may represent more appropriate approaches. These issues should be investigated in other studies in order to address possible influences of age, ethnicity, gender and nutritional status.

Adipose Tissue↗

PubMed2005

Fetal, infant and childhood growth: relationships with body composition in Brazilian boys aged 9 years.

BACKGROUND: Early growth rate has been linked to later obesity categorised by body mass index (BMI), but the development of body composition has rarely been studied. METHODS: We tested the hypotheses that (1) birthweight and weight gain in (2) infancy or (3) childhood are associated with later body composition, in 172 Brazilian boys followed longitudinally since birth. Growth was assessed using measurements of weight and height at birth, 6 months, and 1 and 4 y. Measurements at 9 y comprised height, weight and body composition using foot-foot impedance. RESULTS: Birthweight was associated with later height and lean mass (LM), but not fatness. Weight gain 0-6 months was associated with later height and LM, and with obesity prevalence according to BMI, but not with fatness. Weight gain 1-4 y was associated with later fatness and LM. Weight gain 4-9 y was strongly associated with fatness but not LM. Early growth rate did not correlate positively with subsequent growth rate. CONCLUSIONS: Early rapid weight gain increased the risk of later obesity, but not through a direct effect on fatness. Childhood weight gain remained the dominant risk factor for later obesity. The reported link between early growth and later obesity may be due partly to hormonal programming, and partly to the contribution of LM to obesity indices based on weight and height. Whether our findings apply to other populations requires further research.

Birth Weight↗

PubMed2005

Rapid growth in infancy and childhood and obesity in later life--a systematic review.

The association between obesity and morbidity resulting from chronic diseases is well known. This systematic review addresses studies of the role of rapid growth in infancy and childhood as possible determinants of overweight and obesity later in the life course. We reviewed MEDLINE for studies reporting on growth in infancy and childhood, as well as measures of weight or adiposity in later childhood, adolescence or adulthood. The methodological quality of the papers was assessed using the criteria suggested by Downs and Black. Sixteen articles that fulfilled review criteria were located. There was wide variability in the indicators used for defining rapid growth as well as overweight or obesity. The age range in which weight or adiposity was measured ranged from 3 to 70 years. In spite of differences in definitions used, 13 articles that reported on early rapid growth found significant associations with later overweight or adiposity. Efforts should be made to standardize the definition of rapid growth, as well as that of overweight and obesity in children and adolescents. The most frequent definition for rapid growth in this review was a Z-score change greater than 0.67 in weight for age between two different ages in childhood. Regarding obesity, the definition proposed by the International Obesity Task Force also appears to be most appropriate. The present results indicate that early growth is indeed associated with the prevalence of obesity later in the life course.

Adolescent↗

PubMed2004

[Determinants of malnutrition in a low-income population: hierarchical analytical model].

To investigate the determinants of malnutrition among low-income children, the effects of socioeconomic, environmental, reproductive, morbidity, child care, birthweight and breastfeeding variables on stunting and wasting were studied. All 354 children below two years of age living in two urban slum areas of Pelotas, southern Brazil, were included. The multivariate analyses took into account the hierarchical structure of the risk factors for each type of deficit. Variables selected as significant on a given level of the model were considered as risk factors, even if their statistical significance was subsequently lost when hierarchically inferior variables were included. The final model for stunting included the variables education and presence of the father, maternal education and employment, birthweight and age. For wasting, the variables selected were the number of household appliances, birth interval, housing conditions, borough, birthweight, age, gender and previous hospitalizations.

English Abstract↗

PubMed2003

The silent burden of anaemia in Tanzanian children: a community-based study.

OBJECTIVE: To document the prevalence, age-distribution, and risk factors for anaemia in Tanzanian children less than 5 years old, thereby assisting in the development of effective strategies for controlling anaemia. METHODS: Cluster sampling was used to identify 2417 households at random from four contiguous districts in south-eastern United Republic of Tanzania in mid-1999. Data on various social and medical parameters were collected and analysed. FINDINGS: Blood haemoglobin concentrations (Hb) were available for 1979 of the 2131 (93%) children identified and ranged from 1.7 to 18.6 g/dl. Overall, 87% (1722) of children had an Hb <11 g/dl, 39% (775) had an Hb <8 g/dl and 3% (65) had an Hb <5 g/dl. The highest prevalence of anaemia of all three levels was in children aged 6-11 months, of whom 10% (22/226) had an Hb <5 g/dl. However, the prevalence of anaemia was already high in children aged 1-5 months (85% had an Hb <11 g/dl, 42% had an Hb <8 g/dl, and 6% had an Hb <5 g/dl). Anaemia was usually asymptomatic and when symptoms arose they were nonspecific and rarely identified as a serious illness by the care provider. A recent history of treatment with antimalarials and iron was rare. Compliance with vaccinations delivered through the Expanded Programme of Immunization (EPI) was 82% and was not associated with risk of anaemia. CONCLUSION: Anaemia is extremely common in south-eastern United Republic of Tanzania, even in very young infants. Further implementation of the Integrated Management of Childhood Illness algorithm should improve the case management of anaemia. However, the asymptomatic nature of most episodes of anaemia highlights the need for preventive strategies. The EPI has good coverage of the target population and it may be an appropriate channel for delivering tools for controlling anaemia and malaria.

Anemia↗

PubMed2003

Knowledge into action for child survival.

The child survival revolution of the 1980s contributed to steady decreases in child mortality in some populations, but much remains to be done. More than 10 million children will die this year, almost all of whom are poor. Two-thirds of these deaths could have been prevented if effective child survival interventions had reached all children and mothers who needed them. Translation of current knowledge into effective action for child survival will require leadership, strong health systems, targeted human and financial resources, and modified health system to ensure that poor children and mothers benefit. A group of concerned scientists and policy-makers issues a call to action to leaders, governments, and citizens to translate knowledge into action for child survival.

Child↗

PubMed2003

Breast milk and energy intake in exclusively, predominantly, and partially breast-fed infants.

OBJECTIVE: To investigate the extent to which breast milk is replaced by intake of other liquids or foods, and to estimate energy intake of infants defined as exclusively (EBF), predominantly (PBF) and partially breast-fed (PartBF). DESIGN: Cross-sectional. SETTING: Community-based study in urban Pelotas, Southern Brazil. SUBJECTS: A total of 70 infants aged 4 months recruited at birth. MAIN OUTCOME MEASURES: Breast milk intake measured using a "dose-to-the-mother" deuterium-oxide turnover method; feeding pattern and macronutrient intake assessed using a frequency questionnaire. RESULTS: Adjusted mean breast milk intakes were not different between EBF and PBF (EBF, 806 g/day vs PBF, 778 g/day, P=0.59). The difference between EBF and PartBF was significant (PartBF, 603 g/day, P=0.004). Mean intakes of water from supplements were 10 g/day (EBF), 134 g/day (PBF) and 395 g/day (PartBF). Compared to EBF these differences were significant (EBF vs PBF, P=0.005; EBF vs PartBF, P<0.001). The energy intake of infants receiving cow or formula milk (BF+CM/FM) in addition to breast milk tended to be 20% higher than the energy intake of EBF infants (EBF, 347 kJ/kg/day vs BF+CM/FM, 418 kJ/kg/day, P=0.11). CONCLUSIONS: There was no evidence that breast milk was replaced by water, tea or juice in PBF compared to EBF infants. The energy intake in BF+CM/FM infants tended to be 20% above the latest recommendations (1996) for breast-fed and 9% above those for formula-fed infants. If high intakes are maintained, this may result in obesity later in life. SPONSORSHIP: International Atomic Energy Agency through RC 10981/R1.

Bottle Feeding↗

PubMed2003

Birth size, early childhood growth, and adolescent obesity in a Brazilian birth cohort.

DESIGN: Cross-sectional visit to a subsample of a population-based birth cohort. SAMPLE: A total of 1076 adolescents aged 14-16 y; 51% males. MEASUREMENTS: Weight, height, subscapular and triceps skinfolds were used for assessing overweight and obesity in adolescence, using WHO-recommended criteria. Anthropometric status in early life was measured through birthweight and through weight and length/height at average ages of 20 and 43 months. RESULTS: All analyses were adjusted for socioeconomic and maternal confounding factors. Birthweight and attained size (Z-scores of weight-for-age, height-for-age and weight-for-height) at 20 and 43 months were associated linearly and positively with overweight and obesity in adolescence. Four in each five obese adolescents were not overweight in childhood. Rapid weight gain, both between birth and 20 months, and between 20 and 43 months, was also associated with adolescent overweight and with obesity. Rapid height gain between 20 and 43 months was associated with overweight only. Most associations were stronger for boys. CONCLUSIONS: Birth size, attained size in childhood and particularly growth velocity in early life were associated with increased prevalence of obesity and overweight in Brazilian adolescents. On the other hand, the vast majority of overweight or obese adolescents were not overweight children. Early interventions are undoubtedly important, but population-based strategies aimed at improving diets and physical activity appear to have greater long-term potential than measures targeted at overweight children.

Adolescent↗

PubMed2003

Early and late growth and blood pressure in adolescence.

OBJECTIVE: To assess the effect of growth during infancy and childhood on blood pressure in adolescence. DESIGN: Birth cohort study. SETTING: Pelotas, southern Brazil. PARTICIPANTS: 749 adolescents with complete information on birth weight and gestational age, as well as on anthropometric data at all three follow up visits (mean age 20 months, 42 months, and 15 years). MAIN OUTCOME MEASUREMENTS: Systolic and diastolic blood pressure at adolescence. RESULTS: After controlling for possible confounding variables, birth weight was negatively associated with systolic blood pressure, one unit increase in standard deviation score of birth weight for gestational age was associated with a decrease of 1.23 mm Hg (95% confidence intervals -2.03 to -0.43) in systolic blood pressure. Weight for age z score at the age of 15 years showed a strong positive association with systolic blood pressure, one unit increase in standard deviation score of birth weight for gestational age was associated with an increase of 4.4 mm Hg (95% confidence intervals 3.50 to 5.3). Diastolic blood pressure was not associated with birth weight. For adequate for gestational age infants, the positive association between weight in adolescence and blood pressure became stronger when previous weights were added to the model. CONCLUSION: This study showed that early--as well as--late catch up growth is associated with increased systolic blood pressure in adolescence, whereas only late catch up is related with diastolic blood pressure. These findings suggest that catch up growth, irrespective of age, is associated with increased blood pressure in adolescence.

Adolescent↗

PubMed2002

Comparison of two methods for assessing injuries among preschool children.

BACKGROUND: Most studies of injuries use health services records or recall rather than prospective methods, and there is no information on how these different methods compare. This study was aimed at comparing a report (retrospective) with a diary (prospective) for recording childhood injuries. METHODS: The study included 1,273 and 620 children, the retrospective and prospective subsamples, respectively, from a population based birth cohort in Pelotas, southern Brazil. The reported incidence of injuries in the preceding month were compared with those reported over month by diary (prospective study). RESULTS: Both methods were well accepted and 92.7% of the diaries were returned. One or more injuries per child month were reported for 20.8% (retrospective) and 48.4% (prospective) of the children. The total number of reported injuries for the 620 children were 145 (retrospective) and 715 (prospective). Using the prospective method as the gold standard, the retrospective method detected only 20.2% of all injuries. Under-reporting did not vary significantly with maternal education, but was greater (51.8%) for injuries requiring medical care than for those managed at home (18.3%; p=0.003). CONCLUSIONS: The diary was well accepted and resulted in higher incidences of reported injuries than the recall method, particularly for injuries that did not require medical care. Use of this method should be promoted to provide more complete epidemiological information to guide preventive strategies.

Brazil↗

PubMed2001

Infant mortality due to perinatal causes in Brazil: trends, regional patterns and possible interventions.

CONTEXT: Brazilian infant and child mortality levels are not compatible with the country's economic potential. In this paper, we provide a description of levels and trends in infant mortality due to perinatal causes and malformations and assess the likely impact of changing intermediate-level determinants, many of which are amenable to direct interventions through the health or related sectors. TYPE OF STUDY: Review paper. METHODS: Two main sources of mortality data were used: indirect mortality estimates based on censuses and surveys, and rates based on registered deaths. The latter were corrected for under-registration. Combination of the two sources of data allowed the estimation of cause-specific mortality rates. Data on current coverage of preventive and curative interventions were mostly obtained from the 1996 Demographic and Health Survey. Other national household surveys and Ministry of Health Statistics were also used. A thorough review of the Brazilian literature on levels, trends and determinants of infant mortality led to the identification of a large number of papers and books. These provided the background for the analyses of risk factors and potential interventions. RESULTS: The indirect infant mortality rate estimate for 1995-97 is of 37.5 deaths per thousand live births, about six times higher than in the lowest mortality countries in the world. Perinatal causes account for 57 % of all infant deaths, and congenital malformations are responsible for 11.2 % of these deaths. Mortality levels are highest in the Northeast and North, and lowest in the South and Southeast; the Center-West falls in between. Since surveys of the North region do not cover rural areas, mortality for this region may be underestimated. CONCLUSIONS: A first priority for the further reduction in infant mortality in Brazil is to improve equality among regions, since the North and Northeast, and particularly rural areas, still show very high death rates. Further reductions in infant mortality will largely depend on decreasing deaths due to perinatal causes. Improvements in the coverage and particularly in the quality of antenatal and delivery care are urgently needed. Another intervention with a potential important impact on infant mortality is the promotion of family planning. Improving birth weight might lead to an 8 % reduction in infant mortality but the efficacy of available interventions is low.

Birth Weight↗

PubMed2001

Images of the body and the reproductive system among men and women living in Shantytowns in Porto Alegre, Brazil.

This paper presents the results of anthropological research on graphic and verbal images of the reproductive system carried out among 99 women and 103 men living in four shantytowns in Porto Alegre, Brazil. Interviewers were instructed to ask for the drawings in the course of interviews lasting 12-20 hours. Some 55 drawings of the female reproductive system by men and 99 by women were produced and are analysed here together with information from the interviews and observational data. The majority of the men's drawings of women's reproductive system tended to include 'external' body parts only, in contrast with the 'hidden' nature of the internal body parts, which were commonly depicted by the women. Women have been more exposed to the health system than men and the majority made basic biomedical types of drawings. However, their verbal representations were sometimes informed by other notions and values and their physical experience of their bodies. Lack of contact with the health system does not fully account for the men's apparent lack of knowledge about the reproductive body. Rather, biomedical knowledge was simply not a point of reference for the men's understandings of the body. The majority of drawings made by men of the female reproductive body portrayed the primacy of sexuality in their view of the reproductive system.

Adolescent↗