Background: Fat distribution, rather than total body fat, has been identified as a significant risk factor for chronic disease. Patterning of subcutaneous fat, in particular, may play a pervasive role in shaping the metabolic milieu that is critical for disease development. Several studies have shown that early-life nutrition may influence later body composition. The effect of breastfeeding and formula feeding on early patterns of subcutaneous fat deposition, however, are uncertain. Objective: At a time when early infant growth is emerging as a predictor for later chronic disease, it is the aim of the present analysis to investigate whether feeding style (breastfeeding versus formula feeding) modifies subcutaneous fat growth rates and trajectories in the first year of life with a focus on the historical iterations of WHO infant feeding recommendations (0 to 4 months, 4 to 6 months, and 6 to 12 months of age). Methods: This is an ex post-facto design that utilizes data collected as part of a longitudinal growth study in the first year of life. Subcutaneous fat mass was anthropometrically assessed weekly by skinfold thickness (triceps, quadriceps, calf, subscapular, suprailiac, midaxillary, and abdominal) in 21 infants. Feeding data were collected through daily parental records and are entered here as a categorical variable (predominantly breast fed and predominantly formula fed). Multi-level mixed effects models for repeated measures were used (STATA 14) adjusting for age, sex, weight, birthweight, and number of feeding episodes per day. Statistical significance was accepted at p Results:Infants experienced fat accretion only during the first four months, and this was limited to peripheral skinfolds. Thereafter, subcutaneous skinfolds followed a trend of declining rates. Breastfed and formula fed infants, however, demonstrated different patterns of subcutaneous fat deposition in both the sum of skinfolds and in each skinfold site. During the first four months, formula fed infants experienced greater rates for the subscapular, abdominal, suprailiac, trunk, quadriceps, sum of skinfolds (p Conclusion: Weekly skinfold assessments of seven subcutaneous sites have identified that feeding style predicts differences in deposition patterns in the first year of life. Breastfed infants demonstrated both slower rates of accretion and decline by comparison with their formula fed peers. This analysis further suggests that the first four months may be a critical period for subcutaneous fat deposition. Feeding specific effects were identified for truncal deposition and utilization, which suggests that future studies may benefit from depot-specific inquiries.

Orientador: Lilia Freire Rodrigues de Souza Li / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T11:40:45Z (GMT). No. of bitstreams: 1 Simoes-Brandao_JoyceMaradeAbreu_M.pdf: 2725392 bytes, checksum: d1962906bda18ae22f1e17fa97566158 (MD5) Previous issue date: 2013 / Resumo: Os pacientes com mielomeningocele apresentam baixa estatura com frequência bem mais elevada do que a população geral. Duas questões se destacam: as variáveis que influenciam o processo de crescimento e as medidas antropométricas, visto que as deformidades ortopédicas comuns a essa população limitam a obtenção de dados fidedignos. Objetivo: Analisar as variáveis relacionadas à ocorrência de baixa estatura em crianças com mielomeningocele. Avaliar se existe equivalência entre a altura e métodos antropométricos alternativos, que seriam utilizados quando o ortostatismo não for viável. Método: Estudo analítico transversal com 260 crianças, entre 3 e 9 anos, sendo 125 com mielomeningocele (grupo MMC) e 135 sem deficiências físicas (grupo controle). Em ambos os grupos foram avaliados: peso, altura, comprimento, envergadura, medida do braço, peso ao nascimento, história pregressa de patologias, condição socioeconômica e hospitalizações anteriores. No grupo MMC foram investigadas: infecções de repetição, presença de hidrocefalia e malformação de Chiari, nível neurológico da lesão medular e classificação funcional, ocorrência de deformidades ortopédicas, desenvolvimento puberal, idade óssea, malformações e desvios da coluna, avaliação laboratorial (hormônios da tireóide, função renal, IGF1 e IGFBP3). Foram calculadas estaturas estimadas utilizando equação de Stevenson e regressão linear. As estaturas foram comparadas pelo método Bland-Altman. As variáveis independentes foram avaliadas individualmente por regressão logística simples e as que obtiveram p-valor <0.25 foram incluídas na análise de regressão logística para determinar sua associação com a baixa estatura. As variáveis com p-valor <0.1 permaneceram no modelo final. Resultados : No grupo MMC foram 52 meninos e 73 meninas, com média de 6.6 anos e desvio-padrão (DP) 2.1 anos. No grupo controle foram 72 meninos e 63 meninas, média de idade 6.9 anos e DP 2 anos. Na análise do grupo controle, os resultados não mostraram diferenças entre altura, envergadura e estatura estimada por regressão linear pela envergadura e pelo braço (0.0cm, p=0.942, p=0.990 e p=0.999, respectivamente), entretanto revelou-se significativa para a diferença entre altura, comprimento (2.0cm/p<0.001) e estatura estimada por Stevenson (0.8cm/p=0.019). Observamos as seguintes prevalências de baixa estatura, de acordo com a medida utilizada como referência, no grupo MMC: 34% (altura), 47.2% (comprimento) e 16.5% (envergadura) e no grupo controle: 3%, 0.7% e 3.7%, para altura, comprimento e envergadura, respectivamente. A presença de lesão medular alta (p<0.09), gênero feminino (p<0.059), baixo peso a nascimento (p<0.071) e valores de IGF1 abaixo da mediana (p<0.054) foram significativamente associados à baixa estatura em análise de regressão logística multivariada. Conclusões: Das medidas avaliadas, a comparação da altura com a envergadura (medida direta e estimada) não mostrou diferença média entre as duas medidas e apresentou intervalo de concordância dentro do aceitável, mostrando-se, portanto, adequada para substituir a altura. As meninas com MMC, que tiveram baixo peso ao nascimento, possuem lesões medulares altas e mostram valores mais baixos de IGF-I devem ter acompanhamento mais rigoroso do crescimento, já que possuem risco maior de desenvolver baixa estatura, conforme evidenciado pela regressão logística / Abstract: Individuals with short stature are frequent among patients with mielomeningocele than in general population. Two questions appear to be important in this context: the variables that influence the growth process and appropriate anthropometric measurements must be made, since the orthopedic deformities¿common among this population¿limit the recording of reliable data. Aim: To evaluate whether there is equivalence between height and alternative anthropometric methods that can be used when orthostatism is not feasible, and to determine the variables related to the occurrence of short stature in children with myelomeningocele. Method: In this cross-sectional study, we examined 260 children (aged from 3 to 9 years), including 125 with myelomeningocele (MMC group) and 135 without any physical disabilities (control group). In both groups were evaluated: weight, height, length, arm span, birth weight, history of chronic diseases, socioeconomic status and previous hospitalizations. In the MMC group the following variables were also assessed: recurrent infections, presence of hydrocephalus and Chiari malformation, neurological level, occurrence of orthopedic deformities, pubertal development, bone age, spine malformations and deviations, and laboratory data (thyroid hormones, kidney function, IGF1, and IGFBP3). Heights estimated were calculated according to the equation proposed by Stevenson and the formula developed from linear regression. The heights were compared applying the Bland-Altman method. The independent variables were evaluated individually with simple logistic regression and were included in the logistic regression analysis when p-value <0.25, to determine their association with short stature. Variables with p-value <0.1 remain in the final model. Results: The MMC group included 52 boys and 73 girls, with mean age of 6.6 years and standard deviation (SD) of 2.1 years. The control group included 72 boys and 63 girls, with a mean age of 6.9 years and SD of 2 years. In the analysis of the control group, we observed that there was no significant difference between the height and arm span, and the heights estimated by the arm span and arm measurement (0.0 cm, p=0.942, p=0.990, and p=0.999, respectively). However, the differences between height and length (2.0 cm, p< 0.001) and height estimated by Stevenson (0.8 cm, p=0.019) were significant. Observe the prevalence of short stature in the MMC group, according to the measure used: 34% (height), 47.2% (length) and 16.5% (arm span). In the control group the values were 3%, 0.7% and 3.7% for height, length and arm span, respectively. The presence of high neurological level (p<0.09), female gender (p<0.059), low birth weight (p<0.071) and IGF1 values below the median (p<0.054) were significantly associated with short stature in multivariate logistic regression analysis. Conclusions: From the measures evaluated, the comparison between height and arm span (both direct and estimated measurements) showed no difference with the mean measurements of height, presented an acceptable concordance interval and, thus, appeared to be a suitable substitute. The girls with MMC, which had low birth weight, have high neurological level and show lower levels of IGF1 should have stricter control of growth as they have a higher risk of develop short stature as evidenced by logistic regression / Mestrado / Pediatria / Mestra em Ciências

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Visceral leishmaniasis is a severe systemic illness and early case management is important for the avoidance complications and control of the disease. Improving health workers’ knowledge on leishmaniasis is essential in improving the control programme. A quantitative, retrospective study of patient records and descriptive, explorative study of health care professionals’ knowledge on leishmaniasis were conducted. Data was collected from patient records (n=299) using a structured audit tool and from health care professionals (n=55) by means of a structured questionnaire. The study findings highlight that the commonest clinical manifestations of visceral leishmaniasis are fever and splenomegaly. Severe malnutrition and HIV co-infection contribute to mortality. The findings indicate the need for training to improve health care professionals’ awareness of visceral leishmaniasis. Leishmaniasis disease surveillance and support by the regional and district heath offices should be improved / Health Studies / M.A. Public Health (MPH)

Anthropometric quantities are widely used in epidemiologic research as possible confounders, risk factors, or outcomes. 3D laser-based body scans (BS) allow evaluation of dozens of quantities in short time with minimal physical contact between observers and probands. The aim of this study was to compare BS with classical manual anthropometric (CA) assessments with respect to feasibility, reliability, and validity. We performed a study on 108 individuals with multiple measurements of BS and CA to estimate intra- and inter-rater reliabilities for both. We suggested BS equivalents of CA measurements and determined validity of BS considering CA the gold standard. Throughout the study, the overall concordance correlation coefficient (OCCC) was chosen as indicator of agreement. BS was slightly more time consuming but better accepted than CA. For CA, OCCCs for intra- and inter-rater reliability were greater than 0.8 for all nine quantities studied. For BS, 9 of 154 quantities showed reliabilities below 0.7. BS proxies for CA measurements showed good agreement (minimum OCCC > 0.77) after offset correction. Thigh length showed higher reliability in BS while upper arm length showed higher reliability in CA. Except for these issues, reliabilities of CA measurements and their BS equivalents were comparable.

Based on previous studies, the increasing prevalence of hypertension may be associated with factors such as obesity, dietary salt and fat intake. This study examined the common biochemical and anthropometric markers that are associated with blood pressure elevation, increasing metabolic and haemodynamic derangement in subjects in Hong Kong, and related those phenotypic markers to some genetic polymorphisms relevant to hypertension. / Five hundred and thirty nine Hong Kong Chinese subjects were examined. They were aged from 20 to 60 years, and were hypertensive or normotensive siblings from families with a hypertensive proband, and normotensive controls without a family history of hypertension. The interrelationships between pathophysiological changes and various neurohormones considered relevant to the development of hypertension were investigated. Fasting blood and 24 hour urine samples were collected. Plasma insulin, plasma leptin, plasma renin activity (PRA), serum angiotensin converting enzyme (ACE) activity, aldosterone, 24 hour urine noradrenaline, adrenaline, dopamine and kallikrein were measured. A robust assay for the measurement of urine free cortisol and cortisone and 6beta-hydroxycortisol by an LC-MS/MS method was developed and validated. The ratio between urine free cortisol and cortisone was used as an estimate of the activity of 11beta-hydroxysteroid dehydrogenase type II (11betaHSD2) for cortisol metabolism. These parameters were related to polymorphisms in three genes, the angiotensinogen (AGT) gene M23 5T, the dopamine D1 receptor (DD1R) gene A-48G and the dopamine D2 receptor (DD2R) gene Taq1 A polymorphisms. Analysis of variance was employed for the parameters in the three groups of subjects and for an age-matched sibling pair analysis (using 1 normotensive and 1 hypertensive sibling from each family). Comparisons between parameters were also made after dividing the whole population into 3 groups according to the tertiles of blood pressure. (1) Central (higher waist to hip ratio and waist circumferences) and general (greater body mass index and weight) obesity were found in both hypertensive patients and the normotensive siblings compared to the control subjects. These obesity indices showed strong positive relationships with increased insulin resistance and blood pressure. The obesity indices were also independently associated with systolic and diastolic blood pressure, with central obesity showing the stronger associations. (2) Hypertensives had more adverse lipid profiles, insulin resistance and higher fasting plasma glucose levels. This suggested that the blood pressure elevation in the hypertensives may be mediated through obesity and insulin resistance. (3) Both the hypertensive and normotensive members of sibling pairs had lower noradrenaline and cortisol excretion and higher activity of 11betaHSD2 compared to the normotensive controls. The result showed positive relationships between noradrenaline and increased obesity, insulin resistance and blood pressure, while the relationship between adrenaline and blood pressure was inversed. (4) Lower plasma ACE activity and aldosterone were found in the hypertensives and their siblings than in the normotensive controls. There was a reduction in PRA across the blood pressure tertiles as blood pressure increased. In addition to the higher 11betaHSD2 activity, a negative relationship between aldosterone and blood pressure in hypertensive siblings was observed. These findings may indicate the protective mechanism of these systems in this population. In subjects with the different polymorphisms of AGT M235T, there were no differences in the PRA, serum ACE activity or aldosterone, but lower urine cortisol and kallikrien were found in relation to increasing numbers of the T allele. There was a weak association between the AGT M235T polymorphism and hypertension. (5) Despite the strong correlation of dopamine excretion between hypertensive and normotensive siblings within families, lower dopamine levels were found in the normotensive siblings. A consistent positive relationship was found between urine dopamine and sodium excretion, which supports the concept of the natriuretic effect of dopamine. There was no phenotypic difference found in any of the biochemical parameters in relation to the DDIR A-48G and DD2R Taq1 A polymorphisms, but there were weak associations with blood pressure and these polymorphisms in the sibling study. / The normotensive siblings had metabolic abnormalities similar to but less severe than the hypertensive probands, which suggests that the genetic effects and interacting effect of shared lifestyle and environmental factors with their hypertensive family member may be influential on the healthy siblings. Adaptive changes were seen in some of the blood pressure regulating systems in both the hypertensive probands and the normotensive siblings. The major factors predisposing to the hypertension in these subjects appeared to be obesity and insulin resistance and the adaptive changes were insufficient to compensate for these in the hypertensive subjects. / Chu Ten Wah Tanya. / "March 2006." / Adviser: Brian Tom Linson. / Source: Dissertation Abstracts International, Volume: 68-03, Section: B, page: 1547. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (p. 304-341). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

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