Introdução: Déficits de altura-para-idade (DAI) descrevem falhas no crescimento da criança e estão associados a condições de saúde e socioeconômicas. Evidências sugerem que intervenções durante os primeiros 1000 dias de vida são mais efetivas para reduzir a carga global de DAI. Entretanto, há evidências de recuperação do DAI após este período, fenômeno chamado de catch-up growth (CUG). O CUG descreve um rápido crescimento linear que permite o indivíduo acelerar para e, em condições favoráveis, voltar a sua curva de crescimento pré-doença. Contudo, não há uniformidade na definição operacional de CUG e existem divergências acerca do melhor mensurador do CUG, fator decisivo nas conclusões sobre o tema. Objetivos: Analisar evidências de crescimento acelerado entre crianças e adolescentes de populações multiétnicas utilizando distintas formas de mensuração e caracterizar aspectos epidemiológicos do CUG. Métodos: Utilizaram-se bases de dados de populações multiétnicas. Medidas de altura foram convertidas em escore-z a partir do padrão e referência OMS (2006/07). O CUG foi avaliado pelo escore-z altura-para-idade (HAZ) e pela diferença altura-para-idade (HAD), em centímetros, por meio da variação destes índices e pela canalização do crescimento, utilizando três valores de amplitude de canal (0,67, 0,75 e 0,86 desvio-padrão), assim como pela recuperação do DAI inicial. Os efeitos dos fatores associados ao crescimento sobre o CUG foram estimados em modelos de regressão de Poisson e análise multinível. Entre as variáveis independentes configuraram características socioeconômicas, maternas e da criança e variável contextual indicando o nível de desenvolvimento do país. Resultados: Nas coortes Young Lives e nas Filipinas o HAZ declinou nas idades iniciais e aumentou até o último seguimento. O HAD, contudo, indicou aumento do déficit de altura até o último acompanhamento. Em São Paulo e na Grã-Bretanha ambos índices apresentaram incremento entre os períodos inicial e final, indicando melhoria do estado nutricional. Houve desigualdade de ambos indicadores entre os estratos socioeconômicos. Maiores prevalências de DAI ocorreram nos países menos desenvolvidos, em áreas rurais, em domicílios sem acesso a saneamento e em indivíduos com baixo peso ao nascer, episódios de diarreia na infância e cujas mães possuíam baixa estatura e menor escolaridade; houve relação dose-resposta com o quinto de renda. Houve substancial recuperação do DAI em todos países, com maiores taxas nos mais desenvolvidos. A incidência de CUG a cada cinco anos variou de 7,9% a 15,4% entre 1 e 12 anos de idade e foi 1% nas Filipinas entre 0 e 19 anos. Em todos os estudos, o grupo com DAI inicial obteve as maiores incidências. A maior parte dos indivíduos que se recuperaram do DAI inicial apresentaram crescimento acelerado considerando os três limites de canalização. O número de eventos de CUG durante a trajetória de crescimento foi o principal determinante da ocorrência de CUG final e recuperação do DAI, bem como o grau de DAI inicial e o estrato socioeconômico. Os efeitos randômicos sobre estes desfechos variaram em torno de 9%. Conclusões: Os resultados indicam potencial para o CUG e recuperação do DAI. O uso de distintos mensuradores levou a interpretações divergentes acerca da ocorrência de CUG. / Introduction: Height-for-age déficits (stunting) describe failures in child growth and are associated with health and socioeconomic conditions. Evidence suggests that interventions during the first 1000 days of life are more effective in reducing the overall burden of stunting. However, there is evidence of recovery of stunting after this period, a phenomenon called catch-up growth (CUG). CUG describes a rapid linear growth that allows the individual to accelerate to and, under favorable conditions, return to their pre-disease growth curve. However, there is no uniformity in the operational definition of CUG and there are disagreements about the best CUG measurer, a decisive factor in the conclusions about the subject. Objectives: To analyze evidence of accelerated growth among children and adolescents of multiethnic populations using different forms of measurement and to characterize the epidemiological aspects of CUG. Methods: Databases of multiethnic populations were used. Height measurements were converted to z-score from the WHO standard and reference (2006/07). The CUG was evaluated by height-for-age z-score (HAZ) and height-for-age difference (HAD), in centimeters, by variation of these indices and by canalisation of growth, using three values of amplitude (0.67, 0.75 and 0.86 standard deviation), as well as by recovery of the initial stunting. The effects of growth-related factors on CUG were estimated in Poisson regression models and multilevel analysis. Among the independent variables configured socioeconomic, maternal and child characteristics and a contextual variable indicating the level of development of the country. Results: In the Young Lives Cohorts and in the Philippines HAZ declined in the early ages and increased until the last follow-up. HAD, however, indicated an increase in height deficit until the last follow up. In São Paulo and Great Britain, both indexes showed an increase between the initial and final periods, indicating an improvement in nutritional status. There was inequality of both indicators among the socioeconomic strata. Higher prevalence of stunting occurred in less developed countries, in rural areas, in households without access to sanitation, and in individuals with low birth weight, episodes of childhood diarrhea and whose mothers had short stature and lower schooling; there was a dose-response relationship with the income. There was a substantial recovery of stunting in all countries, with higher rates in the most developed. The incidence of CUG every five years ranged from 7.9% to 15.4% between 1 and 12 years of age and was 1% in the Philippines between 0 and 19 years. In all studies, the group with initial stunting had the highest incidence. Most of the individuals who recovered from the initial stunting presented accelerated growth considering the three canalisation limits. The number of CUG events during the growth trajectory was the main determinant of the occurrence of final CUG and recovery of the stunting, as well as the degree of initial stunting and the socioeconomic stratum. The random effects on these outcomes varied around 9%. Conclusions: The results indicate potential for CUG and recovery of stunting. The use of different measurers led to divergent interpretations regarding the occurrence of CUG.

Introdução: Déficits de altura-para-idade (DAI) descrevem falhas no crescimento da criança e estão associados a condições de saúde e socioeconômicas. Evidências sugerem que intervenções durante os primeiros 1000 dias de vida são mais efetivas para reduzir a carga global de DAI. Entretanto, há evidências de recuperação do DAI após este período, fenômeno chamado de catch-up growth (CUG). O CUG descreve um rápido crescimento linear que permite o indivíduo acelerar para e, em condições favoráveis, voltar a sua curva de crescimento pré-doença. Contudo, não há uniformidade na definição operacional de CUG e existem divergências acerca do melhor mensurador do CUG, fator decisivo nas conclusões sobre o tema. Objetivos: Analisar evidências de crescimento acelerado entre crianças e adolescentes de populações multiétnicas utilizando distintas formas de mensuração e caracterizar aspectos epidemiológicos do CUG. Métodos: Utilizaram-se bases de dados de populações multiétnicas. Medidas de altura foram convertidas em escore-z a partir do padrão e referência OMS (2006/07). O CUG foi avaliado pelo escore-z altura-para-idade (HAZ) e pela diferença altura-para-idade (HAD), em centímetros, por meio da variação destes índices e pela canalização do crescimento, utilizando três valores de amplitude de canal (0,67, 0,75 e 0,86 desvio-padrão), assim como pela recuperação do DAI inicial. Os efeitos dos fatores associados ao crescimento sobre o CUG foram estimados em modelos de regressão de Poisson e análise multinível. Entre as variáveis independentes configuraram características socioeconômicas, maternas e da criança e variável contextual indicando o nível de desenvolvimento do país. Resultados: Nas coortes Young Lives e nas Filipinas o HAZ declinou nas idades iniciais e aumentou até o último seguimento. O HAD, contudo, indicou aumento do déficit de altura até o último acompanhamento. Em São Paulo e na Grã-Bretanha ambos índices apresentaram incremento entre os períodos inicial e final, indicando melhoria do estado nutricional. Houve desigualdade de ambos indicadores entre os estratos socioeconômicos. Maiores prevalências de DAI ocorreram nos países menos desenvolvidos, em áreas rurais, em domicílios sem acesso a saneamento e em indivíduos com baixo peso ao nascer, episódios de diarreia na infância e cujas mães possuíam baixa estatura e menor escolaridade; houve relação dose-resposta com o quinto de renda. Houve substancial recuperação do DAI em todos países, com maiores taxas nos mais desenvolvidos. A incidência de CUG a cada cinco anos variou de 7,9% a 15,4% entre 1 e 12 anos de idade e foi 1% nas Filipinas entre 0 e 19 anos. Em todos os estudos, o grupo com DAI inicial obteve as maiores incidências. A maior parte dos indivíduos que se recuperaram do DAI inicial apresentaram crescimento acelerado considerando os três limites de canalização. O número de eventos de CUG durante a trajetória de crescimento foi o principal determinante da ocorrência de CUG final e recuperação do DAI, bem como o grau de DAI inicial e o estrato socioeconômico. Os efeitos randômicos sobre estes desfechos variaram em torno de 9%. Conclusões: Os resultados indicam potencial para o CUG e recuperação do DAI. O uso de distintos mensuradores levou a interpretações divergentes acerca da ocorrência de CUG. / Introduction: Height-for-age déficits (stunting) describe failures in child growth and are associated with health and socioeconomic conditions. Evidence suggests that interventions during the first 1000 days of life are more effective in reducing the overall burden of stunting. However, there is evidence of recovery of stunting after this period, a phenomenon called catch-up growth (CUG). CUG describes a rapid linear growth that allows the individual to accelerate to and, under favorable conditions, return to their pre-disease growth curve. However, there is no uniformity in the operational definition of CUG and there are disagreements about the best CUG measurer, a decisive factor in the conclusions about the subject. Objectives: To analyze evidence of accelerated growth among children and adolescents of multiethnic populations using different forms of measurement and to characterize the epidemiological aspects of CUG. Methods: Databases of multiethnic populations were used. Height measurements were converted to z-score from the WHO standard and reference (2006/07). The CUG was evaluated by height-for-age z-score (HAZ) and height-for-age difference (HAD), in centimeters, by variation of these indices and by canalisation of growth, using three values of amplitude (0.67, 0.75 and 0.86 standard deviation), as well as by recovery of the initial stunting. The effects of growth-related factors on CUG were estimated in Poisson regression models and multilevel analysis. Among the independent variables configured socioeconomic, maternal and child characteristics and a contextual variable indicating the level of development of the country. Results: In the Young Lives Cohorts and in the Philippines HAZ declined in the early ages and increased until the last follow-up. HAD, however, indicated an increase in height deficit until the last follow up. In São Paulo and Great Britain, both indexes showed an increase between the initial and final periods, indicating an improvement in nutritional status. There was inequality of both indicators among the socioeconomic strata. Higher prevalence of stunting occurred in less developed countries, in rural areas, in households without access to sanitation, and in individuals with low birth weight, episodes of childhood diarrhea and whose mothers had short stature and lower schooling; there was a dose-response relationship with the income. There was a substantial recovery of stunting in all countries, with higher rates in the most developed. The incidence of CUG every five years ranged from 7.9% to 15.4% between 1 and 12 years of age and was 1% in the Philippines between 0 and 19 years. In all studies, the group with initial stunting had the highest incidence. Most of the individuals who recovered from the initial stunting presented accelerated growth considering the three canalisation limits. The number of CUG events during the growth trajectory was the main determinant of the occurrence of final CUG and recovery of the stunting, as well as the degree of initial stunting and the socioeconomic stratum. The random effects on these outcomes varied around 9%. Conclusions: The results indicate potential for CUG and recovery of stunting. The use of different measurers led to divergent interpretations regarding the occurrence of CUG.

A link between early malnutrition and development of components of the metabolic syndrome later in life has been shown in epidemiological and animal data. Moreover, studies now tend to demonstrate that not only fetal environment is important for developmental programming but postnatal milieu could also participate to this process. The “predictive adaptive response” hypothesis stipulates that not only a suboptimal environment during fetal life will lead to development of metabolic disorders later in life but more likely is a mismatch between the early environment and that one really encountered later on that increases the risk of developing later disease. Based on this hypothesis, we examined the effect of an early mismatched environment produced by fetal protein restriction and postnatal catch-up growth on the development of obesity and cardiovascular disease in male mice. We focussed our study on the analysis of adipose tissue with in vitro examination of differentiation, proliferation of preadipocytes. We also investigated in vivo the development of overweight in adult mice and we measured the expression of specific adipose tissue molecules with microarray. Finally, we investigated the development of hypertension and atherosclerosis in parallel to obesity. Our results indicated that postnatal catch-up growth after fetal protein restriction favours the development of obesiy in adult male mice. Early mismatched nutrition also influenced the capacity of proliferation of preadipocyte as well as the expression of adipose tissue specific molecules involved mainly in lipid biosynthesis. Finally, early nutrition also induced hypertension in adult male mice while no influence of fetal protein restriction and postnatal catch-up growth was observed on atherosclerosis development.

Nepakankama mityba iki nėštumo ir per nėštumą gali lemti palikuonio svorio pokyčius, vėlesnę brandą ar lėtines neinfekcines ligas suaugus. Darbo tikslas: Įvertinti mitybos iki nėštumo ir per nėštumą įtaką žiurkių palikuonių fizinei būklei. Uždaviniai: 1. Nustatyti ir palyginti žiurkių palikuonių svorio kitimo tendencijas tarp pirmos ir antros palikuonių kartų. 2. Įvertinti morfologinius pirmos ir antros kartos palikuonių išvaizdos ir elgsenos pokyčius. Tyrime naudotos 12 motininių žiurkių patelių ir 121 palikuonis. Žiurkių maitinimas vyko nustatytomis eksperimento sąlygomis: I eksperimentinės grupės (N=5) žiurkės buvo 50 proc. ribotos maisto 1 mėnesį iki nėštumo ir per visą nėštumo laikotarpį, II eksperimentinės grupės (N=5) žiurkės buvo ribotos 50 proc. maisto 1 mėnesį iki nėštumo, III eksperimentinė grupė (N=2) – kontrolinė, buvo maitinama ad libitum (apie 20 g/p). Vėliau visų grupių žiurkės šertos ad libitum. Palikuonys sverti kartą per savaitę, vertinta metabolinį stresą patyrusių ir nepatyrusių žiurkių palikuonių išvaizda, elgsena ir kiti metabolinio streso požymiai: domėjimasis aplinka, bailumas, agresyvumas, nervingumas. Rezultatai: 1. ▪ Suaugę pirmos kartos iki nėštumo ir per nėštumą maisto medžiagų ribojimą patyrusių žiurkių vyriškos lyties palikuonys sveria reikšmingai daugiau už kitas grupes; ▪ Suaugę antros kartos tik iki nėštumo maisto medžiagų ribojimą patyrusių žiurkių vyriškos lyties palikuonys sveria reikšmingai daugiau nei kitų grupių palikuonys... [toliau žr. visą tekstą] / Unsufficient diet before pregnancy or in time of pregnancy can lead to inadequate weight of offspring, delayed maturation as well as obesity and greater risk of noncommunicable diseases in adulthood. The main objective of this study was to explore if there is a change in rat offspring’s body weight that can be attributed to maternal nutrition. Materials and methods. The animals were housed under standard conditions in the vivarium of the Institute of Biochemistry. All animal procedures are in accordance with the The State Food and Veterinary Service. The cohort of 12 mature female Wistar rats was divided into 3 groups with respect to nutritional restriction. The rats were fed either a control (1 group) or restricted diet (2 groups): one experimental group was food-restricted prior to pregnancy and the other - one month prior and through the pregnancy period. Both food-restricted rat groups received 50 percent less of the feed eaten in the control group. After 1 month maternal rats were mated. After weaning all pups were fed with control diet ad libitum. Pups were weighted weekly with the same, calibrated scales. After 4 months female offspring were mated following a standard above mentioned procedure. 2nd offspring generation was kept and weighted under the same standardized conditions. We also observed and evaluated offspring appearance, behavior and other signs of metabolic stress: interest in the environment, fear, aggressiveness, nervousness. Results show that 1... [to full text]

Introdução - O peso mais baixo ao nascimento (PN<3 kg) pode estar relacionado a modificações na composição corporal na infância e vida adulta, pois a desnutrição intra-utero pode se associar a diminuição de massa magra e muitas vezes ao aumento de massa gorda. O peso mais alto ao nascimento (PN3 kg) e/ou ganho ponderal acima de 2DP em relação ao peso de nascimento nos primeiros dois anos de vida (catch-up growth) também podem se associar ao aumento de massa gorda, IMC, circunferência abdominal e circunferência do pescoço. Objetivos - Verificar a associação entre peso ao nascimento, ganho de peso nos primeiros dois anos de vida e alteração na composição corporal na idade escolar. Materiais e métodos - Estudo transversal avaliando-se 124 crianças escolares com cinco anos de idade, matriculadas no primeiro ano de quatro escolas municipais e uma particular de Capão Bonito, SP. Foram investigados fatores socioeconômicos e demográficos através de questionários e realizadas medidas antropométricas (peso, estatura, circunferências abdominal e do pescoço). A bioimpedanciometria foi utilizada para avaliação da composição corporal. O peso ao nascimento (PN) foi transcrito das fichas hospitalares dos recém-nascidos e o ganho de peso nos primeiros dois anos de vida, das carteiras de vacina ou prontuários médicos dos postos de saúde de Capão Bonito. Análise estatística - Para armazenamento e análise dos dados foi utilizado o software Stata versão 10. Foi estabelecido um nível de significância de 5 por cento . Para investigação das relações entre peso ao nascimento, ganho ponderal nos primeiros dois anos de vida e composição corporal aos 5 anos de idade, foi utilizada análise de regressão linear múltipla. Resultados O PN 3,0 kg, o catch-up growth (>2DP) e a obesidade materna se associaram a aumentos de média de massa gorda (p=0,036; p=0,007; p= 0,018, respectivamente); IMC (p=0,011; p=0,004; p=0,002, respectivamente) e circunferência abdominal (p= 0,002; p=0,001; p= 0,002, respectivamente). O PN 3 kg e catch-up growth se associaram (p=0,003 nos dois casos) ao aumento da média da circunferência do pescoço. Quando avaliados separadamente por sexo tanto o catch-up growth como a obesidade materna apresentaram associação com aumentos na média de massa gorda (p= 0,033 e p=0,014, respectivamente) e circunferência abdominal (0,048; 0,003, respectivamente) em meninos. A obesidade materna teve associação com maior media de IMC (p=0,001) no sexo masculino. O PN 3 kg esteve associado a aumentos de média de IMC (p=0,008), circunferência abdominal (p=0,001) e circunferência do pescoço em meninas (p=0,002). Conclusões Nesta pesquisa as maiores médias de massa gorda, IMC, circunferência abdominal estiveram associadas ao PN 3kg, catch-up growth e à obesidade materna. Maiores médias de circunferência de pescoço estiveram associadas ao PN 3kg e à ocorrência de catch-up. No sexo masculino as maiores médias de massa gorda e circunferência abdominal apresentaram associação positiva com a ocorrência de catch-up growth e obesidade materna. A maior média de IMC esteve associada à obesidade materna. Não houve associação entre a circunferência do pescoço e as variáveis independentes estudadas. No sexo feminino não foi observada associação de massa gorda com estas variáveis, contudo houve associação de maiores médias de IMC, circunferência abdominal e circunferência do pescoço com PN 3kg. Visando a prevenção e controle de sobrepeso e obesidade em crianças e adultos, é importante considerar PN, catch-up growth, historia de obesidade materna e o sexo do individuo / Introduction: Sub nutrition during intra-uterine life may be related to a decrease in lean mass and, quite often, to an increase in fat mass. Therefore, lower birth weight (BW<3kg) may bear a relationship with changes in body composition during childhood and adult life. Heavier birth weight (BW3kg) and/or weight gain during the first two years above 2 DP in relation to birth weight (catch-up growth) may also be associated to increased fat mass, BMI, abdominal and neck circumferences. Objectives: To determine the relationship between birth weight, weight gain during the first two years of life and changes in body composition at school age. Materials and methods: One hundred twenty four children aged five years were included in a cross-sectional study carried out in Capão Bonito, SP, Brazil. A survey was carried out by means of structured questionnaires in order to establish socioeconomic and demographic parameters. In addition, anthropometric data (weight, height, abdominal and neck circumferences) were recorded for each student. Body composition was determined by bioimpedance measurements. Birth weight (BW) was obtained from medical records on file at the local hospital, while weight gain during the first two years was transcribed from the childs vaccination card or from medical files available at public health stations in Capão Bonito. Statistical Analysis: Data storage and analysis was carried out using the Stata statistical package, Version 1.0, using 5 per cent as the significance level. A multiple regression analysis was used to determine the relationship between birth weight, weight gain during the first two years of life and changes in body composition at school age. Results: BW3.0 kg, catch-up growth (>2DP) and maternal obesity were related to increased fat mass (p=0,036; p=0,007; p= 0,018, respectively), BMI (p=0,011; p=0,004; p=0,002, respectively) and abdominal circumference (p=0,002; p=0,001; p=0,002, respectively). BW 3.0 kg, catch-up growth (>2DP) were associated (p=0,003 in both cases) with increased neck circumference. When the results were considered separately for boys and girls, for boys there was a relationship between the two variables: catch-up growth and maternal obesity with fat mass (p=0,033 and p=0,014, respectively) and abdominal circumference (p=0,048 and p=0,003, respectively). BW 3.0 kg was associated with increases in BMI (p=0,008), abdominal circumference (p=0,001) and neck circumference (p=0,002) in girls. Conclusions This research shows that high averages of fat mass, BMI and abdominal circumference were associated to three main factors: i) BW 3 kg; ii) catch-up growth and, iii) maternal obesity. It also shows that high averages of neck circumference were associated to BW 3 kg and to the occurrence of catch-up growth. For males, high averages of fat mass and high averages of abdominal circumference were positively associated to the occurrence of catch-up growth and maternal obesity; the highest average of BMI was associated to maternal obesity. There was no association between neck circumference and the independent variables studied. In contrast, for females this research did not show associations between fat mass and BW 3kg, catch-up growth or maternal obesity. However, there was a positive association between high averages of BMI, abdominal circumference and neck circumference with BW 3kg.These findings indicate that, in order to prevent and control overweight and obesity in children and adults, it is important to consider BW, catch-up growth, maternal obesity and gender

The aim of this thesis is to gain improved understanding of the income convergence between Finland and Sweden 1950-2000 with a focus on catch-up growth, wage formation, productivity growth, migration and structural change in a setting of structural and institutional differences on the factor markets. Earlier studies of Finnish and Swedish convergence has overlooked the international perspective and therefore missed the general European – US convergence during the period. The results shows that Sweden converged to 80 percent of the US productivity level in the early 1970s and is following US productivity growth thereafter. The Finnish catch-up growth towards the US continues until the beginning of the 1990s. This corresponds well with the convergence of labour productivity between Finland and Sweden which took place around 1970 and the gap was closed in the beginning of the 1990s. The convergence between the countries can therefore be understood from the catch-up growth against the USA and if the countries growth rates are plotted against their income level 1950 one can see that the two countries are well in line with other West European countries. This means that either country is deviating in a positive or negative direction during the period. This is to some extent in contrast with the view that has been put forward in the countries national economic historical writing where Finland is often since as a growth miracle while Sweden especially since 1970s is seen as a case of falling behind.      In order to explain the convergence scenario structural and institutional differences on the countries factor markets is examined. One aspect concerns Barry Eichengreens hypothesis regarding wage moderation as cause of the Post-War European convergence. The wage setting system in Sweden has been put forward by Eichengreen as a raw model for the type of institutional setting that would promote wage moderation. One central finding in this thesis is that we can not find support for wage moderation for Sweden as the labour share of the national income rises during the phase of Swedish catch-up growth while the labour income share was constant and periodically falling in Finland. In contrast with the view of the Finnish low interest rate policy during the post- the actual real interest rate was lower in Sweden.      There has also been a significant migration flow from Finland to Sweden especially from the 1950s to mid 1970s.  In the thesis we find a positive and significant relationship between wage and productivity differences on industry level between the countries. This supports the conclusion that migration was leading towards factor price convergence between the countries.      The shift-share analysis shows that there were higher gains for the productivity growth in reallocating labour on the Finnish labour market than in Sweden. This could be explained by the higher share of the labour in the agricultural sector as predicted by Peter Temin.

Submitted by Igor Matos (igoryure.rm@gmail.com) on 2017-02-02T12:59:38Z No. of bitstreams: 1 DISS_2015_Gisele do Couto Oliveira.pdf: 3804725 bytes, checksum: 45e896c07dc1435809923cc413a2e8ac (MD5) / Approved for entry into archive by Igor Matos (igoryure.rm@gmail.com) on 2017-02-03T12:04:51Z (GMT) No. of bitstreams: 1 DISS_2015_Gisele do Couto Oliveira.pdf: 3804725 bytes, checksum: 45e896c07dc1435809923cc413a2e8ac (MD5) / Made available in DSpace on 2017-02-03T12:04:51Z (GMT). No. of bitstreams: 1 DISS_2015_Gisele do Couto Oliveira.pdf: 3804725 bytes, checksum: 45e896c07dc1435809923cc413a2e8ac (MD5) Previous issue date: 2015-08-14 / Introdução – O nascimento prematuro está associado a riscos de prejuízos a curto e longo prazo no crescimento, desenvolvimento, capacidade produtiva e qualidade de vida. Estudos sobre o crescimento de prematuros ainda são escassos e inconclusivos. Objetivo – Analisar o catch-up de crescimento de uma coorte de recém-nascidos prematuros atendidos no ambulatório de seguimento do Hospital Geral Universitário, Cuiabá – MT no período de 01/01/2005 a 31/12/2011. Método – Estudo observacional de coorte retrospectiva de pacientes prematuros acompanhados no ambulatório de seguimento de um hospital universitário no período de 01/01/2005 a 31/12/2011. Os dados do estudo foram obtidos a partir de revisão de arquivos e prontuários médicos. Curvas de crescimento foram construídas e analisadas conforme as curvas-padrão de Fenton e Organização Mundial de Saúde (OMS) a partir das medidas de peso, altura, perímetro cefálico e índice de massa corpórea (IMC) registradas em cada consulta. As medidas antropométricas foram avaliadas ao nascimento e às idades corrigidas de 40 semanas e 1 ano. O desfecho foi catch-up de crescimento. Associações entre grupos foram investigadas por análise univariada. Resultados: Foram estudados 276 prematuros, a média de peso ao nascimento foi 1.960g ± 540g e a média de idade gestacional foi 33,7 ± 2,1 semanas, 52,17% eram do sexo masculino, 64,59% eram de raça negra e 83,70% eram prematuros moderados a tardios. Cerca de 64% tinham baixo peso ao nascer, 17,03% eram pequemos para a idade gestacional (PIG), 8,70% tiveram crescimento intrauterino restrito (CIUR) e 54,05% evoluíram com restrição do crescimento extrauterino na alta hospitalar ou à idade corrigida de 40 semanas. Entre os PIG e CIUR, 75% eram prematuros moderados a tardios. A maioria realizou pré-natal (89,35%) em serviço público com média de consultas de 5,8 ± 2,06; nasceu por via cirúrgica (68%); recebeu alta em aleitamento materno exclusivo (76,72%) e permanecia amamentando aos 6 meses de idade corrigida (64,13%), com ou sem complementação com fórmula. As características maternas foram: mediana de idade de 24 anos, 59,31% com escolaridade acima de 8 anos, 69,88% tinham um companheiro e 40,12% tinham renda familiar per capita abaixo de 0,5 salário mínimo. A maioria das crianças apresentou catch-up de crescimento no primeiro ano de vida, com mediana de idade em dias para peso = 49 (23,0 – 126,0), altura = 121,5 (48,8 – 197,5), perímetro cefálico = 65 (27,5 – 122,5) e IMC = 60 (39,0 – 142,0). Não houve diferenças significativas entre sexos e subgrupos de idade gestacional, exceto para os prematuros menores de 28 semanas. As medidas das crianças à idade corrigida de 1 ano foram dentro do padrão da OMS, porém abaixo da média para peso, altura e perímetro cefálico e acima da média para o IMC. Conclusão: O perfil de crescimento dos prematuros acompanhados neste serviço foi semelhante ao relatado na literatura, exceto para o perímetro cefálico que apresentou catch-up mais tardio que o peso. Houve predomínio de prematuros moderados a tardios com elevada taxa de restrição de crescimento extrauterino, mas a maioria alcançou o catch-up no primeiro ano de vida, principalmente nos primeiros seis meses, mostrando que ambulatórios de seguimento são fundamentais para o crescimento adequado dos prematuros egressos de Unidade de Terapia Intensiva neonatal / Background - Premature birth is associated with risks of short and long-term damage on growth, development, production capacity and quality of life. Studies about the premature growth are still scarce and inconclusive. Objective - Analyze the catch-up growth of a cohort of premature infants seen at follow-up clinic of the Hospital Geral Universitário, Cuiabá - MT during the period from 01/01/2005 to 31/12/2011. Method - Retrospective cohort study of premature infants followed in a university hospital from 2005/01/01 to 2011/12/31. The data were obtained from a review of files and medical records. Growth curves were constructed and analyzed according to the standard curves of Fenton and WHO as of weight, height, head circumference and body mass index (BMI) recorded at each visit. The anthropometric measurements were assessed at birth and corrected ages of 40 weeks and 1 year. The outcome was catch-up growth. Associations between groups were investigated by univariate analysis. Results: 276 premature infants were analyzed, the mean birth weight was 1960 ± 540g and the mean gestational age was 33.7 ± 2.1 weeks, 52.17% were male, 64.59% were black and 83.70% were moderate/late premature. Approximately 64% were preterm low birth weight infants, 17.03% were small for gestational age (SGA), 8.70% had intrauterine growth restriction (IUGR) and 54.05% evolved with extrauterine growth restriction at discharge or at the corrected age of 40 weeks. Between SGA and IUGR, 75% were moderate/late premature. Most performed prenatal care (89.35%) in public service averaging 5.8 ± 2.06 consultations; born by surgery (68%); was discharged on exclusive breastfeeding (76.72%) and remained breastfeeding at 6 months of corrected age (64.13%), with or without supplementation with formula. Maternal characteristics were: median age of 24 years, 59.31% with education above 8 years, 69.88% had a companion and 40.12% had family income below 0.5 minimum wage. Most children reached growth catch-up in the first year of life with a median age in days for weight = 49 (23.0 to 126.0), height = 121.5 (48.8 to 197.5) head circumference = 65 (27.5 to 122.5) and BMI = 60 (39.0 to 142.0). There were no significant differences between sexes and gestational age subgroups, except for extremely preterm infants. The measures of children at the corrected age of 1 year were within the WHO standard, but below the average for weight, height and head circumference and above average for BMI. Conclusion: the growth pattern of premature followed in this hospital was similar to that reported in the literature, except for the head circumference that showed catch-up later that weight. There was a predominance of moderate to late preterm with high extrauterine growth restriction rate, but most achieved catch-up in the first year of life, especially in the first half, showing that follow-up clinics are essential for the proper growth of premature infants who were discharged from Neonatal Intensive Care Unit

Introdução - O peso mais baixo ao nascimento (PN<3 kg) pode estar relacionado a modificações na composição corporal na infância e vida adulta, pois a desnutrição intra-utero pode se associar a diminuição de massa magra e muitas vezes ao aumento de massa gorda. O peso mais alto ao nascimento (PN3 kg) e/ou ganho ponderal acima de 2DP em relação ao peso de nascimento nos primeiros dois anos de vida (catch-up growth) também podem se associar ao aumento de massa gorda, IMC, circunferência abdominal e circunferência do pescoço. Objetivos - Verificar a associação entre peso ao nascimento, ganho de peso nos primeiros dois anos de vida e alteração na composição corporal na idade escolar. Materiais e métodos - Estudo transversal avaliando-se 124 crianças escolares com cinco anos de idade, matriculadas no primeiro ano de quatro escolas municipais e uma particular de Capão Bonito, SP. Foram investigados fatores socioeconômicos e demográficos através de questionários e realizadas medidas antropométricas (peso, estatura, circunferências abdominal e do pescoço). A bioimpedanciometria foi utilizada para avaliação da composição corporal. O peso ao nascimento (PN) foi transcrito das fichas hospitalares dos recém-nascidos e o ganho de peso nos primeiros dois anos de vida, das carteiras de vacina ou prontuários médicos dos postos de saúde de Capão Bonito. Análise estatística - Para armazenamento e análise dos dados foi utilizado o software Stata versão 10. Foi estabelecido um nível de significância de 5 por cento . Para investigação das relações entre peso ao nascimento, ganho ponderal nos primeiros dois anos de vida e composição corporal aos 5 anos de idade, foi utilizada análise de regressão linear múltipla. Resultados O PN 3,0 kg, o catch-up growth (>2DP) e a obesidade materna se associaram a aumentos de média de massa gorda (p=0,036; p=0,007; p= 0,018, respectivamente); IMC (p=0,011; p=0,004; p=0,002, respectivamente) e circunferência abdominal (p= 0,002; p=0,001; p= 0,002, respectivamente). O PN 3 kg e catch-up growth se associaram (p=0,003 nos dois casos) ao aumento da média da circunferência do pescoço. Quando avaliados separadamente por sexo tanto o catch-up growth como a obesidade materna apresentaram associação com aumentos na média de massa gorda (p= 0,033 e p=0,014, respectivamente) e circunferência abdominal (0,048; 0,003, respectivamente) em meninos. A obesidade materna teve associação com maior media de IMC (p=0,001) no sexo masculino. O PN 3 kg esteve associado a aumentos de média de IMC (p=0,008), circunferência abdominal (p=0,001) e circunferência do pescoço em meninas (p=0,002). Conclusões Nesta pesquisa as maiores médias de massa gorda, IMC, circunferência abdominal estiveram associadas ao PN 3kg, catch-up growth e à obesidade materna. Maiores médias de circunferência de pescoço estiveram associadas ao PN 3kg e à ocorrência de catch-up. No sexo masculino as maiores médias de massa gorda e circunferência abdominal apresentaram associação positiva com a ocorrência de catch-up growth e obesidade materna. A maior média de IMC esteve associada à obesidade materna. Não houve associação entre a circunferência do pescoço e as variáveis independentes estudadas. No sexo feminino não foi observada associação de massa gorda com estas variáveis, contudo houve associação de maiores médias de IMC, circunferência abdominal e circunferência do pescoço com PN 3kg. Visando a prevenção e controle de sobrepeso e obesidade em crianças e adultos, é importante considerar PN, catch-up growth, historia de obesidade materna e o sexo do individuo / Introduction: Sub nutrition during intra-uterine life may be related to a decrease in lean mass and, quite often, to an increase in fat mass. Therefore, lower birth weight (BW<3kg) may bear a relationship with changes in body composition during childhood and adult life. Heavier birth weight (BW3kg) and/or weight gain during the first two years above 2 DP in relation to birth weight (catch-up growth) may also be associated to increased fat mass, BMI, abdominal and neck circumferences. Objectives: To determine the relationship between birth weight, weight gain during the first two years of life and changes in body composition at school age. Materials and methods: One hundred twenty four children aged five years were included in a cross-sectional study carried out in Capão Bonito, SP, Brazil. A survey was carried out by means of structured questionnaires in order to establish socioeconomic and demographic parameters. In addition, anthropometric data (weight, height, abdominal and neck circumferences) were recorded for each student. Body composition was determined by bioimpedance measurements. Birth weight (BW) was obtained from medical records on file at the local hospital, while weight gain during the first two years was transcribed from the childs vaccination card or from medical files available at public health stations in Capão Bonito. Statistical Analysis: Data storage and analysis was carried out using the Stata statistical package, Version 1.0, using 5 per cent as the significance level. A multiple regression analysis was used to determine the relationship between birth weight, weight gain during the first two years of life and changes in body composition at school age. Results: BW3.0 kg, catch-up growth (>2DP) and maternal obesity were related to increased fat mass (p=0,036; p=0,007; p= 0,018, respectively), BMI (p=0,011; p=0,004; p=0,002, respectively) and abdominal circumference (p=0,002; p=0,001; p=0,002, respectively). BW 3.0 kg, catch-up growth (>2DP) were associated (p=0,003 in both cases) with increased neck circumference. When the results were considered separately for boys and girls, for boys there was a relationship between the two variables: catch-up growth and maternal obesity with fat mass (p=0,033 and p=0,014, respectively) and abdominal circumference (p=0,048 and p=0,003, respectively). BW 3.0 kg was associated with increases in BMI (p=0,008), abdominal circumference (p=0,001) and neck circumference (p=0,002) in girls. Conclusions This research shows that high averages of fat mass, BMI and abdominal circumference were associated to three main factors: i) BW 3 kg; ii) catch-up growth and, iii) maternal obesity. It also shows that high averages of neck circumference were associated to BW 3 kg and to the occurrence of catch-up growth. For males, high averages of fat mass and high averages of abdominal circumference were positively associated to the occurrence of catch-up growth and maternal obesity; the highest average of BMI was associated to maternal obesity. There was no association between neck circumference and the independent variables studied. In contrast, for females this research did not show associations between fat mass and BW 3kg, catch-up growth or maternal obesity. However, there was a positive association between high averages of BMI, abdominal circumference and neck circumference with BW 3kg.These findings indicate that, in order to prevent and control overweight and obesity in children and adults, it is important to consider BW, catch-up growth, maternal obesity and gender

Le faible poids de naissance et/ou une accélération de la croissance pondérale durant l’enfance sont reconnus actuellement comme facteur de risque de maladies cardiovasculaires (hypertension artérielle, en particulier). Leur rôle dans la progression des maladies rénales chroniques de l’adulte est moins évident. Cette association entre un faible poids de naissance et un risque accru d’hypertension artérielle (HTA) à l’âge adulte ferait intervenir une réduction du nombre de néphrons. Ce déficit néphronique, associé au faible poids de naissance, est responsable d’une hyperfiltration glomérulaire au sein de chaque néphron. Ce mécanisme adaptatif entraîne au fil du temps des lésions rénales, une protéinurie, une insuffisance rénale chronique et une véritable hypertension artérielle. Mais l’hypothèse pathogénique du déficit néphronique reste discutable. De plus peu l’influence de la nutrition postnatale précoce a été très peu étudiée chez l’animal. A travers 2 modèles de restriction de croissance intra-utérine (RCIU) chez le rat, nous avons montré que, plus que la RCIU elle-même, le devenir vasculaire et rénal chez le rat RCIU dépend de la sévérité du déficit néphronique. Un déficit néphronique modéré n’est pas suffisant pour affecter à long terme les fonctions/structures vasculaires et rénales chez le rat RCIU obtenu par une restriction protéique maternelle modérée (caséine 9 %)Nous avons également validé un modèle de rattrapage pondéral précoce, chez le rat. Nous avons montré qu’un rattrapage pondéral et/ou une croissance exagérée durant la période néonatale jouent un rôle primordial sur la pression artérielle, les fonctions et la structure rénale à l’âge adulte. Ces paramètres étaient d’autant plus affectés que la suralimentation néonatale était associé à une RCIU. Les maladies vasculaires et rénales résulteraient, en grande partie, d’une inadéquation entre le nombre de néphrons, réduit lors d’un faible poids de naissance, et la nutrition néonatale/postnatale, surabondante.Chez l’homme, la mise en place de nouvelles cohortes est nécessaire afin de mieux comprendre le rôle de la nutrition durant différentes phases de croissance (fœtale, néonatale, enfance et adolescence) dans le développement des maladies chroniques de l’adulte. Ces études devraient évaluer la pertinence de marqueurs précoces, et permettre la mise en œuvre de stratégies préventives précoces nutritionnelles ou médicamenteuses chez les personnes les plus à risques. / Evidence suggest that low birth weight and/or postnatal catch-up growth increase the risk for long term cardiovascular diseases (hypertension especially). Their role on the progression of chronic kidney disease is less evident. The mechanism is incompletely known. Nephron number deficit, associated with low birth weight, may play an important role. In such a condition, an adaptative single nephron glomerular hyperfiltration to meet excretory demands may lead overtime to renal damages. However this hypothesis is still questionable.In the rat, through two experimental models of intrauterine growth restriction (IUGR), we have shown that adverse long term vascular and renal functions are highly dependent on the severity of nephron number deficit. Moreover, we have demonstrated that a rapid neonatal catch-up growth plays a determinant role. Neonatal overfeeding and a high protein diet following IUGR accelerate the expression of hypertension and the progression of chronic kidney disease. Long term vascular and renal diseases may thus result from a mismatch between adverse fetal environment and postnatal beneficial environment. In human prospective epidemiological studies are needed with the aim to evaluate the effect of postnatal nutrition and to determine early markers for future preventive studies.