A Thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in ful lment of the requirements for the degree of Doctor of Philosophy in Medicine Johannesburg, South Africa 2017. / Background: The persistent burden of undernutrition, with increasing prevalence of obesity and metabolic disease risk among children and adolescents, has become a global public health problem. Research has shown that risk factors established in childhood and adolescence may contribute to the development of non-communicable diseases (NCDs) in adulthood. This is of particular concern in South Africa, given its rapid socio-economic, political and epidemiological transitions. Research into the trends of nutrition transition in rural children and adolescents, whose particular health needs have been under-served and poorly delineated in the past, provides a unique opportunity to study the e ects of rapid health transitions on development. Aim: To determine the association of nutrition, body composition and metabolic disease risk in rural South African children and adolescents. Study design: Three cross-sectional studies were undertaken to address the overall aim of this research. The speci c objectives of each study were: (1) to determine the association of nutrition on body composition and metabolic disease risk in children and adolescents; (2) to examine the associations between body mass index (BMI), disordered eating attitude and body dissatisfaction in female adolescents, and descriptive attributes assigned to silhouettes of di ering body habitus in male and female adolescents; and (3) to investigate associations between diet and cardiovascular disease (CVD) risk factors in adolescents. Method: One cross-sectional study, 3 analyses were nested within the Agincourt Health and Socio-demographic Surveillance System (HDSS) site, in the Bushbuckridge subdistrict, Mpumalanga Province, South Africa. In 2009, a random sample of 600 children and adolescents, from age groups 7 to 8 years, 11 to 12 years and 14 to 15 years, were selected from 3489 children who had participated in a 2007 growth survey. These children and adolescents had to have lived in Agincourt at least 80% of the time since birth or since 1992, when enrolment into the Agincourt Health and Socio-Demographic Surveillance System (HDSS) began. Height and weight were measured to determine BMI. Age and sex-speci c cut-o s for underweight and overweight/obesity were determined using those of the International Obesity Task Force. Body image satisfaction using Feel-Ideal Discrepancy (FID) scores, Eating Attitudes Test-26 (EAT-26), perceptual female silhouettes and pubertal assessment were collected through self-administered questionnaires. Blood pressure (systolic (SBP) and diastolic (DBP)) was measured, fasting blood samv ples were collected for the determination of glucose and lipids. Waist to hip ratio cut-o s of (WHR) >0.85 for females, >0.90 for males, waist to height ratio (WHtR) of >0.5 for both sexes, and waist circumference (WC) of >80 cm for females and >94 cm for males were used to determine the risk of adiposity. For abnormal lipids: high density lipoprotein cholesterol (HDL-C) cut-o s of >1.03 mmol/l, low density lipoprotein-cholesterol (LDL-C) of >2.59 mmol/l, triglycerides (TGs) of >1.7 mmol/l and total cholesterol (TC) of >5.17 mmol/l were used. Pre-hypertension prevalence was computed using the average of 2 readings of SBP or DBP, being >90th but <95th percentile for age, sex and height. Dietary intake was assessed using semi-quantitative food frequency questionnaire. T-test and ANOVAs for normally distributed data and Wilcoxon-Mann- Whitney test was used to determine signi cant di erences by sex and by pubertal stages for EAT-26 and EAT-26 sub-scores. Chi square tests were done to determine signi cant associations between the categorical variables. Bivariate linear regression was employed to test associations and signi cant tests were set at the p<0.05 level. Results: Study component (1): Stunting levels were higher in the boys than in the girls in mid to late childhood and combined overweight and obesity prevalence was higher in girls than in boys. The girls' BMI was signi cantly greater at ages 11 and 12 years than that of the boys [girls: 18 3.4, 95% con dence interval (CI): 17.33- 18.69; boys: 17 2, 95% CI: 16.46-17.25; p-value 0.004] and at ages 14-15 years (girls: 22 4.1, 95% CI: 20.82-22.47; boys: 19 2.4, 95% CI: 18.39-19.38; p-value < 0.001). Prehypertension (de ned as < 90th centile for age, sex and height) was higher in girls (15%) than boys (10%). Further, impaired fasting glucose was detected in 5.3% of girls and 5% of boys. High-density lipoprotein cholesterol (>1.03 mmol/l) concentrations were observed in 12% of the girls and 0.7% of the boys, which is indicative of cardiometabolic risk. Study component (2): The prevalence of overweight and obesity was higher in girls than boys in early and mid to post pubertal stages. The majority (83.5%) of the girls reported body image dissatisfaction (a desire to be thinner or fatter). The girls who wanted to be fatter had a signi cantly higher BMI than the girls who wanted to be thinner (p=0.001). There were no di erences in EAT-26 score between pubertal groups, or between boys and girls within the two pubertal groups. The majority of the boys and the girls in both pubertal groups perceived the underweight silhouettes to be \unhappy" and \weak" and the majority of girls in both pubertal groups perceived the normal silhouettes to be the \best". Study component (3): Added sugar and sweets contributed 10% and maize meal and vi bread contributed 7.2% to the total number of food items consumed respectively. Girls had higher intakes of total fat, saturated fat and cholesterol after adjusting for dietary energy intake and age (all p<0.001). The prevalence of combined overweight and obesity was 13.8% in girls and 3.1% in boys (p<0.001). In addition, indicators of adiposity were higher in females, abnormal waist circumference (WC) (6.7%), waist to hip ratio (WHR) (22.0%) and waist to height ratio (WHtR) (18.0%), compared to males, (0%), (3.1%) and (6.2%) respectively (all p<0.001). Girls had higher low-density lipoprotein (LDL) (12(9.3%) vs. 3(2.3%), p=0.01), total cholesterol (17(12.7%) vs. 5(3.5%), p<0.001) and were more pre-hypertensive (28(15.3%) vs.15(8.4%), p=0.04) than the boys. Furthermore, the bivariate associations between dietary intakes (total energy, total carbohydrate (CHO), total dietary fat and saturated fat) and anthropometric indices (BMI and WC) showed that body mass index (BMI) was associated with total energy (p=0.05) and BMI and WC were associated with total fat (p=0.01, p=0.03) and saturated fat (p<0.001, p=0.02) in females respectively. Conclusions: In conclusion, this thesis highlights that girls in rural South Africa had a higher prevalence of combined overweight and obesity than did boys, stunting was more prevalent amongst boys than girls in mid to late childhood and metabolic risk factors that were associated with adiposity, and linked to diet, were higher in girls than in boys. This study has provided useful information for targeting critical health promotion intervention programmes to optimise child nutrition as part of a noncommunicable disease preventative strategy, especially, in remote areas in rapidly transitioning South Africa. / LG2018

This systematic review examined the shifts in undernutrition and overnutrition in Nepal during the past two decades. We searched PubMed for studies and reports published between January 1, 2000, and June 30, 2018. Publications with a sample size greater than or equal to 500 that reported prevalence of nutritional status were included. Six large national reports and 36 studies met study inclusion criteria and were included. Overall, available nationally representative data remained limited. The Nepal Demographic and Health Survey 2001 to 2016 showed that underweight prevalence decreased from 26.7% to 17.2% and prevalence of overweight/obesity increased from 6.5% to 22.1% among women of reproductive age (15-49 years). In preschool children, prevalence of stunting, wasting, and underweight decreased from 57.2% to 35.8%, 11.2% to 9.7%, and 42.7% to 27.0%, respectively. Prevalence of overweight/obesity was low among children and was higher in higher socio-economic status (SES) groups. The overweight-obesity/underweight ratios indicate a shift from undernutrition to overnutrition problem; it was more evident in urban areas and higher SES groups. In conclusion, Nepal is experiencing a nutrition transition. More research is warranted to address this shift, and well-tailored public health efforts need to combat the double burden of overweight/obesity and undernutrition.

No description available.

Introdução: O aumento da idade é considerado risco para subnutrição, em idosos. Objetivo: Identificar a incidência de subnutrição e risco para subnutrição e associação com variáveis sociodemográficas e clínicas, em idosos domiciliados no município de São Paulo/Brasil, em 2000 e 2006. Métodos: Foram utilizados dados do Estudo SABE Saúde, Bem-estar e Envelhecimento, de coorte, epidemiológico, de base domiciliar, realizado em 2000 (n=2.143) e em 2006 (n=1.115), entrevistando idosos ( 60 anos), de ambos os sexos, selecionados por amostra probabilística. Foram incluídos idosos que apresentaram todos os dados necessários, para identificação de subnutrição e risco para subnutrição, pela Mini Avaliação Nutricional, considerando subnutrição (MAN® < 17 pontos), risco para subnutrição (MAN® 17 a 23,5 pontos), e que, em 2000, não apresentaram esse distúrbio nutricional. As variáveis analisadas foram: dependente - subnutrição e risco para subnutrição, explanatórias - sexo, grupos etários (60 a 74; 75), renda, depressão (Escala de Depressão Geriátrica), declínio cognitivo (Mini Exame do Estado Mental), companhia no domicílio e número de doenças referidas (câncer, diabete melito, hipertensão arterial, doença coronariana, doença pulmonar crônica, doença vascular cerebral, doença articular e osteoporose). Para identificar a associação entre as variáveis, utilizou-se teste Rao & Scott, para amostra complexa, e regressão logística múltipla (p<0,05) e o programa Stata/SE 10.0 for Windows. Resultados: Foram reavaliados 636 idosos e a taxa de incidência de subnutrição e risco para subnutrição foi 17,1/1.000 pessoas/ano. A maior proporção (21,40 por cento ) de indivíduos subnutridos ou com risco para subnutrição, era composta pelo grupo 75 anos (p=0,002) e que apresentavam sintomas depressivos (23,5 por cento ) (p=0,000). A subnutrição e o risco para subnutrição associou-se, diretamente, ao grupo etário 75 (OR= 2,47; IC=1,42-4,29) e à depressão (OR= 2,90; IC=1,64-5,13). Conclusão: A subnutrição e o risco para subnutrição apresentaram incidência elevada e associação direta com depressão e grupo etário 75 / Introduction: Increasing age is considered risk for undernutrition in the elderly. Objective: Identify the incidence of undernutrition and risk for undernutrition in the elderly, living in São Paulo / Brazil, in 2000 and 2006, and association with sociodemographic and clinical variables.Methods: We used data from the SABE Survey: Health, Wellbeing and Aging, cohort, epidemiological, household-based, conducted in 2000 (n = 2,143) and 2006 (n = 1,115), interviewing the elderly ( 60 years) of both sexes, selected by random sample. The study included individuals who had all the necessary data for identification of undernutrition and risk for undernutrition by the Mini Nutritional Assessment (MNA®), considering undernutrition (MNA® <17 points), risk for undernutrition (MNA® 17 - 23.5 points), and that in 2000, did not show this nutritional disorder. The variables were: dependent - undernutrition and risk for undernutrition, explanatory - gender, age groups (60 - 74; 75), income, depression (Geriatric Depression Scale), dementia (Mini Mental State Examination) home company and number of reported illnesses (cancer, diabetes mellitus, hypertension, coronary disease, chronic pulmonary disease, cerebrovascular disease, joint disease and osteoporosis To identify the association among the variables, it was applied the Rao Scott test, for complex samples, multiple logistic regression (p<0.05) and statistical software Stata/SE 10.0 for Windows. Results: We reviewed 636 elderly and the incidence rate of undernutrition and risk for undernutrition was 17.1 / 1,000 person-years. The largest proportion (21,4 per cent ) of undernourished individuals or risk for undernutrition, was composed by the group 75 years (p = 0.002) and depressive symptoms (23,5 per cent ) (p=0,000). Undernutrition and risk for undernutrition were associated directly to the age group 75 (OR = 2.47, CI = 1.42 to 4.29) and depression (OR = 2.90, CI = 1.64 - 5.13).Conclusion: Undernutrition and risk for undernutrition had high incidence and direct association with depression and age 75

Introdução: O aumento da idade é considerado risco para subnutrição, em idosos. Objetivo: Identificar a incidência de subnutrição e risco para subnutrição e associação com variáveis sociodemográficas e clínicas, em idosos domiciliados no município de São Paulo/Brasil, em 2000 e 2006. Métodos: Foram utilizados dados do Estudo SABE Saúde, Bem-estar e Envelhecimento, de coorte, epidemiológico, de base domiciliar, realizado em 2000 (n=2.143) e em 2006 (n=1.115), entrevistando idosos ( 60 anos), de ambos os sexos, selecionados por amostra probabilística. Foram incluídos idosos que apresentaram todos os dados necessários, para identificação de subnutrição e risco para subnutrição, pela Mini Avaliação Nutricional, considerando subnutrição (MAN® < 17 pontos), risco para subnutrição (MAN® 17 a 23,5 pontos), e que, em 2000, não apresentaram esse distúrbio nutricional. As variáveis analisadas foram: dependente - subnutrição e risco para subnutrição, explanatórias - sexo, grupos etários (60 a 74; 75), renda, depressão (Escala de Depressão Geriátrica), declínio cognitivo (Mini Exame do Estado Mental), companhia no domicílio e número de doenças referidas (câncer, diabete melito, hipertensão arterial, doença coronariana, doença pulmonar crônica, doença vascular cerebral, doença articular e osteoporose). Para identificar a associação entre as variáveis, utilizou-se teste Rao & Scott, para amostra complexa, e regressão logística múltipla (p<0,05) e o programa Stata/SE 10.0 for Windows. Resultados: Foram reavaliados 636 idosos e a taxa de incidência de subnutrição e risco para subnutrição foi 17,1/1.000 pessoas/ano. A maior proporção (21,40 por cento ) de indivíduos subnutridos ou com risco para subnutrição, era composta pelo grupo 75 anos (p=0,002) e que apresentavam sintomas depressivos (23,5 por cento ) (p=0,000). A subnutrição e o risco para subnutrição associou-se, diretamente, ao grupo etário 75 (OR= 2,47; IC=1,42-4,29) e à depressão (OR= 2,90; IC=1,64-5,13). Conclusão: A subnutrição e o risco para subnutrição apresentaram incidência elevada e associação direta com depressão e grupo etário 75 / Introduction: Increasing age is considered risk for undernutrition in the elderly. Objective: Identify the incidence of undernutrition and risk for undernutrition in the elderly, living in São Paulo / Brazil, in 2000 and 2006, and association with sociodemographic and clinical variables.Methods: We used data from the SABE Survey: Health, Wellbeing and Aging, cohort, epidemiological, household-based, conducted in 2000 (n = 2,143) and 2006 (n = 1,115), interviewing the elderly ( 60 years) of both sexes, selected by random sample. The study included individuals who had all the necessary data for identification of undernutrition and risk for undernutrition by the Mini Nutritional Assessment (MNA®), considering undernutrition (MNA® <17 points), risk for undernutrition (MNA® 17 - 23.5 points), and that in 2000, did not show this nutritional disorder. The variables were: dependent - undernutrition and risk for undernutrition, explanatory - gender, age groups (60 - 74; 75), income, depression (Geriatric Depression Scale), dementia (Mini Mental State Examination) home company and number of reported illnesses (cancer, diabetes mellitus, hypertension, coronary disease, chronic pulmonary disease, cerebrovascular disease, joint disease and osteoporosis To identify the association among the variables, it was applied the Rao Scott test, for complex samples, multiple logistic regression (p<0.05) and statistical software Stata/SE 10.0 for Windows. Results: We reviewed 636 elderly and the incidence rate of undernutrition and risk for undernutrition was 17.1 / 1,000 person-years. The largest proportion (21,4 per cent ) of undernourished individuals or risk for undernutrition, was composed by the group 75 years (p = 0.002) and depressive symptoms (23,5 per cent ) (p=0,000). Undernutrition and risk for undernutrition were associated directly to the age group 75 (OR = 2.47, CI = 1.42 to 4.29) and depression (OR = 2.90, CI = 1.64 - 5.13).Conclusion: Undernutrition and risk for undernutrition had high incidence and direct association with depression and age 75

Introduction: Millions of children worldwide die before they reach their fifth birthday. Approximately 50% of all deaths in children are associated with malnutrition. Although remarkable improvements have been seen in the past few decades, child malnutrition remains a major public health problem in Ethiopia. Malnutrition has been linked to various morbidities and as the underlying cause of 57% of mortality in the country. It is caused by complex and multidimensional biological, social economic, and environmental factors. There are scarce literatures examining the environmental factors, such as access to water and sanitation, on the likelihood of child malnutrition as measured by stunting, wasting, and underweight in Ethiopia, which the current study sought to investigate. Aim: The primary aim of this study was to examine the relationship between households’ access to water and sanitation facilities and the likelihood that a child will become stunted or wasted or underweight. Methods: The study utilized a nationally representative data from 2011 Ethiopia Demographic and Health Survey. The sample size was 9,611 children aged 0-59 months. A weighted descriptive statistical analysis was performed to examine the frequency distribution of the study’s primary independent variables (sanitation and water), dependent variables (childhood stunting, wasting, and underweight), and all other variables included in the study. Weighted bivariate analysis was conducted using logistic regression to quantify association between stunting, wasting, and being underweight and different independent variables. Weighted multivariate logistic regression analysis was performed to control for potential confounders while examining the relationship between the primary independent and dependent variables. Odds ratios, 95% confidence limits, and p-value were calculated. We considered three sets of potential confounders: child’s (child’s gender, child’s age, and child’s size at birth diarrheal disease, fever), maternal (maternal education) and household characteristics (maternal BMI, place of residence, wealth index, stool disposal, time to get water). Only variables that showed significant association (p-value Main results: Approximately 44%, 10%, and 29% of the children under-five years of age were stunted, wasted, and underweight, respectively. About 54% of the study population used unimproved source of drinking water and about 82% used unimproved sanitation facility. Our bivariate logistic analysis revealed that children in households with unimproved source of drinking water had higher odds of stunting compared to children in households with improved drinking water source (OR: 1.2; 95% CL 1.02-1.34). Adjustment for child’s characteristics yielded AOR: 1.2; 95% CL 1.0-1.4. Addition of maternal characteristics attenuated this association (AOR: 1.1; 95% CL 1.0-1.3 1.0; 95% CL 0.8-1.2). Finally, inclusion of household characteristics showed stunting was not associated with unimproved source of drinking water (AOR: 1.0; 95% 0.8-1.2). The bivariate analysis revealed household access to unimproved source of drinking water was not significantly associated with wasting (OR: 1.0; 95% CL 0.8-1.3) and underweight (OR: 1.2; 95% CL 1.0-1.4). Adjustment of child, maternal, and household characteristic showed an inverse association between source of drinking water and wasting (AOR: 0.7; 95% CL 0.6-0.9). In the bivariate analysis, access to unimproved sanitation was significantly associated with stunting (OR: 1.3; 95% CL 1.02-1.74) and underweight (OR: 1.5; 95% CL 1.1-2.1). Compared to children living in homes with access to improved sanitation facility, children in household with unimproved sanitation facility had 1.4 increased odds of being stunted (95% CL 1.1-1.9) after adjustment for child’s characteristics. Adjustment of child, maternal, and household characteristics attenuated this association (AOR: 1.1; 95% CL 0.8-1.5). Children in household with unimproved sanitation facility had higher odds of being underweight after adjusting for child characteristics (AOR: 1.6; 95% CL 1.2-2.2). Addition of maternal characteristic reduced the association (AOR: 1.5; 95% CL 1.1-2.0). Finally, the addition of household characteristics further attenuated this association (AOR: 1.4; 95% CL 1.1-1.9). Children from households with improved water but unimproved sanitation had higher odds of wasting and being underweight compared to children living in household with both services: AORs adjusted for child’s characteristics were 2.3 (95% CL 1.3-4.3) for wasting and 2.4 (95% CL 1.6-3.6) for underweight; when maternal characteristics were included, AORs were 2.2 (95% CL 1.2-4.1) and 2.1 (95% 1.4-3.3) for wasting and underweight, correspondingly; finally, when household characteristics were included AORs were 2.0 (95% CL 1.1-3.9) and 1.9 (95% CL 1.2-3.0), respectively. Conclusion: Our results suggest that household access to unimproved source of drinking water and sanitation increase the likelihood of malnutrition. Therefore, initiatives to increase access to improved sources of drinking water and sanitation facilities along with nutritional intervention could help alleviate the high burden of malnutrition in Ethiopia.

Les rapports scientifiques l’attestent, la progression de l’obésité serait irrémédiable. Elle ferait peser sur la santé des individus des risques considérables et menacerait de faire imploser notre système de santé. Ce constat alarmant, a conduit les autorités publiques à prendre le problème à bras le corps. Par sa place centrale dans le dispositif des soins, il est demandé à l’hôpital de s’organiser pour répondre à ce véritable tsunami sanitaire. Or, la réalité hospitalière offre un étonnant contraste. La maladie semble apparemment invisible dans les services de soins. Dans le domaine des pathologies reliées aux troubles du comportement alimentaire, l’obésité ne serait pas « première ». Elle serait plutôt une maladie « secondaire ». En dehors des Centres Hospitaliers Universitaires, ou des centres spécialisés, elle ne concernerait en définitive que très peu d’établissements hospitaliers. Mais, dans ces établissements où l’obésité a été visibilisée, le modèle hospitalier actuel polarisé sur la rationalité des soins, les progrès scientifiques et la performance médicale autour de plateaux techniques imposants, est bousculé. Dans un contexte d’intensification du travail hospitalier et de changement des modes de financement, la prise en charge de l’obésité impose à ces institutions d’engager une réflexion sur les pratiques professionnelles en s’ouvrant à l’environnement hospitalier. De nouvelles formes de coopération apparaissent avec des acteurs locaux qui assurent aux sujets obèses le maintien des liens sociaux et qui participent à la prévention du développement de la maladie. / Scientific reports indicate that the progression of obesity is irremediable. It represents a considerable health risk for individuals and threatens our health system with collapse. This alarming fact has led the public authorities to tackle the problem head-on. In view of their central position in the care system, hospital is required to organize in order to respond to this veritable healthcare tsunami. The situation of hospital does, however, offer an astonishing contrast. The illness appears to be invisible in the healthcare services. In the field of eating disorders, obesity is not in the foreground. It is a “secondary” disease. Outside university hospitals, or specialized centers, it is only of concern to very few hospitals. In those establishments in which obesity has been given a high profile, though, the current hospital model, focused on rational healthcare, scientific progress and medical performance involving impressive technical platforms, is being shaken up. In a scenario of increased hospital work and of changes in funding mechanisms, dealing with obesity obliges these institutions to reflect on professional practices, opening up to their environment. New forms of cooperation are created with local agents who ensure the maintenance of social connections for obese patients and who help to prevent the disease from developing.

Introdução - O sobrepeso e a obesidade são doenças de características endêmicas, tanto em países desenvolvidos como em países em desenvolvimento e podem coexistir com a desnutrição, principalmente, nas camadas sociais de baixa renda. Objetivo - Estimar as prevalências de desnutrição, sobrepeso e obesidade, segundo sexo e idade, bem como os fatores associados à sua ocorrência em adolescentes de 10 a 14,9 anos de idade, matriculados na rede de ensino público da cidade de Piracicaba, São Paulo, Brasil. Material e Métodos - Este foi um estudo transversal. A amostra foi composta por 269 adolescentes de ambos os sexos (118 meninos e 151 meninas). Foram aplicados questionários para obtenção do consumo alimentar, maturação sexual, nível de atividade física e características demográficas e feita a mensuração de peso e altura. Para a análise estatística utilizou-se o teste de associação pelo qui-quadrado e modelos de regressão multinomial univariados e múltiplos para verificar a relação entre o estado nutricional e as variáveis independentes. Resultados - As prevalências de desnutrição para meninos e meninas foram, respectivamente, 5,1% e 4,0%. As prevalências de sobrepeso foram de 15,3% entre os meninos e de 13,2% entre as meninas. A obesidade apresentou prevalências de 18,6% em meninos e 11,9% em meninas. O fator que apresentou associação com a presença de desnutrição nos meninos foi a idade, verificando-se que a faixa etária de 13,0 a 14,9 anos apresentou maior proporção de desnutridos em relação a faixa etária de 10,0 a 12,9 anos (respectivamente 14,3% x 0,0%; p= 0,028). Os fatores que mostraram associação com a desnutrição para as meninas foram o estágio puberal (OR= 10,20; p=0,005) e horas diante da televisão por dia (OR= 6,13; p= 0,019). Para o sobrepeso e obesidade, a ingestão de energia mostrou associação com a obesidade, ajustada pela idade e tempo em minutos por dia de prática de atividade física (ORajustada=6,74; p= 0,013) no grupo masculino. Nas adolescentes a obesidade foi associada ao números de horas diante de televisão por dia, ajustada pela idade ingestão de energia e tempo em minutos por dia de prática de atividade física (ORajustada=5,39; p= 0,006). Conclusões - Os achados do presente estudo evidenciaram que as prevalências de desnutrição são baixas, enquanto que, as prevalências de sobrepeso e obesidade são preocupantes, demonstrando o processo de transição nutricional no qual a cidade de Piracicaba se encontra. Dentre os fatores associados à estes agravos, destacam-se aqueles passíveis de modificação, ao se adotar hábitos de vida saudáveis como evitar o consumo excessivo de alimentos com alto valor calórico, bem como a redução do número de horas assistindo televisão. / Background - The overweight and obesity are occurring in developed as in developing countries. It can coexist with the undernutrition, mainly, in the lower social class. Objective – To estimate the prevalences of undernutrition, overweight and obesity, according to sex and age, and to determine demographics, of lifestyle characteristics and dietary intake associated to nutritional status in adolescents aged 10 to 14,9 years who were attending a public school in Piracicaba (SP - Brazil). Material and Methods - This was a cross-sectional study. The sample was composed by 269 adolescents of both sex (118 boys and 151 girls). Demographic and anthropometric data, dietary habits, sexual maturation, physical activity, physical inactivity were collected using questionnaires. The statistical analyses were done using chi-square test and univariate and multiple multinomial regression models. Results - The prevalences of undernutrition on boys was 5,1% and on girls was 4.0%. Prevalence of overweight in boys and girls were 15.3% and 13.2%, respectively. The prevalence of obesity was 18.6% in boys and 11,9% in girls. The undernutrition was associated with age on boys (respectively, 14,3% x 0,0%; p= 0,028). The undernutrition was associated with pubertal status (OR= 10,20; p=0,005) and hours of television watching (OR= 6,13; p= 0,019) among girls. The factors associated with obesity was energy intake in boys (ORadjusted=6,74; p= 0,013) and hours of television watching in girls (ORadjusted=5,39; p= 0,006). Conclusions - The prevalence of undernutrition are low and the prevalences of overweight and obesity were high in adolescents; demonstrating the process of nutrition transition in Piracicaba. The results showed that undernutrition determinants are age, on boys and pubertal status and hours of television watching, on girls. The obesity determinants were energy intake among boys and hours of television watching among girls. These findings indicate that the preventive intervention programmes should emphasize the healthy practices.

A subnutrição tem sido ao longo dos anos um dos maiores problemas de saúde pública do mundo, que acomete principalmente crianças de países em desenvolvimento. Estima-se que em Moçambique na África Oriental, cerca de 40% das crianças são acometidas pela desnutrição crônica que resulta dentre outras afecções em baixa estatura e diminuição da capacidade física. Este estudo visa avaliar a estrutura óssea de ratos wistar submetidos à dieta básica da população de Moçambique (DM) reproduzida em laboratório. Para isso a DM foi oferecida aos animais em fase pré e pós-natal durante 42 dias. Para alguns desses animais foi fornecida a DM acrescida de 20% de caseína (DMC) subsequentemente os grupos subnutrido de Moçambique (SM) e nutrido de Moçambique (NM). Foi formado também um grupo denominado renutrido (RM) composto por animais que receberão a DMC a partir do 22&ordm; dia e até completarem 42 dias de vida. Após o desmame foram mensurados os parâmetros metabólicos da ingestão alimentar e hídrica, excreção de urina e fezes. A tíbia e o úmero do lado direito foram macerados quimicamente a fim de verificar as medidas ósseas. Esses ossos do lado esquerdo foram processados com técnicas rotineiras histológicas e corados de forma a evidenciar as estruturas cartilagineas. Os dados obtidos foram submetidos a análise de variância paramétrica seguida por comparações múltiplas pelo método de Tukey, com nível de significância p&lt;0,05. Os resultados apontam que a Subnutrição é capaz de modificar a espessura da CA e da LE e os componentes de sua MEC. Embora a inserção de caseína na dieta dos animais SM, tenha reestabelecido parâmetros da osteometria, na LE e na CA a melhora apresentada, não foi o suficiente para atingir seus parâmetros normais apresentados no grupo NM / Undernutrition has been over the years one of the major public health problems worldwide, which affects mainly children in developing countries. It is estimated that in Mozambique in East Africa, about 40% of children are affected by chronic undernutrition resulting from other conditions in stature and diminished physical capacity. This study aims to evaluate the bone structure of Wistar rats submitted to the staple diet of the population of Mozambique (DM) reproduced in the laboratory. To this DM was given to the animals in pre and postnatal 42 days. For some of these animals was provided to DM plus 20% casein (DMC) subsequently the undernourished groups of Mozambique (SM) and nursed Mozambique (NM). Also it has formed a group called renutrido (RM) consists of animals that receive the DMC from the 22nd day until completing 42 days of life. After weaning metabolic parameters were measured food and water intake, urine output and feces. The tibia and the humerus on the right side were chemically macerated in order to verify the bone measurements. These bones on the left side were processed with routine histological techniques, and stained to show the form cartilage structures. The data were subjected to parametric analysis of variance followed by multiple comparisons by the Tukey method, with significance level of p <0.05. The results show that the Malnutrition is able to modify the thickness of the CA and LE and the components of its MEC. Although the inclusion of casein in the diet of animals SM, has reestablished osteometria parameters in LE and CA improvement presented, was not enough to achieve their normal parameters presented in NM group

A subnutrição é um quadro caracterizado por escassez proteico-calórica e sua manifestação na República de Moçambique é responsável por um terço das mortes de crianças com idade inferior a 5 anos. É a responsável pela falha no crescimento nos primeiros anos de vida e no Brasil, até 2011, era considerada um problema grave de saúde pública. O objetivo deste trabalho foi investigar possíveis repercussões no tecido nervoso periférico de ratos Wistar subnutridos, comparando-os com aqueles que receberam a dieta padrão de Moçambique (baseada em proteína vegetal) e com aqueles que receberam nutrição balanceada. Para a realização deste estudo foram utilizados 15 ratos machos da linhagem Wistar e as técnicas utilizadas foram: Microscopia Eletrônica de Transmissão e Varredura, possibilitando a aquisição de dados quantitativos e qualitativos, utilizando ainda princípios estereológicos. Os resultados demonstraram alterações morfológicas nos grupos S e M, assim como diferenças quanto ao contorno das fibras nervosas e a disposição das camadas de mielina. Em relação ao peso e a ASTn, os três grupos são diferentes estatisticamente. Ao contrário, quanto à densidade de fibras nervosas mielínicas e ao número total estimado de fibras mielínicas, não houve diferença significante entre os grupos. Em relação à ASTax do nervo isquiático, houve significância entre os três grupos, já na análise da ASTbm e da ASTfm, houve diferença apenas entre os grupos S &ne; N, M &ne; N. Foi concluído, portanto que a subnutrição promoveu alterações morfológicas na estrutura do nervo isquiático e nas fibras nervosas mielínicas que podem ser irreparáveis, e numericamente gerou um mecanismo compensatório de aumento de densidade em relação a área do nervo, ou seja, um nervo de área menor, porém com fibras nervosas mais próximas, não havendo diferença na quantidade de fibras por nervo / Undernutrition is a condition characterized by protein-calorie shortage and its manifestation in the Republic of Mozambique is responsible for a third of deaths of children under the age of 5 years. It is responsible for growth failure early in life and in Brazil until 2011, was considered a serious public health problem. The objective of this study was to investigate possible effects on peripheral nerve tissue of Wistar rats undernourished, comparing them with those who received standard diet of Mozambique (based on vegetable protein) and those who received balanced nutrition. For this study were used 15 male rats of the Wistar and techniques used were: Transmission Electron Microscopy and Scanning, enabling acquisition of quantitative and qualitative data, using stereological principles. The results showed morphological changes in S and M groups as well as differences in the contour of nerve fibers and of the layers of myelin. In terms of weight and ASTn, the three groups are statistically different. Rather, density of myelinated nerve fibers and the estimated total number of myelinated fibers, not present significant difference between groups. Regarding ASTax sciatic nerve, there was significant difference between the three groups, and in the analysis of ASTms and ASTmf, there was difference only between the groups. It was concluded therefore that malnutrition promoted morphological changes in the sciatic nerve structure and myelin nerve fibers that may be irreparable, numerically generating a compensatory mechanism of density increase in relation to nerve area, in other words, a nerve smaller area but with next nerve fibers, with no difference in the number of nerve fibers by