Introdução: Estudos epidemiologicos sugerem que a exposicao intra-uterina a agravos como desnutricao, hiperglicemia ou hipercortisolemia durante periodos criticos do desenvolvimento leva a alteracoes metabolicas e endocrinas que persistem na vida adulta, fenomeno denominado de Programação Fetal das Doenças. Objetivos: Avaliar a relacao entre peso ao nascer (PN) com os valores atuais de pressao arterial, medidas antropometricas e de composicao corporal. Métodos: Estudo de coorte retrospectivo utilizando dados de RONDO (2003) em Jundiai-SP. No seguimento da coorte, avaliou-se 472 criancas, atualmente com idade de 5 a 8 anos. Avaliacoes clinicas consistiram em: medida de pressao arterial (PA), peso (P) e estatura (E) e dosagens bioquimicas: colesterol total (CT), LDL colesterol (LDLc) e HDL colesterol (HDLc) e triglicerides(TG). A composicao corporal foi avaliada pela prega cutanea triciptal (PCT) e subescapular (PCS), circunferencia braquial (CB) e da cintura (CC), area gordurosa do braco (AGB) e area muscular do braco (AMB) e indice de massa corporal para a idade (IMC). Avaliaram-se as condicoes socioeconomicas e demograficas em entrevista domiciliar. Para determinacao de associacao entre variaveis continuas, utilizou-se o teste de Correlacao de Pearson. Para variaveis categoricas, utilizou-se o teste do quiquadrado; e teste t" de Student para comparacao de medias. Utilizaram-se modelos de regressao linear multipla para investigar as relacoes entre as variaveis independentes: PN e comprimento ao nascer (CN) e as variaveis dependentes: IMC, CC, AGB, pressao arterial sistolica (PAS) e pressao arterial diastolica (PAD), controlando-se os fatores de confusao (sexo, idade, IMC, colesterol total, HDL-c, renda per capita e escolaridade)Resultados: A media de idade foi de 78,9}7,9 meses, sendo que 53,81% das criancas eram do sexo feminino. As prevalencias de desnutricao, risco de sobrepeso e de sobrepeso foram de 9,53%, 14,19% e 8,47%, respectivamente. A prevalencia de criancas com pressao arterial sistolica ≥95 foi alta (35,16%) e a de pressao arterial diastolica ≥95 foi de 5,09%. Em relacao a analise bioquimica, 17,16% (n=81) das criancas apresentaram HDLc reduzido. Destas, a maior parte (22,83%) eram do sexo feminino. O PN mostrou uma correlacao positiva com AGB e IMC (p<0.001). As PAS e PAD correlacionaram-se positivamente com IMC e AGB (p<0.001). Na regressao multipla, ao incluir a variavel IMC, observou-se associacao inversa significante entre PN e pressao arterial sistolica. Nao houve associacao significante entre PN e pressao diastolica e entre CN e PAS e PAD. Conclusões: A relacao inversa entre PN com pressao arterial sistolica, a relacao direta da pressao arterial com IMC e massas de gordura e muscular e a elevada prevalencia de risco de sobrepeso/sobrepeso justificam o controle do estado nutricional de criancas desde o periodo fetal e a vigilancia de medidas da pressao arterial na rotina pediatrica. / Introduction: Epidemiological studies suggest that intra-utero exposure to malnutrition, hyperglycemia or hypercortisolemia during critical periods of development leads tometabolic and endocrinological changes that will be expressed in adult life, a condition known as Fetal Programming". Objectives: To assess the relationship between birth weight (BW) and blood pressure, anthropometric and body composition measurements. Methods: This is a retrospective cohort study based on RONDO (2003) data, involving 472 children, aging 5 8 years, from Jundiai, Sao Paulo. Clinical evaluation included blood pressure (BP), weight (W), height (H) and body mass index (BMI) to age. Body composition: tricipital (TSF) and subscapular skinfold thickness (SSF), mid-upper arm circumference (MUAC), waist circumference (WC), fat mid-upper arm area (FMUAA) and muscle mid-upper arm area (MMUAA). The following elements were determined by biochemical analysis: total cholesterol (TC), LDL-cholesterol (LDLc), HDLcholesterol (HDLc) and triglycerides (TG). Household interview included data about socioeconomic and demographic conditions. In order to check the association among continuous variables, Pearson correlation test" was performed. Chi-square" and tstudent" tests were also performed for categorical variables in order to compare means. Linear regression models were applied to investigate the relationship among independent variables (BW and birth length BL) and dependent variables (W, S, BMI, WC, FMUAA, systolic blood pressure SBP and diastolic blood pressure DBP), controlling for confounders such as gender, age, BMI, total cholesterol, HLD-c, per capita income and escolarity. Results: Mean age was 78,9 + 7,9 months; 53,81% of the children were female. The prevalences of malnutrition, risk of overweight and overweight were 9.53%, 14,19% and 8.47%, respectively. The prevalence of children with a SBP ≥ the 95 centile was high (35.16%) and 5.09% of the children had a DBP ≥ the 95 centile. Eight one (17.16%) of the children had low HDL-c; from those, 22,83% were female. BW was positively correlated with FMUAA and BMI (p < 0.001). SBP and DBP were positive correlated with BMI and FMUAA (p < 0.001). In the final linear regression model, adjusted for BMI, it was noticed a significant inverse relationship between BW and SBP. There were no statistically significant associations between BW and DBP and between BL and systolic and diastolic pressures. Conclusions: The inverse relationship between BW with actual SBP, the straight relationship of BP with fat and muscle mass and BMI, and the high prevalence of the risk of overweight/overweight, justify the control of the nutritional status of children since the fetal period and the monitoring of BP measurements in the pediatric routine.
| Identifer | oai:union.ndltd.org:usp.br/oai:teses.usp.br:tde-05122007-134552 |
| Date | 09 October 2007 |
| Creators | Pereira, Joilane Alves |
| Contributors | Rondo, Patricia Helen de Carvalho |
| Publisher | Biblioteca Digitais de Teses e Dissertações da USP |
| Source Sets | Universidade de São Paulo |
| Language | Portuguese |
| Detected Language | English |
| Type | Dissertação de Mestrado |
| Format | application/pdf |
| Rights | Liberar o conteúdo para acesso público. |
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