Children of Low Socioeconomic Status Show Accelerated Linear Growth in Early Childhood; Results from the Generation R Study

Objectives: People of low socioeconomic status are shorter than those of high socioeconomic status. The first two years of life being critical for height development, we hypothesized that a low socioeconomic status is associated with a slower linear growth in early childhood. We studied maternal educational level (high, mid-high, mid-low, and low) as a measure of socioeconomic status and its association with repeatedly measured height in children aged 0-2 years, and also examined to what extent known determinants of postnatal growth contribute to this association. Methods: This study was based on data from 2972 mothers with a Dutch ethnicity, and their children participating in The Generation R Study, a population-based cohort study in Rotterdam, the Netherlands (participation rate 61%). All children were born between April 2002 and January 2006. Height was measured at 2 months (mid-90% range 1.0-3.9), 6 months (mid-90% range 5.6-11.4), 14 months (mid-90% range 13.7-17.9) and 25 months of age (mid-90% range 23.6-29.6). Results: At 2 months, children in the lowest educational subgroup were shorter than those in the highest (difference: -0.87 cm; 95% CI: -1.16, -0.58). Between 1 and 18 months, they grew faster than their counterparts. By 14 months, children in the lowest educational subgroup were taller than those in the highest (difference at 14 months: 0.40 cm; 95% CI: 0.08,0.72). Adjustment for other determinants of postnatal growth did not explain the taller height. On the contrary, the differences became even larger (difference at 14 months: 0.61 cm; 95% CI: 0.26,0.95; and at 25 months: 1.00 cm; 95% CI: 0.57,1.43) Conclusions: Compared with children of high socioeconomic status, those of low socioeconomic status show an accelerated linear growth until the18th month of life, leading to an overcompensation of their initial height deficit. The long-term consequences of these findings remain unclear and require further study

Determinants of weight gain in pregnant women attending a public prenatal care facility in Rio de Janeiro, Brazil: a prospective study, 2005-2007.

The objective of this study was to evaluate the determinants of weight gain during pregnancy. The study adopted a prospective cohort design with four follow-up waves and included a sample of 255 pregnant women that received prenatal care at a public health care facility in Rio de Janeiro, Brazil. A mixed-effects linear longitudinal regression model was used, having as the dependent variable the weight assessed in four follow-up waves, and as independent variables: demographic, socioeconomic, reproductive, behavioral, and nutritional data. Mean weight gain was 0.413kg per gestational week, consistent with recommendations by the Institute of Medicine. Per capita family income and smoking were associated with total weight gain during gestation. According to the longitudinal multiple linear regression model, age (beta = 0.6315), menarche (beta = -2.3861), triglycerides (beta = 0.0437), blood glucose (beta = 0.1544), and adequacy of energy consumption (beta = -0.0642) were associated with gestational weight gain. Special attention should be given to these sub-groups, due to increased risk of excessive weight gain

Determinants of weight gain in pregnant women attending a public prenatal care facility in Rio de Janeiro, Brazil: a prospective study, 2005-2007.

The objective of this study was to evaluate the determinants of weight gain during pregnancy. The study adopted a prospective cohort design with four follow-up waves and included a sample of 255 pregnant women that received prenatal care at a public health care facility in Rio de Janeiro, Brazil. A mixed-effects linear longitudinal regression model was used, having as the dependent variable the weight assessed in four follow-up waves, and as independent variables: demographic, socioeconomic, reproductive, behavioral, and nutritional data. Mean weight gain was 0.413kg per gestational week, consistent with recommendations by the Institute of Medicine. Per capita family income and smoking were associated with total weight gain during gestation. According to the longitudinal multiple linear regression model, age (beta = 0.6315), menarche (beta = -2.3861), triglycerides (beta = 0.0437), blood glucose (beta = 0.1544), and adequacy of energy consumption (beta = -0.0642) were associated with gestational weight gain. Special attention should be given to these sub-groups, due to increased risk of excessive weight gain

[Factors accountable for macrosomia incidence in a study with mothers and progeny attended at a Basic Unity of Health in Rio de Janeiro, Brazil].

PURPOSE: to investigate factors accountable for macrosomia incidence in a study with mothers and progeny attended at a Basic Unity of Health in Rio de Janeiro, Brazil. METHODS: a prospective study, with 195 pairs of mothers and progeny, in which the dependent variable was macrosomia (weight at delivery > or =4,000 g -- independent of the gestational age or of other demographic variables), and socioeconomic, previous pregnancies/gestation course, biochemical, behavioral and anthropometric, the independent variables. Statistical analysis has been done by multiple logistic regression. Relative risk (RR) values have been estimated, based on the simple form: RR=OR/ (1 - I0) + (I0 versus OR), in which I0 is the macrosomia incidence in non-exposed people. RESULTS: Macrosomia incidence was 6.7%, the highest value being found in the progeny of women > or =30 years old (12.8%), white (10.4%), with two or more children (16.7%), with male newborns (9.6%), with height > or =1.6 m (12.5%), with overweight or obesity as a nutritional pre-gestational state (13.6%), and with excessive gestational gain of weight (12.7%). The final model has shown that having two or more children (RR=3.7; CI95%=1.1-9.9), and having a male newborn (RR=7.5; CI95%=1.0-37.6) were the variables linked to the macrosomia occurrence. CONCLUSIONS: macrosomia incidence was higher than the one observed in Brazil as a whole, but inferior to the one reported in studies from developed countries. Having two or more children and a newborn male were the factors accountable for the occurrence of macrosomia

[Factors accountable for macrosomia incidence in a study with mothers and progeny attended at a Basic Unity of Health in Rio de Janeiro, Brazil].

PURPOSE: to investigate factors accountable for macrosomia incidence in a study with mothers and progeny attended at a Basic Unity of Health in Rio de Janeiro, Brazil. METHODS: a prospective study, with 195 pairs of mothers and progeny, in which the dependent variable was macrosomia (weight at delivery > or =4,000 g -- independent of the gestational age or of other demographic variables), and socioeconomic, previous pregnancies/gestation course, biochemical, behavioral and anthropometric, the independent variables. Statistical analysis has been done by multiple logistic regression. Relative risk (RR) values have been estimated, based on the simple form: RR=OR/ (1 - I0) + (I0 versus OR), in which I0 is the macrosomia incidence in non-exposed people. RESULTS: Macrosomia incidence was 6.7%, the highest value being found in the progeny of women > or =30 years old (12.8%), white (10.4%), with two or more children (16.7%), with male newborns (9.6%), with height > or =1.6 m (12.5%), with overweight or obesity as a nutritional pre-gestational state (13.6%), and with excessive gestational gain of weight (12.7%). The final model has shown that having two or more children (RR=3.7; CI95%=1.1-9.9), and having a male newborn (RR=7.5; CI95%=1.0-37.6) were the variables linked to the macrosomia occurrence. CONCLUSIONS: macrosomia incidence was higher than the one observed in Brazil as a whole, but inferior to the one reported in studies from developed countries. Having two or more children and a newborn male were the factors accountable for the occurrence of macrosomia

Determinantes da velocidade média de crescimento de crianças até seis meses de vida: um estudo de coorte

This study aimed to investigate some factors that contributed to higher or lower growth rate of children up to the sixth month of life. This is a cohort study with 240 children evaluated in four stages. Variables of birth, eating habits of the child, mothers’ breast-feeding difficulty and pacifier use were investigated. Children’s weight gain rate (grams/day) and size gain (cm/month) were measured in all assessments and compared according to the variables of interest. In the first month, weight gain rate of children born by cesarean section was smaller. By the second month, the growth rate (weight and size gain) was higher among children who were exclusively or predominantly breastfed and lower among those who consumed infant formula. Children of mothers who reported difficulty to breastfeed showed a lower growth rate until the second month. Children age four months who consumed porridge had lower weight and size gain rate. Pacifier use was associated with lower weight gain rates up the first, second and fourth month

Distorções no diagnóstico nutricional de crianças relacionadas ao uso de múltiplas curvas de crescimento em um país em desenvolvimento Distorsiones en el diagnóstico nutricional de niños relacionados al uso de múltiples curvas de crecimiento en un país en desarrollo Distortions in child nutritional diagnosis related to the use of multiple growth charts in a developing country

OBJETIVO: Visto que inúmeras unidades de saúde ainda utilizam curvas variadas para a avaliação do crescimento infantil, estimou-se a concordância diagnóstica do estado nutricional e suas possíveis distorções na prevalência de desvios nutricionais pela utilização das referências National Center for Health Statistics (NCHS, 1977) e Centers for Disease Control and Prevention (CDC, 2000), considerando como padrão-ouro a referência da Organização Mundial de Saúde (OMS, 2006). MÉTODOS: Estudo transversal desenvolvido com 646 crianças com idades entre 12 e 60 meses que frequentavam creches no Rio de Janeiro. Foram avaliados: peso para idade, peso para estatura, estatura para idade e índice de massa corporal para idade, considerando valores <-2 escore Z de peso para idade, peso para estatura e estatura para idade como déficits ponderoestaturais e valores >+2 escore Z de peso para estatura e índice de massa corporal para idade como excesso de peso. RESULTADOS: As frequências de déficit de estatura para idade foram subestimadas pelas referências NCHS, e CDC. A frequência de déficit de peso para idade e para estatura foi superestimada por CDC, particularmente entre meninas e crianças entre 12 e 23 meses para o peso para idade e entre meninos e crianças entre 24 e 60 meses para o peso para estatura. O uso da referência NCHS ocasionou frequências de déficit semelhantes àquelas obtidas com a OMS para o peso para idade e o peso para estatura. NCHS e CDC subestimaram o diagnóstico do excesso de peso para peso para estatura e índice de massa corporal para idade, particularmente entre meninas e crianças entre 24 e 60 meses. CONCLUSÕES: Como distorções na estimativa dos desvios nutricionais podem trazer prejuízos em nível individual e coletivo, recomenda-se que apenas a referência OMS, 2006, seja utilizada para vigilância nutricional de pré-escolares, a fim de se obter um diagnóstico fidedigno.<br>OBJETIVO: Visto que innúmeras unidades de salud todavía utilizan curvas variadas para evaluar el crecimiento infantil, se estimó la concordancia diagnóstica del estado nutricional y las posibles distorsiones en la prevalencia de desvíos nutricionales por el uso de las referencias National Center for Health Statistics (NCHS-1977) y Centers for Disease Control and Prevention (CDC-2000), considerando como estándar oro la referencia World Health Organization (WHO-2006). MÉTODOS: Estudio transversal, desarrollado con 646 niños entre 12 y 60 meses frecuentando guarderías en Rio de Janeiro, Brasil. Se evaluaron: peso para la edad (P/I), peso para estatura (P/E), estatura para edad (E/I) e Índice de Masa Corporal para Edad (IMC/I), teniendo en cuenta valoras <-2 z escore de P/I, P/E, E/I como déficits ponderoestaturales, y valores >+2 z escore de P/E e IMC/I como exceso de peso. RESULTADOS: Las frecuencias de déficit de E/I fueron subestimadas por las referencias NCHS-1977 y CDC-2000. La frecuencia de déficit de P/I y P/E fue sobrestimada por CDC-2000, en especial entre muchachas y niños entre 12 y 23 meses para P/I, y entre muchachos y niños entre 24/60 meses de edad para P/E. El uso de la referencia NCHS-1977 ocasionó frecuencias de déficit semejantes a aquellas obtenidas con la referencia WHO-2006 para P/I y P/E. NCHS-1977 y CDC-2000 subestimaron el diagnóstico de exceso de peso para P/E e IMC/I, en especial entre muchachas y niños entre 24 y 60 meses. CONCLUSIONES: Como distorsiones en la estimativa de los desvíos nutricionales puede traer perjuicios en nivel individual y colectivo, se recomienda utilizar solamente la referencia WHO-2006 para vigilancia nutricional de pre-escolares, a fin de obtener un diagnóstico fidedigno.<br>OBJECTIVE: Since many health facilities still use different versions of growth references, this study aimed to estimate the diagnostic agreement of nutritional status and its possible distortions in the prevalence of nutritional disorders in children by using the growth curves of the National Center for Health Statistics (NCHS, 1977), and of the Centers for Disease Control and Prevention (CDC, 2000), considering the World Health Organization charts (WHO, 2006) as gold-standard. METHODS: A cross-sectional study developed with 646 children aged 12 to 60 months attending day care centers in Rio de Janeiro, Brazil. Weight-for-age, weight-for-height, height-for-age, and body mass index-for-age were evaluated. The cut-off values <-2 Z-score for weight-for-age, weight-for-height, height-for-age were used to classify weight and height deficits, and values >+2 Z-score for weight-for-height e body mass index-for-age were used to classify overweight. RESULTS: The frequencies of height-for-age deficits were underestimated when NCHS, and CDC curves were applied. The frequency of weight-for-age and weight-for-height deficits was overestimated when using CDC reference, particularly among females and children aged 12 to 23 months for weight-for-age, and among boys and children aged 24 to 60 months for weight-for-height. The use of NCHS resulted in deficit frequencies similar to WHO curve for weight-for-age and weight-for-height. Diagnosis of obesity by weight-for-height and body mass index-for-age was underestimated by using both NCHS and CDC curves particularly among children aged 24 to 60 months. CONCLUSIONS: Since distortions in the estimated nutritional disorders may be collectively and individually harmful, it is recommended that only WHO 2006 standards be used for monitoring nutritional status of preschool age children, in order to obtain a reliable diagnosis

Comparação entre as curvas de crescimento do Centers for Disease Control and Prevention e da Organização Mundial da Saúde para lactentes com idade de seis a 12 meses Comparison between the Centers for Disease Control and Prevention and the World Health Organization growth curves for six to 12 months old infants

OBJETIVO: Comparar o estado nutricional de lactentes de ambos os sexos de acordo com a curva proposta pelo Centers for Disease Control and Prevention (CDC-2000) e com a nova curva de crescimento proposta pela Organização Mundial da Saúde (OMS-2006). MÉTODOS: Estudo longitudinal no qual foram acompanhadas crianças de ambos os sexos, nascidas a termo, com idade entre seis meses e um ano, em aleitamento materno predominante ou exclusivo. Os dados foram coletados por um único pesquisador por meio de ficha de atendimento nutricional composta por dados demográficos, antropométricos e sobre a alimentação da criança. Foram realizados testes de Wilcoxon e Friedman para comparar cada medida das curvas e analisar a variância, respectivamente. RESULTADOS: Da amostra final de 55 crianças, 51% (n=28) eram do sexo masculino. Os percentuais de eutrofia dos índices de peso por idade e de estatura adequada para idade de ambos os sexos apresentaram-se acima de 80%. Não houve diferença significante na classificação do estado nutricional, segundo as curvas utilizadas. A porcentagem de concordância das duas curvas em relação ao peso e à estatura foi de 98,2 e 96,4%, respectivamente. CONCLUSÕES: As curvas de crescimento da OMS-2006 e do CDC-2000 foram similares para classificar o estado nutricional de lactentes entre 6-12 meses em aleitamento materno.<br>OBJECTIVE: Compare the nutritional status of male and female infants classified according to the growth curve proposed by the Center for Disease Control and Prevention (CDC-2000) and the new growth curve proposed by the World Health Organization (WHO-2006). METHODS: This longitudinal study enrolled children of 6-12 months old of both genders. They were born at term and exclusively or predominantly breastfed. A single researcher collected demographic, anthropometric and nutritional data. The Wilcoxon test was used to compare curves and the Friedman test was used to analyze the variance. RESULTS: Among the 55 followed children, 51% (n=28) were males. The percentages of normal weight-for-age and proper height-for-age in both genders were above 80%. The nutritional status classification according to both growth curves was similar. Agreement between the two curves regarding weight and height was 98.2 and 96.4%, respectively. CONCLUSIONS: CDC-2000 and WHO-2006 growth curves were similar regarding nutritional status classification of 6-12 months old breastfeed infants