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CRECIMIENTO INTRAUTERINO Y PRESIÓN ARTERIAL EN EL ADULTO JOVEN
Pizarro T, Bustos P, Zumelzu E, Amigo H.
Universidad de Chile, Facultad de Medicina, Departamentos de Nutrición
y Pediatría
Se ha señalado que habría una relación directa
entre retardo de crecimiento intrauterino y enfermedades crónicas
del adulto. El objetivo de este trabajo fue analizar la asociación
entre crecimiento intrauterino y presión arterial en dos cohortes
que nacieron en una ciudad chilena entre 1974-1978. Se definió como
cohorte expuesta a la que tenía un retardo de crecimiento inferior
a menos una desviación estándar (DE) de peso según
edad gestacional y la no expuesta estuvo formada por los que se ubicaban
por sobre -0.5 DE . El tamaño muestral fue de 70 casos por grupo.
Para clasificar el crecimiento intrauterino se utilizó una curva
nacional que considera el peso en relación a la edad gestacional,
considerando sexo y paridad.
Los resultados señalan que no hay asociación significativa entre
el retardo de crecimiento y presión diastólica y existe una relación
directa aunque no significativa ( p de 0.19) entre ser pequeño para la
edad gestacional y presión sistólica más elevada en la edad
adulta, controlando por peso corporal y sexo.
Si la exposición es considerada en un continuo ( expresada en puntajes
z) se observa una interacción significativa entre este puntaje e Indice
de masa corporal (IMC) (p<0,005), ante lo cual se elaboraron modelos de regresión
lineal estratficados para los adultos con IMC mayor y menor de 25, constatándose
que los con IMC menor de 25 son los que presentan una asociación significativa
entre ser más pequeño para la edad gestacional y tener mayor presión
arterial sistólica, incrementándose en 1.8 mm de Hg al disminuir
en un puntaje z el peso según edad gestacional, siendo que el promedio
de la muestra fue de 109 mm de Hg.
En conclusión esta investigación apoya la teoría del origen
precoz del aumento de la presión sistólica si se controla el IMC.
Financiado por Fondecyt, proyecto 1010572
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Pizarro T, Bustos P, Zumelzu E, Amigo H.
University of Chile, Faculty of Medicine, Department of Nutrition
and Pediatrics
It has been pointed out that there is a direct relation between intrauterine
growth retardation and non communicable chronic diseases in adults.
The aim of this study was to analyze the association between fetal
growth and blood pressure in two cohorts born in a Chilean city between
1974 and 1978. The newborn with less of one standard deviation (SD)
of weight in relation of the gestational age constituted the exposed
cohort and those located above -0.5 SD belong to the non exposed cohort.
The sample size was 70 cases by group. A national standard was used
to classify intrauterine growth, this standard considers the weight
in relation to gestational age, including sex and parity.
There wasn't a significantly association between intrauterine growth retardation
and diastolic blood pressure and there was a direct but not significant relation
between being small for gestational age and having higher systolic blood pressure
in adulthood, controlling by weight and sex.
If the exposure is considered as a continuous variable (expressed as z score),
there was a significantly interaction between this score and body mass index
(BMI) (p<0,005). Different regression models were built stratified by BMI
above and under 25. Models with BMI under 25 had a significant association between
being smaller for gestational age and higher systolic blood pressure, increasing
in 1,8 mm of Hg when z score decreased in one point. Mean systolic blood pressure
for this sample was 109 mm Hg.
In conclusion, this research supports the early origin of increased systolic
blood pressure when BMI is controlled.
Financed by Fondecyt, project number 1010572
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78
RELACIÓN ENTRE EL GASTO EN SALUD Y LA MORTALIDAD NEONATAL (MN) DEL RECIÉN
NACIDO DE BAJO PESO AL NACER (RNBP) EN ARGENTINA ENTRE LOS AÑOS 1995 Y
1999.
de Sarasqueta P.
Area Terapia Intensiva Neonatal. Hospital de Pediatría "Prof. Dr.
J. Garrahan"
INTRODUCCION:
En la década del 90 la mortalidad infantil descendió cerca del
30% mayormente a expensas de la MN del RNBPN. Durante el mismo período
se comprobaron importantes diferencias en la mortalidad de este grupo de niños
entre las distintas regiones y provincias del país.
OBJETIVO:
Se considera que la MN del RNBP es dependiente de la calidad y complejidad de
los cuidados intensivos neonatales, implicando un elevado gasto en salud. Con
el fin de confirmar esta hipótesis se analizó
la relación entre MN de RNBP en cada provincia con el gasto
en salud de cada una de ellas.
MATRIAL Y MÉTODOS:
Se comparó la MN especifica en intervalos de 500 gr de peso al nacer con
el gasto en salud en cada provincia para los cinco años de estudio. Se
realizaron gráficos de relación entre ambos indicadores para todos
los intervalos seleccionados.
RESULTADOS:
Se comprobó una relación inversa entre la MN del RNBP y el gasto
en salud en la mayoría de las provincias. La Capital Federal tuvo el mayor
gasto con la menor MN, mientras que las provincias del Noroeste y Noreste presentaron
mayor MN con menor gasto en salud
Se constataron unas pocas excepciones en provincias donde el menor gasto no se
relacionó con una mayor MN.
CONCLUSIONES:
1- La MN del RNBP presentó grandes diferencias entre provincias y regiones
del país entre 1995 y 19999 con tasas mayores en las regiones del Norte.
2- La mayor MN se relacionó en la mayoría de los casos con un menor
gasto en salud..
3- El desarrollo y la calidad de los cuidados intensivos neonatales depende de
una adecuada inversión en salud, lo que permite obtener los mejores resultados
en la MN de RNBP.
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78
HEALTH EXPENDITURE AND MORTALITY RATE OF LOW BIRTH WEIGHT INFANTS (LBWI) IN ARGENTINA
BETWEEN 1995-1999.
de Sarasqueta P.
Neonatal Intensive Care Unit. Hospital de Pediatría "Prof. Dr. .J.
P. Garrahan"
Introduction:
Infant mortality has decreased about 30% during the ninety-decade, mainly due
to neonatal mortality of LBWI. During the same period important differences
in mortality rates were seen among the group when referred to the different
regions and districts of the country.
Objective:
It is generally considered that neonatal mortality of LBWI is dependent of quality
and complexity of neonatal intensive care, which implies high health expenditure.
With the aim to confirm that hypothesis the relationship between neonatal mortality
of the LBWI and health expenditure were analyzed for each district.
Material and Methods:
We compared specific mortality in groups of 500 grams of birth weight with health
expenditure for each district during the five-year period.
Graphics of relationships were constructed between both indicators for all selected
groups.
Results:
An inverse relationship was noted between neonatal mortality of LBWI and health
expenditure in the majority of Argentine's districts and regions. The Federal
District showed the highest health expenditure and the Northeastern and Northwestern
districts the lower one, which was related with the highest mortality rates
Conclusions:
1) Neonatal mortality of LBWI showed great differences among regions and districts
of our country between 1995 and 1999, with the higher rates in the Northern regions
2) The highest mortality of LBWI were, in most cases, related to a low health
expenditure
3) The development and quality of neonatal intensive care depend upon and adequate
health investment, which allows achieving the best results in neonatal mortality
of LBWI.
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TERAPÉUTICA VENTILATORIA DE RESCATE CON ALTA FRECUENCIA (HFV) EN LA UNIDAD
DE CUIDADOS INTENSIVOS NEONATALES (UCIN)
Céspedes E, Capelli C, Couceiro C, de Sarasqueta P.
Area Terapia Intensiva Neonatal. Hospital de Pediatría "Prof. Dr.
J. Garrahan"
Introducción: La HFV se ha usado como terapia de rescate en
neonatos con hipoxemia e hipercapnea grave por fracaso de la ventilación
convencional (VC) .- El objetivo del estudio fue describir la experiencia
de la HFV y sus resultados desde su inicio en la UCIN en 1997.-
Material y métodos: Se incluyeron 88 neonatos y lactantes tratados con
HFV por 2 o más horas.- Se emplearon dos equipos Infant Star y Sensormedic.
Un porcentaje elevado de pacientes recibió terapia combinada con Oxido
Nítrico.- Los resultados se presentan como frecuencias relativas y las
diferencias entre el grupo de sobrevivientes y fallecidos por el test t.-
Resultados: Cuadro :Resultados de la HFV (n:88)
|
Diagnóstico
|
peso(gramos)
|
edad al ingreso HFV(días)
|
IO al ingreso
|
fallecidos
|
|
(mediana -rango)
|
(mediana -rango)
|
(mediana -rango)
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||
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SALAM (n:14)
|
3380(2500-4200)
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1.0(1-12)
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30(10-54)
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3
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|
SDR (n:19)
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1500 (750-2870)
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1.0(1-9)
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23(5-92)
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4
|
|
HDC(n:19)
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2900(1660-4200)
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1.0(1-14)
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40(6-166)
|
15
|
|
EA(n:8)
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1900 (650-2890)
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11.0(1-40)
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21(7-45)
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1
|
|
IRB(n:9)
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2200 (850-3560)
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30 (9-80)
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23(6-40)
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2
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|
SEPSIS (n: 8)
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1160 (700-1930)
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30(15-155)
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36(9-90)
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6
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|
HPP (n.2)
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2375(2250-2800)
|
11(1-22)
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25(20-31)
|
1
|
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Otras causas(n: 11)
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2800(1100-3900)
|
3(1-30)
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21 (5-45)
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3
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Conclusiones:
-La HFV fue una estrategia útil en el rescate de 53 neonatos críticos
con fallo respiratorio y fracaso de la VC .- Los sobrevivientes tuvieron mejor
IO alas 6 horas de HFV (p<0.05).-
Los sobrevivientes presentaron una alta incidencia deDBP.- Aunque el ingreso
a HFV fue con frecuencia tardío y con IO muy variables la HFV permitió recuperar
un elevado porcentaje de casos con IO muy altos y alto riesgo de mortalidad.
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RESCUE HIGH FREQUENCY VENTILATION (HFV) THERAPY AT NEONATAL INTENSIVE
CARE UNIT (NICU)
Céspedes E, Capelli C, Couceiro C, de Sarasqueta P.
Neonatal Intensive Care Unit. Hospital de Pediatría "Prof. Dr. .J.
P. Garrahan"
Introduction: HFV has been used as rescue therapy in grave hypoxic
and hypercapnic neonates when conventional mechanical ventilation fails.
The goal of this study was to describe the experience with HFV and
results since its beginning at NICU in 1997.
Material and methods: 88 neonates and infants receiving HFV during a period longer
than 2 hours were included- Infant Start and Sensor Medics equipment were used.
An elevated percentage of patients received combined therapy with nitric oxide.
The results are presented as relative rates and t test was used to show differences
between survivors and no survivors -
Results: Table: HFV Results (n: 88)
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Diagnostic
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Weight (gm)
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HFV starting age (days)
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Initial OI
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Deceased
|
|
(Mean -range)
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(Mean -range)
|
(Mean -range)
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||
|
MAS (n:14)
|
3380(2500-4200)
|
1.0(1-12)
|
30(10-54)
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3
|
|
RDS (n:19)
|
1500 (750-2870)
|
1.0(1-9)
|
23(5-92)
|
4
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|
CDH(n:19)
|
2900(1660-4200)
|
1.0(1-14)
|
40(6-166)
|
15
|
|
AL(n:8)
|
1900 (650-2890)
|
11.0(1-40)
|
21(7-45)
|
1
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|
LRF(n:9)
|
2200 (850-3560)
|
30 (9-80)
|
23(6-40)
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2
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|
SEPSIS (n: 8)
|
1160 (700-1930)
|
30(15-155)
|
36(9-90)
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6
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|
PPH (n.2)
|
2375(2250-2800)
|
11(1-22)
|
25(20-31)
|
1
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Others causes(n: 11)
|
2800(1100-3900)
|
3(1-30)
|
21 (5-45)
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3
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Conclusions:
-HFV was a useful strategy in rescue 53 critical neonates with respiratory failure
and when conventional ventilation failed. . - At 6 hours of HFV survivors showed
better OI (p<0.05). - BPD incidence was high among survivors. - Although
HFV beginning was frequently late and with variable OI, HFV allowed to rescue
an elevated percentage of patients with very high OI and high risk mortality.
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ANÁLISIS CLINICO DE 27 RECIEN NACIDOS VENTILADOS EN ALTA
RECUENCIA
HOSPITAL DEL SALVADOR, SERVICIO DE NEONATOLOGÍA, 1999-2001.
Tejerína H, Hering E, Gonzales R.
Servicio de Neonatología, Hospital del Salvador, Facultad de Medicina
Universidad de Chile.
La morbimortalidad en recién nacidos que han requerido ser
ventilados a presión positiva es un problema importante dentro
de las unidades de cuidado intensivo neonatal. La ventilación
de alta frecuencia oscilatoria (VAFO), es una alternativa en el fracaso
de ventilación convencional. El objetivo del estudio es evaluar
su uso en recién nacidos con insuficiencia respiratoria grave.
Método. Se hace un análisis descriptivo de 27 recién nacidos
ventilados en VAFO, en un periodo entre Noviembre de 1999 y Agosto del 2001 comparando
parámetros en ventilación convencional (VC) previo cambio a VAFO
(inicio), a las 3 a 5 horas y los parámetros durante la VAFO en la que
se alcanzaron las máximas presiones ventilatorias (max). Resultados. Se
ventilaron 27 RN, 74% pretérminos entre 25 y 36 sem y pesos entre 730
-3100g, 26% de término con pesos hasta 4250g. Las principales causas de
conexión a VAFO fueron el fracaso a VC (44,4%), Enfisema intersticial
(22,2%), Neumotórax (11,1%), Hipertensión pulmonar (22,2%). Los
promedios, valores máximos y mínimos de Indice de oxigenación(IO)
fueron: 25 (7-48) inicio, 18(7-38) 3-5 hrs, 16(6-36) max;
amplitud de presión: 23(20-30) inicio, 26(20-43) 3-5 hrs, 27(20-43) max;
Presión media de vía aérea: 12(7-16) inicio, 13(7-24) 3-5
hrs, 14(9-20) max.
En dos pacientes se requirió el uso de óxido nítrico, por
el lapso de tres días en cada uno de ellos. La PaCO2 presentó
descenso significativo desde el primer control entre las 3 y 5 horas,
los valores de CO2 medidos por sensor transcutaneo fueron similares
a los registrados en los gases arteriales. Cinco pacientes fallecieron,
3 prematuros extremos con muy mala condición previa, una cardiopatía
congénita y un RN con sepsis severa a estreptococo grupo b.
Complicaciones: Seis RN evolucionaron con displasia broncopulmonar,
uno con oxígeno dependencia al alta, 7 Hemorragias intracerebrales,
grado I, II y solo una grado IV, 2 pacientes prematuros de 26 semanas
la presentaron hemorragia pulmonar en su fase terminal, previo a su
deceso.
Conclusiones. La VAFO es una alternativa válida en pacientes con insuficiencia
respiratoria grave, principalmente como rescate ventilatorio.
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CLINIC ANALYSES OF 27 NEONATES IN HIGH FREQUENCY VENTILATION
HOSPITAL DEL SALVADOR, SERVICE OF NEONATOLOGY, 1999-2001.
Tejerina H, Hering E, Gonzales R.
Servicio de Neonatologia, Hospital Del Salvador, Facultad de Medicina, Universidad
de Chile.
Neonates required to be ventilated with positive pressure is an important problem in units of neonative intensive care. High frequency oscilatory ventilation (HFOV), is an alternative in the failure of conventional ventilation. The objective of the study is to evaluate its use in neonates with serious respiratory failure. Method. Descriptive analysis of 27 neonates required HFOV, a period between November of 1999 and August of the 2001 comparing parameters in conventional ventilation (CV) in HFOV (beginning), at 3 to 5 hours from de beginning and parameters during the HFOV in which the maximum ventilatorias pressures were reached (max). Results. From the 27 neonates, 74% were preterms between 25 and 36 sem and weights between 730-3100g, 26% term new borns with weights until 4250g. The main causes of connection to HFOVwere the failure to CV (44,4%), interstitial Enfisema (22,2%), Neumotórax (11,1%), pulmonary Hypertension (22,2%). The average, maximum and minimum values of Indice of oxigenación(IO) were: 25 (7-48) beginning, 18(7-38) 3-5 hrs, 16(6-36) max; pressure amplitude: 23(20-30) beginning, 26(20-43) 3-5 hrs, 27(20-43) max; Medial airway pressure 12(7-16) beginning, 13(7-24) 3-5 hrs, 14(9-20) max. In two patients the nitric oxide use was required, by the lapse of three days in each one of them. The PaCO2 presented significant reduction from de beginning to the first control between the 3 and 5 hours, the values of CO2 measured by transcutan sensor were similar to the registered ones in arterial gases. Five patients passed away, 3 premature with very bad previous condition, a congenital cardiopathy and one severe sepsis to estreptococo group b. Complications: Six neonates broncopulmonar displasia, one with oxygen dependency to the discharge, 7 intracerebral Hemorrhages, degree I, II and single a degree IV, 2 premature patients of 26 weeks presented pulmonary hemorrhage in their final stage, previous to their decease. Conclusions. The HFOV is a valid alternative in patients with serious respiratory insufficiency, mainly as rescue ventilation.
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81
ESTUDIO PILOTO DE LA RELACIÓN COSTO-BENEFICIO DE LA ADMINISTRACIÓN
DE GENTAMICINA CADA 24 HORAS EN NEONATOS DE TÉRMINO.
Travaglianti M, Cáceres Guido P, Castro G, Bramuglia G,
Casali A, de Sarrasqueta P, Mato G.
Área de Farmacia y Área de Neonatología (Htal. de Pediatría
Prof. Dr. Juan P. Garrahan) y Cátedra de Farmacología (Ftad. de
Farmacia y Bioquímica -UBA)-Grupo de Farmacocinética Aplicada
Introducción: Existe evidencia que la administración
de gentamicina para neonatos en dosis de 4 mg/kg/día es más
segura, determina mejores niveles terapéuticos y disminuye la
necesidad del control de los niveles séricos para ajustar las
pautas de dosificación. Como la información es limitada,
se realizó un estudio aleatorio, prospectivo, doble ciego, comparando
las dosis de 4 mg/kg/día (c/24 hs) con la dosis habitual de
2,5 mg/kg/dosis cada 12 hs. en menores de 7 días de edad postnatal
y 2,5 mg/kg/dosis cada 8 horas en mayores de 7 días de edad
postnatal, con el objeto de estudiar la farmacocinética, ajustar
la pauta de dosificación según los resultados y analizar
el posible ahorro de medicación y tiempo de enfermería
y de uso de bombas de infusión si la pauta de menor frecuencia
fuera más efectiva. Materiales y métodos: Se analizaron
12 neonatos de término (Peso mediana: 2,9 kg; rango 2,5 a 3,6
kg) que recibían gentamicina por infección confirmada
ó sospechada. Se excluyeron los casos de insuficiencia renal
oligúrica (creatinina sérica = 1,2 mg/dl, urea > 40
mg/dl, diuresis < 1 ml/kg/hora) ó con asfixia grave. Se determinaron
dos valores de valle y un valor de pico a partir de la segunda o tercera
dosis, según el esquema de tratamiento. En base a los datos
de los monitoreos del fármaco se ajustaron las dosis y las frecuencias
hasta terminar el tratamiento. Resultados: No hubo valores tóxicos
(>12 µg/ml) ni subterapéuticos en niveles de pico.
El análisis farmacocinético de los 12 casos permitió
disminuir en 11 casos la dosis administrada (mediana de la dosis diaria:
3,59 mg/kg/día). A su vez el intervalo mas largo determinó
el ahorro de horas de trabajo de enfermería y menor uso de bombas
de infusión (mediana: 50 %; rango 33% a 66 %). La evolución
clínica de la infección fue satisfactoria en todos los
casos.
Conclusiones: 1 - La dosis de gentamicina de 4 mg/kg/día c/24 hs. es efectiva
y segura. 2 - El análisis farmacocinético clínico permitió descender
la dosis diaria y disminuir la cantidad de aminoglucósido administrado
y produjo ahorro en uso de bombas de infusión y del trabajo de enfermería
relacionado a la antibioticoterapia.
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STUDY OF THE COST-BENEFIT RELATIONSHIP OF THE ONCE DAY ADMINISTRATION OF GENTAMICIN
IN TERM NEONATES PATIENTS.
Travaglianti M, Cáceres Guido P, Castro G, Bramuglia G,
Casali A., de Sarrasqueta P, Mato G.
Área de Farmacia y Área de Neonatología (Htal. de Pediatría
Prof. Dr. Juan P. Garrahan) y Cátedra de Farmacología (Ftad. de
Farmacia y Bioquímica - UBA) - Grupo de Farmacocinética Aplicada
Introduction: previous works have shown that gentamicin 4 mg/kg /24
hs would be safe in neonate patients. It would also allow to optimize
the therapeutic drug monitoring and doses adjustment. A prospective
and randomized study was carried out in order to compare 4mg/kg/24
hs with standard doses of 2.5 mg/kg/12 hs in neonates with less than
7 days of postnatal age, or 2.5 mg/kg/8 hs in neonates with more than
7 days of postnatal age. Peak and trough levels of gentamicin were
obtained in order to characterize pharmacokinetic of each patient using
bayesian non-linear regression analysis. Dose adjustment was then carried
out and the savings in medication and nursing time, together with the
use of iv infusion pumps, were analyzed in relation with dose regimen.
Methods: 12 term neonates (median weight: 2.9 kg; 2.5 - 3.6 kg), treated with
gentamicin were analyzed . Patients with oliguric renal impairment (serum creatinine
= 1.2 mg/dl, urea >40 mg/dl, diuresis < 1ml/kg/h) or with serious asphyxia
were excluded. Two troughs and one peak were obtained from second or third dose,
according with dose regimen. Plasma levels were fit in order to obtain pharmacokinetic
parameters of each patient and to adjust dose regimen.
Results: We did not find peak plasma levels less than 12 µg/ml or sub-therapeutic
levels. Pharmacokinetic analysis allowed to reduced gentamicin daily dose in
11 patients (daily dose median value: 3.59 mg/kg/24 hs, 1.80 - 7.92). Moreover
greater intervals produced savings of nursing working time and a decreased in
the use of iv infusion pump (median values: 50%, 33-66%). Clinical evolution
of the infection was successful in all patients.
Conclusions: 1 - Gentamicin dose of 4mg/kg/24 h showed to be effective and safe.
2 - Clinical pharmacokinetic analysis allowed to decreased the daily dose together
with the amount of gentamicin administered. It also resulted in saving of the
use of iv infusion pumps and the nursing working time related with antimicrobial
therapy.
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82
RELAÇÃO ENTRE FATORES DE RISCO CARDIOVASCULAR E CONSUMO ALIMENTAR
DE ADOLESCENTES.
Sleiman J, Ferrari, Slater B, Fisberg M.
Centro de Apoio e Atendimento ao Adolescente - Universidade Federal de São
Paulo - Faculdade de Saúde Pública - Universidade Estadual de São
Paulo
O presente estudo teve como objetivo relacionar o consumo alimentar de adolescentes com a presença de fatores de risco para doenças cardiovasculares (DCV).O estudo foi realizado com 272 adolescentes voluntários de ambos os sexos, com idade 17-19 anos, estudantes do 3º ano do ensino médio do São Paulo. Os alunos participantes do estudo, inicialmente preencheram um questionário sobre a presença de fatores de risco para DCV (histórico familiar e de dislipidemia, uso de anticoncepcional oral, tabagismo, hipertensão arterial e atividade física). Foram também coletados dados sobre peso e altura para cálculo do Índice de Massa Corporal (IMC). Foi igualmente aplicado um questionário de freqüência alimentar para adolescentes, semiquantitativo, sobre seus hábitos alimentares. Foram obtidos os valores de colesterol total (CT) e frações e de triglicérides (TG). Dos 272 alunos participantes, 51% (n=139) eram do sexo feminino e 49 (n=133) do sexo masculino, com idade média de 17,5 anos. Através do levantamento de fatores de risco para DCV, 30,5 % dos adolescentes apresentaram ao menos um fator de risco, 36% de dois a três e 6,3% apresentavam quatro ou mais fatores de risco. Os fatores de risco mais prevalentes foram dislipidemia na família (32,4%), sedentarismo (30,4%), excesso de peso (19,8%) e histórico familiar para DCV (18,8%). A porcentagem de adolescente que apresentou dislipidemia, caracterizada por níveis de CT, lipoproteína de baixa densidade (LDL-C) e TG aumentados foi de 18,4%, 7,0% e 10,3% respectivamente. Níveis baixos de HDL-C foram observados em 4% dos adolescentes. Para o consumo alimentar, as médias obtidas em relação à energia, carboidrato, lipídio total, lipídio saturado, lipídio insaturado e fibra foram maiores nos meninos, sendo estatisticamente significante. Não foram encontradas relações entre o consumo alimentar e os grupos de fatores de risco, categorizados em baixo risco (até um fator de risco), médio risco (dois a três) e alto risco (mais de quatro fatores), assim como entre o consumo alimentar e o perfil lipídico. Fatores de risco para as DCV estiveram presentes em mais de 50% dos adolescentes. Apesar de não serem encontradas relações estatísticas com o consumo alimentar, a alimentação é um importante fator de risco devendo ser integrante das estratégias de ação, que minimizem os problemas de saúde que a mesma pode acarretar, em algum momento da vida dos adolescentes
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RELATIONSHIP BETWEEN CARDIOVASCULAR RISK FACTORS AND FOOD CONSUPTION IN TEENAGERS.
Sleiman J, Ferrari, Slater B, Fisberg M.
Centro de Apoio e Atendimento ao Adolescente - Universidade Federal de São
Paulo - Faculdade de Saúde Pública - Universidade Estadual de São
Paulo
The present study aims at relating the adolescent alimentary consumption with the presence of cardiovascular disease risk factors (CVD). Methods: The study was conducted with 272 volunteer adolescent individuals of both sexes, ages ranging between 17 and 19, all 3rd grade students at a technical school located in the city of São Paulo. The participant students have initially filled a form informing on the presence of CVD risk factors (familiar historic and dyslipidemy, oral anti contraceptive use, smoking habits, arterial hypertension and physical activity). Data on weight and height have also been collected in order to calculate the Body Mass Index (BMI). It has been equally applied an adolescent alimentary frequency form, semi-quantitative, concerning their alimentary habits. Through biochemical dosages, the values of total cholesterol (TC) and fractions, as well as triglycerides (TG) have also been collected. Results: Out of the 272 students under study, 51% (n=139) were female and 49% (n=133) were male, with average age of 17,5 years old. Through the obtained information on CVD risk factors, 30,5% of the adolescents presented at least one risk factor, 36% from two to three, and 6,3% presented four or more risk factors. The most present factors were dyslipidemy in the family (32,4%), sedentary (30,4%), weight excess (19,8%) and CVD in the family (18,8%). The percentage of adolescents who presented dyslipidemy, categorized by TC levels, low density lipoprotein (LDL-C) and high TG was 18,4%, 7,0% and 10,3%, respectively. Low levels of HDL-C were observed in 4% of the adolescents. As to alimentary consumption, the average value obtained related to energy, carbohydrate, total lipidium, saturated lipidium, unsaturated lipidium and fiber were higher in the boys, fact which is considered statistically significant. No relations were found between alimentary consumption and the risk factor groups, categorized at low risk (two to three) and high risk (more than four factors), as well as between alimentary consumption and lipidic profile. Conclusion: CVD risk factors were present in over 50% of the adolescents under study. Even though no statistical relations with alimentary consumption were found, nutrition is an important risk factor that should take place in action strategies which minimize the health problems that nutrition may cause at some point of adolescent individuals' life.
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DISTRIBUCIÓN DEL IMC EN UNA POBLACIÓN DE NIÑOS Y ADOLESCENTES
QUE CONSULTAN AL PEDIATRA EN LA REPÚBLICA ARGENTINA.
Berner E, Bay L, Herscovici C, Kovalskys I, Bergesio A, Orellana.
Sociedad Argentina de Pediatría.
Introducción: El Índice de masa corporal (IMC) es un
instrumento útil en pediatría para la determinación
de grasa corporal. Las tablas de IMC usadas internacionalmente se confeccionan
en base a percentilos (Pc) por edad y sexo. El aumento en la prevalencia
de obesidad en todo el mundo revela un desplazamiento de los niños
hacia los percentilos superiores con una mayor concentración
de la población por encima del Pc 50. Objetivo: Determinar la
distribución de los niños estudiados en nuestra población
utilizando los percentilos de IMC de Rolland Cachera. Material y Métodos:
Se determinó el IMC de niños y adolescentes de 10 a 19.9
años de todas las regiones del país, que asistieron a
la consulta pediátrica por diferentes motivos. Pediatras de
la Sociedad Argentina de Pediatría midieron, pesaron y calcularon
el IMC a niños y adolescentes tomados al azar en los consultorios
públicos y privados. La muestra total es de 1971 casos,(1231
mujeres, y 740 varones). Se tomaron datos sociodemográficos
relevantes de los niños y sus familias. El diagnóstico
del grado de IMC se realizó según las tablas de IMC de
Rolland Cachera.
Resultados: Los niños y adolescentes que se encuentran por encima del
Pc 50 son el 65 % de la población estudiada. Un 1.4% se encuentran por
debajo del Pc3. Un 26,5% tienen sobrepeso (s) u obesidad(o) ( PC
> 90). La distribución de IMC fue equivalente en el medio
urbano con en el rural y no hubo diferencias entre la distribución
de los niños atendidos en la consulta pública en relación
a la privada. Hubo un 62.5% de mujeres con IMC superior al percentilo
50, y un 70.4% de varones, con una prevalencia de 30.5% de S y O en
los varones vs 24.1% en las mujeres ( p:0,01) Hay significativamente
más padres reportados como obesos entre los niños agrupados
en los percentilos mas altos comparados con los más bajos.
Conclusión: En la clasificación internacionalmente usada para índice
de masa corporal en pediatría se observa una concentración de nuestra
población en los percentilos más altos. La importancia clínica
radica en el incremento de prevalencia de sobrepeso y obesidad de la población
pediátrica.
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DISTRIBUTION OF BMI IN A POPULATION OF ARGENTINE CHILDREN AND ADOLESCENTS WHO
VISIT THE PEDIATRICIAN.
Berner E, Bay L, Herscovici C, Kovalskys I, Bergesio A, Orellana,
L.
Sociedad Argentina de Pediatría.
Introduction: Body Mass Index (BMI) is a valuable instrument for determining
body fat, of regular use in pediatric practice. The BMI tables used
internationally are based on percentiles (Pc) for age and sex. The
increase in the worldwide prevalence of obesity shows a displacement
of children and adolescents towards the higher percentiles, with an
increase in the concentration of the population above the Pc 50. Objective:
Determine the distribution of the BMI of the population of this study
utilizing the BMI percentiles of Rolland Cachera. Method: The BMI was
calculated for a sample of children and adolescents ages 10 to 19.9
of all the regions of the country who came to the pediatric visit for
any given reason. Pediatricians of the Argentine Society of Pediatrics
measured, weighed and calculated the BMI of a randomized sample of
participants taken from private and public pediatric offices. The total
sample is of 1971 cases,(1231 females and 740 males). Relevant sociodemographic
data was gathered pertaining to the participants and their families.
The BMI was calculated following the Rolland Cahera norms. Results:
A 65% of the children and adolescents of the sample are above Pc50. A 26.5% is
overweight or obese ( Pc>90). 1.4% of the population is under PC 3. The distribution
was similar at urban and rural area and there were no differences between public
and private consultation. A 62,5% of the girls and 70,4% of the boys are above
PC 50, and the prevalence of overweight and obese is higher in the males than
in the females.( 30,5% vs 24.1%) ( 0,0019) More parents of children that are
in the higher percentile reported to be obese ( significant difference) in compared
with the lower ones. Conclusion: using the BMI pediatric reference we observe
a higher concentration of our population in the higher percentiles. The clinical
concern is centered in the rapidly increasing of the prevalence of overweight
and obese children.
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RELACIÓN DE ADIPOSIDAD VISCERAL Y CORPORAL CON VALORES DE LÍPIDOS
SANGUÍNEOS, SEGÚN EDAD PUBERAL, EN ADOLESCENTES OBESAS.
Bravo A, Neri D, Moraga F, Rebollo MJ, Espinoza A, Castillo-Duran
C.
Dpto. Pediatría, Fac. de Medicina, U. Chile; Serv. de Pediatría
y Serv. de Rayos Hosp. San Borja Arriarán; Instituto de Nutrición
y Tecnología de los Alimentos (INTA), U. de Chile.
Actualmente la obesidad es un problema de salud muy frecuente en el
mundo y cuando se inicia en la edad pediátrica, es considerada
un factor de riesgo para enfermedades crónicas no transmisibles
del adulto y sus alteraciones metabólicas. Varios estudios han
mostrado que la morbilidad asociada a la obesidad no tiene necesariamente
una correlación con la magnitud de la acumulación total
de grasa en el organismo, pero sí se relaciona estrechamente
con su distribución abdominal o visceral.
OBJETIVO: Estudiar la asociación existente entre mediciones de adiposidad
visceral y corporal con valores de lípidos sanguíneos, en adolescentes
obesas.
METODOLOGIA: Se realizó un estudio preliminar analítico transversal
en 20 niñas obesas de 10 a 15 años, asistentes a una clínica
de obesidad, con índice de masa corporal (IMC) > p90 (de acuerdo a
desarrollo puberal por Tanner). Se evaluó
peso, talla, índice de masa corporal (IMC), pliegues cutáneos,
perímetro abdominal, relación cintura-cadera, perfil
lipídico y grasa visceral y subcutánea por tomografía
computada, con un corte sobre la cresta ilíaca.
RESULTADOS: El IMC fue 25,5 ± 2,7 Kg/m2; el perímetro abdominal
87,5 ± 8,3 cm; la relación cintura/cadera 0,94
± 0,04. Se observó una correlación entre: IMC
y grasa subcutánea por scanner (r= 0,81; p< 0,001), IMC y
perímetro abdominal (r= 0,88; p< 0,001); estas correlaciones
fueron semejantes al analizar las adolescentes con Tanner I+II vs III-IV.
La grasa visceral medida como distancia columna-músculo recto > 60
mm se asoció
con colesterol > 170 mg/dL (RR 4,50; 1,19-16,96; p= 0,019); fue
mejor que la medición músculo-aorta. No se encontró un
nivel predictor de colesterol elevado en IMC, cintura, cintura-cadera
y pliegues sub-cutáneos.
CONCLUSIONES: La acumulación de grasa visceral en adolescentes obesas
es un bien predictor de elevaciones de los lípidos séricos; la
medición de grasa visceral por tomografía computada es una herramienta
significativa en el estudio de adiposidad visceral.
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RELATIONSHIP AMONG VISCERAL AND BODY ADIPOSITY AND BLOOD LIPID LEVELS,
ACCORDING WITH PUBERAL MADURATION IN OBESE FEMALES ADOLESCENTS.
Bravo A, Neri D, Moraga F, Rebollo MJ, Espinoza A, Castillo-Duran
C.
Dpt. of Pediatrics, Fac. of Medicine, U. Chile; Serv. of Pediatrics and Dept
of Imagenolgy, Hosp. San Borja-Arriarán; Instituto of Nutrition and Food
Technology (INTA), U. de Chile.
Obesity is a worldwide health problem actually, and it is considered
as a risk factor for non-transmittable chronic diseases in adult life,
when it is beginning during childhood. Several studies have shown that
morbidity associated to obesity is partially associated with most of
the usual anthropometric measurements of obesity; the associatino is
stronger with abdominal or visceral mesurements of adiposity.
OBJECTIVE: To evaluate the association among visceral and body measurements of
adiposity and blood lipid levels, in obese female adolescents.
METHODS: A preliminary cross-sectional study in 20 obese adolescents (10-15 y)
was performed. They were attending to a clinic of obesity and presented a body
mass index (BMI) > p90 (in relation to Tanner puberal stages). Weight, stature,
BMI, skinfolds, abdominal circumference (AC), waist-to-hip ratio, blood lipid
fractions, and visceral and subcutaneous fat measurements with computed tomography
(a single
cut at iliac crest level) were studied.
RESULTS: BMI was 25.5 ± 2.7 Kg/m2; AC was 87.5 ± 8.3 cm; waist-to-hip
was 0.94 ± 0.04. a correlation between BMI and scanner subcutaneous fat
was found (r= 0,81; p< 0,001), also between BMI and AC (r= 0,88; p< 0,001);
these correlations were comparable when analyzing adolescents with Tanner I+II
vs III-IV. Visceral fat >
60 mm, evaluated as the straight line vertebrae-muscle, was associated
with total cholesterol > 170 mg/dL (RR 4.50; 1.19-16.96; p= 0.019)
and resulted as better predictor than the aortic-muscle line. No cut-off
point was found for BMI, AC, waist-to-hip ratio or skinfolds to predict
alterations of cholesterol levels.
CONCLUSIONS: The visceral fat in obese female adolescents is a good predictor
for increased serum lipids; measurements of visceral fat through computed tomography
is a tool for studying visceral adiposity.
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HALLAZGOS ANTROPOMETRICOS Y RADIOLOGICOS EN PACIENTES CON HIPOCONDROPLASIA Y
SU CORRELACION CON LA PRESENCIA DE MUTACIONES EN EL GEN DEL RECEPTOR DE FACTORES
DE CRECIMIENTO DE FIBTOBLASTO TIPO 3
del Pino M*, Fano V*, Gravina P**, Chertcoff L**, Barreiro C***,
Lejarraga H.
*Crecimiento y desarrollo ** Biologia Molecular *** Genetica. Hosp J. P. Garrahan.
Bs As. Arg.
La Hipocondroplasia es una displasia esquelética de herencia autosomica dominante caracterizada por baja estatura con miembros cortos que presenta una amplia variabilidad fenotípica. En un 50-70 % de los casos se encuentran mutaciones en el gen del FGFR3. El diagnóstico se basa en los criterios clínicos y radiológicos de Spranger. Objetivo: correlacionar los criterios antropométricos y radiológicos con los hallazgos moleculares en 21 niños con diagnostico de Hipocondroplasia .Pacientes y Métodos: En todos los pacientes se efectuaron mediciones antropométricas del perímetro cefalico (P.C.), estatura (E) estatura sentada (E.S.) y longitud de miembros inferiores (LMI) y se calculó el puntaje Z. Se realizo lectura a ciego de las radiografías. Se analizó por secuenciacion e hibridizacion alelo especifica (ASO) la región del gen FGFR3 que incluye las mutaciones prevalentes (N540K C®A y C®G) y la mayoría de las mutaciones raras descriptas ( N540T, N540S y I538V). Se dividieron la muestra en 2 grupos según el resultado del molecular. Se utilizo el test de la mediana y el test de fisher para comparar ambos grupos. Se selecciono los puntos de corte de las variables significativas por ROC análisis Resultados: en 14 pacientes se detecto una mutación en el gen FGFR3 (8 N540K C®A y 6 N540K C®G) (grupo1) y en 7 su secuencia fue normal (grupo 2). Se encontraron diferencias estadísticamente significativas en el P.C. y en la LMI entre ambos grupos. La mediana del PC fue de 2,05 (0,80/3,80) en el grupo 1 y de -0,10 (-2,29/ 1,13) en el grupo 2 (test de la mediana p=0,001). La mediana de la LMI fue -5,15 (-7,10/ -4,00) y de -4,10 (-5,50/-3,30) para el grupo 1 y 2 respectivamente (test de la mediana p=0,033). El punto de corte del P.C. para separar ambos grupos fue de + 1,13 Ds (Sensibilidad 92,3% y Especificidad de 100%) y de - 5,8 Ds para la LMI (Sensibilidad de 28,6% y Especificidad de 100%). No se encontró asociación entre los criterios radiologicos y la presencia o no de la mutación. Conclusión: En esta población los hallazgos Auxológicos (mayor tamaño del P.C. y menor LMI) permiten diferenciar al grupo de pacientes con las mutaciones en el gen FGFR3 no así los signos radiologicos.
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ANTHROPOMETRIC AND RADIOLOGICAL FINDINGS IN PATIENTS WITH HYPOCHONDROPLASIA AND
ITS CORRELATION WITH THE PRESENCE OF THE GENE MUTATION OF THE FIBROBLAST
GROWTH FACTOR RECEPTOR 3.
del Pino M*, Fano V*, Gravina P**, Chertcoff L**, Barreiro C***,
Lejarraga H.
*Growth and Development ** Molecular Biology. *** Departament of Clinical Genetics
Garrahan Hospital. Buenos Aires. Argentina.
Hypochondroplasia is a skeletal dysplasia with autosomic dominant inheritance characterized by short stature with short limbs, that present a wide phenotypic variation. In 50-70% of the patients the mutations are found in the gene FGFR3. The diagnosis is based on the clinical and radiological criteria described by Spranger. Objective: to correlate the anthropometric and radiological criteria with the molecular findings in 21 patients. Patients and Methods: In all patients we measured the Head Circumference (HC), height, sitting height and leg length (LL), and we calculated Z scores. We also performed a blind reading of the X Rays. The region of the FGFR3 gene that includes prevalent mutations (N540K C®A y C®G) and the majority of the rare mutations (N540T, N540S and I538V) were analyzed by sequencing and allelic specific hybridization (ASO). Median test and Fisher test were used to compare both groups according to the molecular results . We set cut off points for the significant variables with ROC analysis. Results: a mutation in FGFR3 was detected in 14 patients (8 N540K C®A y 6 N540K C®G) (group 1) and in 7 the sequence was normal (group 2). We found statistically significant differences in the HC and LL between both groups. The median in HC was 2,05 (0,80/3,80) (group 1) and -0,10 (-2,29/ 1,13) (group 2) (Median Test p=0,001). The median in LL was -5,15 (-7,10/ -4,00) and -4,10 (-5,50/-3,30) respectively (Median Test p=0,033). The cut off point that divided both groups was for the HC + 1,13 SD (with a sensitivity of 92,3% and specificity of 100%), and - 5,8 SD for the LL (with a sensitivity of 28,65 and specificity of 100%). No association between the radiological criteria and both groups were found/ (N.S. Fisher test). Conclusion: In our sample of patients the auxologic findings (greater HC and shorter LL) permitted the anthropometric differentiation of the patients with the FGFR3 mutation (group 1). The radiological criteria was not useful to predict the presence of the FGFR3 mutation.
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RELACIÓN ENTRE LA ESTATURA DE NIÑOS DE TALLA BAJA Y LA ESTATURA
DE LOS PADRES.
Guimarey L1,2, Apezteguía M1,2, Bolzán A3., Morin
A1, Santucci Z1
1 Endocrinología y Crecimiento. Htal de Niños "SSM Ludovica",
2 Comisión de Investigaciones Científicas, Prov. BsAs, 3 Hospital
Materno Infantil de San Clemente del Tuyú
-Argentina-
El objetivo del presente trabajo fue evaluar la relación entre
la talla de niños con talla baja constitucional y la estatura
de sus padres. Material y Métodos: Se estudiaron 95 niños
(57 varones y 38 niñas) con edad cronológica ³ a
3 años, que consultaron por talla baja, seleccionados de acuerdo
a los siguientes criterios: 1) peso de nacimiento ³3000gr, 2)
diferencia entre la edad ósea y cronológica £ a
2años, 3) velocidad de crecimiento normal y 4) sin patologías
crónicas asociadas. Se calcularon los puntajes z para las tallas
de los niños (ztn), de las madres (ztm) y de los padres (ztp).
Se compararon los valores medios de ztn entre ambos sexos. Tomando
como base a los niños se determinaron 2 subgrupos: (a) 52 niños:
31 varones con edad cronológica £ a 10 años y 21
mujeres con edad cronológica
£ a 9 años, (b) 78 niños (48 varones y 30 mujeres)
con estaturas por debajo del 3er percentilo. Con la muestra (a) se
calcularon los coeficientes de correlación entre ztn y ztm (rnm)
y entre ztn y ztp (rnp). Fue ajustado un modelo de regresión
relacionando ztn con ztm y ztp. Con la muestra (b) se compararon ztm
y ztp mediante el test de Student para muestras apareadas.
Resultados: La media ± DS de los ztn fue -2.25±0.89, de los ztm
-1.13±0.85 y de los ztp -0.69±0.93. No se observaron diferencias
significativas en los valores medios de ztn entre ambos sexos (p=0.259). El rnm
fue 0.48 (p=0.000), y rnp fue 0.40 (p=0.003). Al ajustar el modelo de regresión
lineal considerando ztm y ztp como variables explicativas, el coeficiente de
la ztm fue significativamente diferente de cero (p=0.0081) no así la ztp
(p=0.0977). La comparación de muestras apareadas mostró que la
media de las ztm es inferior a la media de las ztp (p=0.001). Conclusiones: (i)
La talla de los niños estudiados mostró mayor asociación
con la talla materna que con la paterna, (ii) En el grupo de niños con
talla menor que el 3er. percentilo el promedio de las estaturas maternas es significativamente
inferior al de las paternas.
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RELATIONSHIP BETWEEN THE HEIGHT OF SHORT STATURE CHILDREN AND THE PARENT HEIGHT.
Guimarey L1,2, Apezteguía M1,2, Bolzán A3., Morin
A1, Santucci Z1
1 Endocrinología y Crecimiento. Htal de Niños "SSM Ludovica",
2 Comisión de Investigaciones Científicas, Prov. BsAs, 3 Hospital
Materno Infantil de San Clemente del Tuyú
-Argentina-
The aim of the present work was to evaluate the relationship between the height of constitutional short- statured children, and their parents height.Material and Methods: Ninety five short-statured children (57 males and 38 females). Cronological age: ³ 3 years of age. The children were selected by the next criteria: 1) born weight ³ 3000gr, 2) difference between skeletal age and chronological age £ 2 years, 3) normal growth velocity and, 4) absent of chronic associated pathologies. The height z scores were calculated for children (zhch), mothers (zhm) and fathers (zhf). zhch mean values were compared between boys and girls. Children were divided into two subgroups: (a) 52 children: 31 boys £ 10years of age and 21 girls £ 9years of age , (b) 78 children (48 males and 30 females) whose stature was below the 3rd percentil. The correlation coefficient between zhch and zhm (rchm) and between zhch and zhf (rchf)was calculated in subgroup (a). A regression model was determined to relate zhch with zhm and zhf. Zhm and zhf were compared in subgroup (b) by paired t test. Result: The zhch mean±SD was -2.25±0.89, the zhm was-1.13±0.85 and the zhf was -0.69±0.93. Mean values showed no significant differences between both sexes (p=0.259) The rchm was 0.48 (p=0.000), and rchf was 0.40 (p=0.003). On adjusting the lineal model regression considering zhm and zhf as explicative variables, the zhm was significantly different from zero (p=0.0081) on the other hand the zhf was not different from zero (p=0.0977). The comparison by paired t test showed significant differences between zhm and zhf. Mean values for zhm were lower than those for zhf (p=0.001). Conclusions: (i) Children's height was more associated to their mother height than to their father's, (ii) In the group of children whose height was below the 3rd percentil the mother mean height was lower than the father's.
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PERFIL ANTROPOMÉTRICO E PERCENTUAL DE GORDURA DE MODELOS ADOLESCENTES
Rodrigues A, Passos M, Zanetti A, Cavalieri M, Branco L, Cintra
I, Fisberg M.
Centro de Atendimento e Apoio ao Adolescente - Departamento de Pediatria - Universidade
Federal de São Paulo/Brasil - Universidade São Marcos.
Introdução A imagem corporal é, atualmente excessivamente valorizada na sociedade ocidental, especialmente no sexo feminino, e exige de modelos profissionais uma perfeição corporal que segue como padrão a magreza extrema. Este padrão de beleza é, em alguns casos, difícil de ser mantido devido às mudanças de composição corporal normais nessa faixa etária. Na literatura, poucos estudos relatam o estado nutricional desta população exposta a riscos nutricionais próprios da faixa etária e agravados pelo estilo de vida que a profissão exige. Objetivo O objetivo deste estudo foi identificar as características antropométricas e de percentual de gordura de modelos adolescentes de 11 a 19 anos, de ambos os sexos, bem como comparar os resultados obtidos em cada uma das variáveis estudadas, nas diferentes faixas etárias. Métodos A população do estudo compreendeu 192 adolescentes modelos, 171 do sexo feminino e 21 do masculino, nos quais foram realizadas medidas antropométricas de massa e % de gordura corporal, estatura e circunferências braquial e do quadril (para o sexo feminino), por meio de balança e impedanciometro digital modelo Tanita, antropômetro extensível marca Seca e fita métrica, respectivamente. Para análise estatística calcularam-se os valores médios e desvios-padrão de cada variável por faixa etária, comparando-se as médias por meio do teste t de student, agregado à Pearson, e Qui-Quadrado para variáveis qualitativas expressas em proporções, considerando como significativo p < 0,05. Resultados: Verificou-se que 50 modelos (29,24%) tinham entre 11 e 14 anos de idade e que 121 meninas (70,76%) encontravam-se na faixa etária de 15 a 19 anos. Observou-se uma diferença estatisticamente significativa entre as duas faixas etárias do sexo feminino nas seguintes variáveis: massa corporal, estatura, IMC, circunferência do quadril e % de gordura. Quanto aos meninos, todos encontravam-se na faixa etária de 15 a 19 anos. Em relação ao estado nutricional, observou-se que 60% das meninas de 11 a 14 anos 54% na faixa etária de 15 a 19 anos apresentavam IMC<P15. Quanto aos meninos, todos (100%) eram eutróficos. Conclusão: Quanto menor a idade, maior a condição de risco para as meninas. A condição da saúde desse grupo deve ser avaliada, pois além de serem um grupo de risco pela profissão escolhida e faixa etária precoce, ao serem lançados na mídia, os modelos passam a ser referência para os demais. indivíduos, especialmente para mulheres.
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ANTHROPOMÉTRIC PROFILE AND BODY FAT PERCENTAGE OF ADOLESCENT FASHION -
MODELS.
Rodrigues A, Passos M, Zanetti A, Cavalieri M, Branco L, Cintra
I, Fisberg M.
Centro de Atendimento e Apoio ao Adolescente - Departamento de Pediatria - Universidade
Federal de São Paulo/Brasil - Universidade São Marcos.
Introduction: Body image is highly valued in western societies nowadays, specially by female gender, and requires from professional fashion models extreme thinness as usual perfection standards . This beauty standard is in some cases, very dificult to be maintained due to the changes of body composition that occurs at this age range. In literature,very few studies relate the nutritional status of this population so exposed to nutritional risky factors proper of this age range and agravated by the profession lifestyle. Objective: The objective of this study i was identify anthropométric characteristics and body fat percentage of models between 11 and 19 years old, of both sexes, and relate them with age . Méthods: The studied population encompassed 192 adolescent fashion models,171 females and 21 males, in which were done: height and weight( BMI indices) , body fat percentage, arm and hip circunferences (female gender) making use of a scale, a 2polar digital bioimpedanciometer ( TANITA ) , an extensible anthropometer ( SECA ) and a métric scale . For the statistic analisis, medium values and standard deviations were calculated for each variable according to the age range, and comparing the average through the t - Student test in conjunction to Pearsons and X-square to qualitative variables , expressed in proportions, considering as significative an p<0,05. Résults: It was verified that 50 models (29,24%) were between 11 and 14 years old, and that 121 girls (70,76%) were between 15 and 19 years old. It was noticed stastisticlly significant diferences between the two female age groups in the following variables: The older models presented higher heigth, BMI( body mass index), hip circunferece and body fat percentage. As to the boys, all of them were 15 to 19 years old. As to nutritional status, it was noticed that 60% of the girls, being 54% in the age range from 15 to 19 years old , presented a BMI<p15. As for the boys , 100% were eutróphic. Conclusion: Young models presented higher risk as determined by body composition . The health condition of this group is being under analysis, as they are a a risky group due to their choosed profession , being at an early age, and to the fact that when they start to be exposed throughout the media , they do become row models to others teenagers .
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88
CORRELAÇÃO ENTRE O ÍNDICE DE MASSA CORPORAL E A PREGA CUTÂNEA
TRICIPITAL EM CRIANÇAS DA CIDADE DE PAULÍNIA, SÃO PAULO
- BRASIL.
Zambon Mp1, Zanolli Ml1, Marmo Db1, Magna La1, Morcillo Am1, Guimarey
Lm 2.
1universidade Estadual De Campinas (Unicamp). Brasil.
2 Comision De Investigaciones Cientificas. Provincia De Bsas. Argentina
O índice de massa corporal (IMC) tem sido indicado como método
de escolha para o diagnóstico da obesidade em adultos e crianças.
Objetivo: estudar a correlação existente entre o IMC e a prega
cutânea tricipital (PCT).
Casuística e Método: foram avaliadas 4.236 crianças de 3,1
a 10,9 anos, 48,3% do sexo masculino e 51,6% feminino, de quatro estudos realizados
em Paulínia, SP.- Brasil. Mediu-se o peso e a estatura, com os quais calculou-se
o IMC. A PCT foi medida com paquímetro Holtain. Os dados foram transformados
em escores z e comparados à
curva norte-americana (Frisancho, 1993). A população
foi dividida em grupos de acordo com os escores z do IMC: grupo A)
escore z £ -1; B) -1 < escore z < 1; C) escore z ³ 1.
Realizou-se uma análise de regressão linear múltipla
(método stepwise). Os dados foram processados no SPSS.
Resultados: o grupo A, apresentou menor variabilidade na PCT ( = 7,8; DP =2,3)
quando comparado aos demais (B: = 10,1; DP =4 e C: = 17,8; DP =4,4). Na análise
da regressão linear considerando todos os casos a PCT apresentou R2 =
0,478. Nos grupos B e C a PCT teve, R2 = 0,364 e 0,368 respectivamente, enquanto
no grupo A foi apenas 0,032.
Conclusão: a correlação entre o IMC e a PCT é
elevada no grupo de crianças com risco de obesidade (grupo C),
o que justifica o uso indistinto de ambos parâmetros em estudos
populacionais de obesidade em escolares brasileiros.
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88
BODY MASS INDEX AND TRICEPS SKINFOLD CORRELATION IN CHILDREN FROM PAULÍNIA
CITY, SÃO PAULO - BRAZIL
Zambon Mp1, Zanolli Ml1, Marmo Db1, Magna La1, Morcillo Am1, Guimarey
Lm 2.
1universidade Estadual De Campinas (Unicamp). Brazil.
2 Comision De Investigaciones Cientificas. Provincia De Bsas (Cic). Argentina
Body mass index (BMI) has been considered a criterion to define and
analysis obesity in adults and children.
Background: The purpose of this study was to evaluate the correlation between
BMI and triceps skinfold (TSF).
Material and Method: There were studied 4,236 children (3.1-10.9y); 48.3%M:51.6%F,
from four studies follow up in Paulínia, SP-Brazil. Height, weight and
TSF (Holtain caliper) were measured. For each child BMI was calculated and transformed
in SDS, according to North American data (Frisancho, 1993). Multiple linear regression
analysis (stepwise) was used for the whole population and in three groups according
to BMI: A) SDS £ -1.0; B) -1.0 < SDS < 1.0; C) SDS ³ 1.0. Data
were processed with SPSS software.
Results: in group A, the TSF (7.8 ± 2.3) variability was lower when compared
with the groups B (10.1 ± 4.0) and C (17.8 ±
6.2). In multiple linear regression with the whole population, R2 =
0.478 for TSF. In groups B and C, R2 = 0.364 and 0.368 respectively
for TSF, and in group A it was only 0.032.
Conclusions: these observations demonstrated a height correlation between BMI
and TSF in children with obesity risk (group C). Therefore, we conclude that,
in Brazil both BMI and TSF can be used for children's research of obesity in
population studies.
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89
EVOLUÇÃO DO ÍNDICE DE MASSA CORPORAL (IMC) E DO CILINDRO
BRAQUIAL EM MENINOS DA CIDADE DE PAULÍNIA -SP BRASIL (1979/80 - 1993/94).
Zambon Mp1, Marmo Db1, Morcillo Am1, Guimarey Lm2
1universidade Estadual De Campinas (Unicamp). Brasil. 2 Comision De Investigaciones
Cientificas. Provincia De Bsas (Cic). Argentina
A composição corporal pode ser avaliada por parâmetros
antropométricos. Objetivo: analisar a evolução
do IMC e do cilindro braquial -área de gordura (AG) e músculo
(AM)- de meninos de Paulínia. População e Método:
estudou-se 1175 crianças do sexo masculino (6,5 a 10,5 anos),
sendo 310 em 1979/80 (estudo e1) e 865 em 1993/94 (estudo e2). Calculou-se
a média e o desvio padrão do IMC, da AG e da AM. Para
a análise estatística utilizou-se o teste de Kolmogorov-Smirnov.
Resultados: As variáveis mostraram evoluções diversas,
sem organização precisa, com diferença estatística
em seis grupos etários para a AM. Tabela 1
|
Idade
|
IMCe1
|
IMCe2
|
AGe1
|
AGe2
|
AMe1
|
AMe2
|
|
6,5
|
16,2±
2,4
|
15,7±1,7
|
8,9±6,9
|
7,7±4,2
|
17,1±2,8
|
18,2±3,1
|
|
7
|
15,4±1,8
|
15,7±2
|
8,3±3,0
|
8,2±5,0
|
17,1±3,0
|
18,2±2,7*
|
|
7,5
|
15,2±1,7
|
15,8±2,3
|
8,3±3,8
|
8,7±6,2
|
16,8±2,6
|
18,6±2,9*
|
|
8
|
16,0±2,0
|
16,1±2,4
|
8,8±4,2
|
9,3±6,2
|
18,2±3,4
|
19,4±4,1
|
|
8,5
|
15,8±1,8
|
15,7±1,4
|
10,4±4,7
|
8,9±4,4
|
20,4±10,3
|
19,1±2,5*
|
|
9
|
15,5±1,5
|
16,7±2,3*
|
9,3±4,4
|
10,8±7,7
|
19,3±6,3
|
20,5±3,2*
|
|
9,5
|
16,9±2,9
|
16,4±2,1
|
13,5±7,9
|
10,9±7,8*
|
21,0±8,6
|
20,4±4,9
|
|
10
|
17,0±3,2
|
17,2±2,9
|
13,3±8,3
|
3,4±10,0
|
21,9±10,9
|
21,7±3,4*
|
|
10,5
|
16,5±2,6
|
17,2±2,6*
|
12,5±6,6
|
13±8,9
|
19,5±4,1
|
22,1±3,8*
|
* p = 0,05
Conclusão: O IMC e a AG não apresentaram diferenças durante
este intervalo, mas observou-se moderada tendência de aumento da área
muscular nos meninos aos 7, 7.5, 9 e 10,5 anos.
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89
BODY MASS INDEX AND ARM CIRCUNFERENCE TRENDS AMONG MALES SCHOOLCHILDREN FROM
PAULÍNIA CITY, SÃO PAULO - BRAZIL (1979/80 - 1993/94).
1universidade Estadual De Campinas (Unicamp). Brazil. 2 Comision
De Investigaciones Cientificas, Provincia De Bsas (Cic). Argentina.
Body composition has been studied with anthropometric measurements in population studies. Background: the purpose of this study was to evaluate male schoolchildren BMI, upper arm circumference (UAC), upper arm fat area (UAFA) and upper arm muscle area (UAMA) from Paulínia, São Paulo, Brazil between 1979/80 (study s1) and 1993/94 (study s2). Material and methods: trends in BMI, UAFA and UAMA were studied in 1175 boys from 6,5 to 10,5 years old; 310 in s1 and 865 in s2. Median and standard deviation were calculated in both studies, according to gender and age. Kolmogorov-Smirnov test was studied. Results: In boys, all variables changed without a specific organization.
|
Idade
|
BMI s1
|
BMIs2
|
UAFA s1
|
UAFA s2
|
UAMA s1
|
UAMA s2
|
|
6,5
|
16,2±
2,4
|
15,7±1,7
|
8,9±6,9
|
7,7±4,2
|
17,1±2,8
|
18,2±3,1
|
|
7
|
15,4±1,8
|
15,7±2
|
8,3±3,0
|
8,2±5,0
|
17,1±3,0
|
18,2±2,7*
|
|
7,5
|
15,2±1,7
|
15,8±2,3
|
8,3±3,8
|
8,7±6,2
|
16,8±2,6
|
18,6±2,9*
|
|
8
|
16,0±2,0
|
16,1±2,4
|
8,8±4,2
|
9,3±6,2
|
18,2±3,4
|
19,4±4,1
|
|
8,5
|
15,8±1,8
|
15,7±1,4
|
10,4±4,7
|
8,9±4,4
|
20,4±10,3
|
19,1±2,5*
|
|
9
|
15,5±1,5
|
16,7±2,3*
|
9,3±4,4
|
10,8±7,7
|
19,3±6,3
|
20,5±3,2*
|
|
9,5
|
16,9±2,9
|
16,4±2,1
|
13,5±7,9
|
10,9±7,8*
|
21,0±8,6
|
20,4±4,9
|
|
10
|
17,0±3,2
|
17,2±2,9
|
13,3±8,3
|
3,4±10,0
|
21,9±10,9
|
21,7±3,4*
|
|
10,5
|
16,5±2,6
|
17,2±2,6*
|
12,5±6,6
|
13±8,9
|
19,5±4,1
|
22,1±3,8*
|
* p=0,05
Conclusions: boys' BMI and UAFA didn't change but they showed low positive trends
in muscle mass.
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