Several studies have reported data supporting the idea that an impaired intrauterine environment that deprives the fetus of optimal nutrient delivery results in the predisposition of the fetus to experience cardiovascular and metabolic dysfunction in later life. However, contradictory data still exist. Our purpose was to investigate the effects of both birth weight and weight gain on the risk for high blood pressure levels in 6- to 10-year-old children. This cross-sectional study included 739 children divided into quartiles of birth weight. The mean values of both systolic and diastolic pressure were significantly different between quartiles of birth weight, with increasing blood pressure values as the birth weight decreased (P<0.001). Covariance analysis adjusting for gender, prematurity, and body mass index (BMI) showed that both systolic and diastolic pressure remained greater in the lowest than in the highest birth weight quartile. Separating those with low and normal birth weight demonstrated that the risk of childhood hypertension was significantly higher among children with low birth weight and current obesity (odds ratio [OR]: 5.0, confidence interval [CI]: 3.3 to 16.1; P=0.023). The inverse association between birth weight and blood pressure levels appears to be programmed during fetal life, while weight gain during childhood adds to this risk.
ResumoObjetivo: O objetivo do estudo foi identificar fatores de risco associados à desnutrição e morbidade na população de crianças acompanhadas no Programa de Atenção à Saúde da Criança no município do Embu, São Paulo (Brasil), visando o melhor direcionamento das ações de saúde.Métodos: A casuística foi constituída por uma coorte de 1094 crianças, que correspondia a 25,0% (amostra sistemática probabilística) do total de crianças menores de 12 meses inscritas em 6 unidades básicas de saúde do município, no período de julho de 1988 a julho de 1989. Os fatores de risco foram analisados segundo a presença ou ausência de internação e evolução ponderal -favorá-vel ou desfavorável -até os dois anos de idade. Para a análise estatística utilizou-se a análise multivariada, pela técnica de regressão logística.Resultados: Do total de 1094 crianças, 428 (39,1%) foram classificadas como "alto risco", 658 (60,1%) como "baixo risco"S e 8 (0,8%) apresentavam patologias na primeira consulta, sendo excluídas da análise. A prematuridade (RR ajustado=3,35), as intercorrências neonatais graves (RR ajustado=4,12) e a morte de irmão menor de cinco anos (RR ajustado=2,7) constituíram-se em fatores de risco à internação nos primeiros dois anos de vida. A faixa de peso ao nascer entre 2500 e 2750 gramas (RR ajustado=2,46), a presença de irmão desnutrido (RR ajustado=4,17) e a idade materna menor ou igual a 18 anos (RR ajustado=1,87) constituíram-se em fatores de risco para evolução ponderal desfavorável.Conclusões: Esses resultados, bem como o processo de condução deste estudo, subsidiaram a reformulação do Programa de Atenção à Saúde da Criança no Embu, permitindo uma atuação diferenciada para o grupo de maior risco, garantindo-se o essencial para todos.J. pediatr. (Rio J.). 1997; 73(4):244-251: fatores de risco, desnutrição, morbidade. AbstractObjective: The objective of this study was to identify risk factors associated with malnutrition and morbidity in the population of children accompanied by the Child Health Care Program in Embu, São Paulo (Brazil), with the aim of giving a better direction to health activities.Methods: The case-study was constituted by a cross-section of 1024 children, corresponding to 25,0% (probabilistic sistematic sample) of the total of children under 12 months registered in six primary health care centers in the Municipality, during the period from July 1988 to July 1989. The risk factors were analyzed according to the presence or absence of hospitalization and weight evolution -favorable or unfavorable -until two years of age. For the statistical analysis the multivaried approach was used, through the tecnique of logistic regression.Results: Of a total of 1024 children, 428 (39.1%) were classified as high risk, 658 (60.1%) as low risk and 8 (0.8%) presented pathologies at their first appointment, being excluded from the analysis. Prematurity (adjusted RR = 3.35), serious illness in the newborn (adjusted RR = 4.12) and the death of a younger brother or sister of less than five years (adjusted RR = 2.70) cons...
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