Changes in Thyroid and Glycemic Status and Food Intake in Children with Excess Weight Who Were Submitted for a Multi-Component School Intervention for 16 Months

We investigated if children with excess weight who submitted to two types of intervention at school for 16 months showed improvements in thyroid and glycemic function and food intake. Children (8-11 years) with a body mass index-for-age (BMI/A) of ≥1 Z score were divided into two groups: Treatment 1 (n = 73) involved motivation to adopt healthier lifestyle; Treatment 2 (n = 103) involved performing weekly nutritional education, motivational, and physical activities at school. A semi-quantitative food frequency questionnaire was used. The delta BMI/A were similar after 16 months; Treatment 1 showed higher decrease in thyroid-stimulating hormone (TSH; median (range)): -0.45 (-3.19 to 2.17) and 0.06 (-4.57 to 1.63) mIU/L, p = 0.001), FreeT3 (-0.46 (-2.92 to 1.54) and -0.15 (-2.46 to 1.38) pmol/L, p = 0.038), and FreeT4 -1.41 (-6.18 to 3.47) and -0.90 (-4.89 to 2.96) pmol/L, p = 0.018), followed by decrease in energy intake (7304 (6806 to 7840) and 8267 (7739 to 8832) kJ, Ptreatment = 0.439, Ptime <0.001, interaction group-time p < 0.001), macronutrients and sugar. A positive correlation between FreeT3 and BMI/A, and a negative correlation with FreeT4 and insulin were found at baseline (r 0.212, p < 0.01; r -0.155, p < 0.01, respectively) and follow-up (r 0.222, p < 0.01; r -0.221, p < 0.01). The decrease in overall diet and particularly sugar intake was accompanied by a greater reduction in TSH and FreeT3 in Treatment 1, demonstrating the impact of dietary intake on thyroid function.

Albuminuria, renal function and blood pressure in undernourished children and recovered from undernutrition

BACKGROUND

The objective of this study was to investigate some biomarkers of renal function and blood pressure in children who had recovered from undernutrition.

METHODS

This was cross-sectional, comparative study in which a convenience sample of children of both genders (n = 126; age range 6-16 years) treated at the Centre for Nutritional Recovery and Education (São Paulo, Brazil) was used. These children were classified into four groups for analysis: (1) children who were well nourished (control group; n = 50), (2) those showing stunted growth (stunted group; n = 22), (3) those who were underweight (underweight group; n = 23) and (4) those who had recovered from undernutrition (recovered group; n = 31).

RESULTS

No between-group differences were found for mean levels of albuminuria, serum creatinine and cystatin C, and similar mean estimates of glomerular filtration rate (eGFR; using either creatinine, cystatin C or both). Almost 14% of the stunted group, 4% of the underweight group and 3% of the recovered group had albuminuria of >30 mg/g creatinine (chi-square p = 0.034); none of the control children showed albuminuria of >30 mg/g creatinine. Mean systolic (SBP) and diastolic blood pressure (DBP) adjusted for age and gender of the children in the stunted [SBP (95% confidence interval): 92 (88-96) mmHg; DBP: 47 (44-49) mmHg] and recovered [SBP: 93 (90-96) mmHg; DBP: 49 (47-51) mmHg] groups were significantly lower than those of the controls [SBP: 98 (95-100) mmHg, P = 0.027; DBP: 53 (52-55) mmHg, P = 0.001]. After additional adjustment for height, mean DBP remained significantly lower in the recovered group compared with the control group [49 (46-51) vs. 53 (51-55) mmHg, respectively; P = 0.018). Logistic regression analysis showed that the stunted group had a 8.4-fold higher chance of developing albuminuria (>10 mg/g creatinine) than the control children (P = 0.006).

CONCLUSIONS

No alterations in renal function were found in underweight children and those who had recovered from undernutrition, whereas children with stunted growth presented with a greater risk for albuminuria. A lower DBP was found in children with stunted growth and those who had recovered from undernutrition.

Lower waist circumference in mildly-stunted adolescents is associated with elevated insulin concentration

OBJECTIVE

Augmented waist circumference (WC) is associated with non-communicable diseases and could represent a valuable marker in screening for metabolic dysfunctions in subjects with insufficient linear growth. The objective of the present study was to determine whether biochemical and hemodynamic parameters and waist circumference vary between mildly-stunted and non-stunted adolescents from impoverished communities of São Paulo, Brazil.

METHODS

The cross-sectional study involved 206 subjects, aged between 9 and 19 years and living in impoverished areas of São Paulo, Brazil. The sample population was divided according to height-for-age Z-score (HAZ) into stunted (-1 > HAZ ≥ -2) and non-stunted (HAZ ≥ -1) groups, and was sub-divided according to gender. Logistic regression analysis was employed to compare individuals with elevated (> 75th percentile) insulin concentrations. The receiver operating characteristic curves were constructed to determine WC cut-off points that could be used to identify stunted and non-stunted individuals with elevated insulin concentrations.

RESULTS

WC cut-off points of 58.25cm and 67.2cm allowed for correct classification of 90.7% of stunted and 88.7% of non-stunted individuals in the studied population. While the sensitivity of the model was high for stunted and non-stunted subjects (98.8% and 97.2%, respectively), the specificity was modest (57.1% and 41.2%, respectively).

CONCLUSION

The results presented herein suggest that an increase in plasma insulin is one of the primary metabolic modifications in stunted individuals, and that this alteration could be identified at a lower WC cut-off point than in non-stunted counterparts.

Long-lasting effects of undernutrition

Undernutrition is one of the most important public health problems, affecting more than 900 million individuals around the World. It is responsible for the highest mortality rate in children and has long-lasting physiologic effects, including an increased susceptibility to fat accumulation mostly in the central region of the body, lower fat oxidation, lower resting and postprandial energy expenditure, insulin resistance in adulthood, hypertension, dyslipidaemia and a reduced capacity for manual work, among other impairments. Marked changes in the function of the autonomic nervous system have been described in undernourished experimental animals. Some of these effects seem to be epigenetic, passing on to the next generation. Undernutrition in children has been linked to poor mental development and school achievement as well as behavioural abnormalities. However, there is still a debate in the literature regarding whether some of these effects are permanent or reversible. Stunted children who had experienced catch-up growth had verbal vocabulary and quantitative test scores that did not differ from children who were not stunted. Children treated before 6 years of age in day-hospitals and who recovered in weight and height have normal body compositions, bone mineral densities and insulin production and sensitivity.

Mild stunting is associated with higher body fat: study of a low-income population

OBJECTIVE

To test if individuals having height-for-age z scores between -2 and -1 present higher body fat percentage and, therefore, should not be categorized as having normal nutritional status.

METHODS

The study involved 96 individuals (52 boys and 44 girls); 57% of whom had already attained puberty. Body composition was analyzed by dual energy X-ray absorptiometry.

RESULTS

The percentage of abdominal body fat in pre-pubertal stunted girls was higher (27.4%; p = 0.01) in comparison with their non-stunted counterparts (20.6%). Similar differences in abdominal fat content (%) were observed for pubertal stunted and non-stunted girls and boys (37.6 and 29.8%, respectively, p = 0.01; 24.6 and 15.7%, p = 0.01, respectively). The percentages of total body fat percent in pre-pubertal stunted girls and pubertal stunted boys (29.9 and 24.5%, p = 0.03; 26.3 and 18.1%, p = 0.01, respectively) were higher than those of their non-stunted counterparts. Non-stunted groups showed lower waist circumferences.

CONCLUSION

Adolescents with mild stunting exhibit alterations in body composition indicating increased risk of metabolic diseases.

Children recovered from malnutrition exhibit normal insulin production and sensitivity

Protein-energy malnutrition promotes adaptive hormonal changes that result in stunting. A previous study showed that stunted children had increased insulin sensitivity and diminished pancreatic beta-cell function. The objectives of the present study were to analyse the glucose, insulin, homeostasis model assessment of insulin sensitivity (HOMA-S) and homeostasis model assessment of pancreatic beta-cell function (HOMA-B) levels after nutritional recovery. The recovered group (n 62) consisted of malnourished children after treatment at a nutrition rehabilitation centre. At the beginning of treatment their age was 2.41 (sd 1.28) and 2.31 (sd 1.08) years, weight-for-age Z score - 2.09 (sd 0.94) and - 2.05 (sd 0.55) and height-for-age Z score - 1.85 (sd 1.11) and - 1.56 (sd 0.90), for boys and girls respectively. The control group consisted of well-nourished children without treatment (n 26). After treatment, boys of the recovered group gained 1.29 (sd 1.06) Z scores of height-for-age and 1.14 (sd 0.99) Z scores of weight-for-age, and girls, 1.12 (sd 0.91) and 1.21 (sd 0.74) Z scores respectively. No differences were found between control and recovered groups in insulin levels for boys (P = 0.704) and girls (P = 0.408), HOMA-B for boys (P = 0.451) and girls (P = 0.330), and HOMA-S (P = 0.765) for boys and girls (P = 0.456) respectively. The present study shows that the changes observed previously in glucose metabolism and insulin were reverted in children who received adequate treatment at nutritional rehabilitation centres and showed linear catch-up.