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      Malnutrition Is Associated with Increased Blood Pressure in Childhood

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          Abstract

          Background/Aims: Protein-energy malnutrition remains a major public health problem in many countries. Scanty information is available about the effects of malnutrition during childhood on blood pressure (BP). Methods: In a cross-sectional study we assessed the BP of 172 children older than 2 years living in shantytowns in São Paulo city. Ninety-one children were malnourished (height-for-age or weight-for-age Z-score below –1 of the NCHS references); 20 had recovered from malnutrition after an average time of 6.4 years, and 61 were non-malnourished controls. Results: A greater percentage of children in the malnourished and recovered groups had increased systolic or diastolic BP (>95th percentile of the Update of the 2nd Task Force references) after adjusting for age, sex and height, compared to the controls (29, 20 and 2%, respectively, p < 0.001). Mean diastolic BP, adjusted for age, sex, race, weight, height and birth weight, was significantly increased in malnourished and recovered children compared to controls (65.2 ± 0.6, 66.5 ± 1.5, and 61.8 ± 0.8 mm Hg, respectively, p < 0.01). Conclusions: BP is increased in malnourished children and in those who recovered from malnutrition after an average period of 6 years. Malnutrition occurring during childhood may represent a risk factor for increased BP later in life.

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          Most cited references 5

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          Essential hypertension predicted by tracking of elevated blood pressure from childhood to adulthood: the Bogalusa Heart Study.

          It is well known that blood pressure (BP) levels persist over time. The present investigation examines tracking of elevated BP from childhood to adulthood and its progression to essential hypertension. In a community study of early natural history of arteriosclerosis and essential hypertension, a longitudinal cohort was constructed from two cross-sectional surveys > 15 years apart: 1505 individuals (56% female subjects, 35% black), aged 5 to 14 years at initial study. Persistence of BP was shown by significant correlations between childhood and adulthood levels (r = 0.36 to 0.50 for systolic BP and r = 0.20 to 0.42 for diastolic BP), varying by race, sex, and age. These correlations remained the same after controlling for body mass index (BMI). Twice the expected number of subjects (40% for systolic BP and 37% for diastolic BP), whose levels were in the highest quintile at childhood, remained there 15 years later. Furthermore, of the childhood characteristics, baseline BP level was most predictive of the follow-up level, followed by change in BMI. Subsequently, even at ages 20 to 31 years, prevalence of clinically diagnosed hypertension was much higher in subjects whose childhood BP was in the top quintile: 3.6 times (18% v 5%) as high in systolic BP and 2.6 times (15% v 5.8%) as high in diastolic BP, compared to subjects in every other quintile. Of the 116 subjects who developed hypertension, 48% and 41% had elevated childhood systolic and diastolic BP, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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            Food consumed does not account for the higher prevalence of obesity among stunted adults in a very-low-income population in the Northeast of Brazil (Maceió, Alagoas).

            To study the food pattern of stunted and nonstunted, obese and nonobese individuals in a very-low-income population. A household survey. Slum set up by the 'Homeless Movement', city of Maceió (Alagoas), Brazil. A total of 532 adults classified by sex, stature (Z -2s.d. of the NCHS curves), and body mass index (BMI) were compared using the following variables: waist circumference, waist-hip circumference ratio (W/H), percentage body fat (skinfold thickness and bioelectrical impedance), and food intake (24-h recall). The prevalence of stunting was 22.6%. In all, 30% of the stunted subjects were overweight or obese, compared with 23% for the nonstunted individuals (P<0.05). In women, logistic regression analysis showed a strong association among weight, abdominal fat, and stunting (r=0.81). No significant differences were observed in the values of W/H or in the qualitative menu of the different categories. Energy intake was below the RDA figures (about 63%). There was similarity among the groups regarding the proportion of macronutrients, except for the fact that stunted obese women ingested less fat and protein than nonstunted obese women. Stunted obese individuals consumed less energy (5962 kJ) than the population as a whole (6213 kJ), an amount far lower than their average needs, which were calculated on the basis of their shorter stature (8109 kJ). The observed energy consumption seems compatible with the panorama of undernutrition present in the population, but it does not explain the high prevalence of obesity detected.
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              Early linear growth retardation and later blood pressure.

              To examine the effects of stunting in early childhood on blood pressure in later childhood. A cohort study. Kingston, Jamaica. Seven to eight year old children, 120 stunted (height for age -1 s.d. of the NCHS references) at age 9-24 months. Stunted and non-stunted children were identified at age 9-24 months by house to-house survey of poor neighbourhoods in Kingston, Jamaica. Blood pressure and anthropometry were measured at age 7-8 y. Birth weight was obtained from hospital records (73%) or maternal recall. The stunted children remained shorter and thinner than the non-stunted ones. In multiple regression analysis adjusting for size and pulse rate, the stunted children had higher systolic blood pressure (P<0.05). Birth weight was not a significant predictor of systolic blood pressure. Stunting in early childhood may increase the risk of elevated systolic blood pressure in later life. Nutricia Research Foundation, The Netherlands and the Commonwealth Caribbean Medical Research Council.
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                Author and article information

                Journal
                NEC
                Nephron Clin Pract
                10.1159/issn.1660-2110
                Nephron Clinical Practice
                S. Karger AG
                1660-2110
                2004
                June 2004
                17 November 2004
                : 97
                : 2
                : c61-c66
                Affiliations
                aDivision of Nephrology and bDepartment of Physiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
                Article
                78402 Nephron Clin Pract 2004;97:c61–c66
                10.1159/000078402
                15218331
                © 2004 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Tables: 3, References: 32, Pages: 1
                Product
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/78402
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