Browsing by Author "Ramos, Carlos"
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- Childhood obesity and overweight prevalence trends in Portugal – COSI 2008 and 2010Publication . Rito, Ana Isabel; Carvalho, Maria Ana; Ramos, CarlosINTRODUCTION: Previous data indicated that the estimated prevalence of childhood overweight and obesity was above 30%, being Portugal one of the European countries with the highest prevalence. OBJECTIVE: The purpose of this study was to monitor trends in childhood overweight and obesity in Portugal, based on the first and second data collection (2008 and 2010) from the National Nutritional Surveillance System - COSI Portugal. METHODS. Specific prevalence of overweight and obesity was determined, using 2 different diagnostic criteria from the first and second data collection (2008 and 2010) of the National Nutritional Surveillance System - COSI Portugal - among the seven geographic regions. The survey is affiliated with the World Health Organization European Childhood Obesity Surveillance Initiative and followed a standardized methodological protocol. 3765 children (6-8 years old) were enrolled from 181 schools in 2008 and 4020 children from 172 schools in 2010 (national representative samples). Height and weight were directly measured by trained fieldworkers. Overweight (including obesity) and obesity prevalence were calculated using the international body mass index cut-offs according to CDC and IOTF criteria. RESULTS: According to IOTF criteria the mean crude prevalence of overweight decreased from 28,1% (2008) to 26,5% (2010) (p=0,49), and childhood obesity varied from 8,9% (2008) to 9,1% (2010). With the CDC criteria we found that the prevalence of overweight and obesity varied from 32,3% and 14,6% in 2008 to 30,3% and 14,2% in 2010. Gender differences have remained relatively stable from 2008-2010, according to IOTF criteria, i.e. the prevalence of overweight was significantly higher in boys (30,0%-2008 and 26,8%-2010) than in girls (26,1%-2008 and 25,8%-2010). CONCLUSION: Overall we observed that the prevalence of overweight decreased suggesting that childhood overweight and obesity in Portugal might be leveling off. However, these results reinforce that Portugal continues to be, consistently, one of the countries with the highest magnitude of childhood obesity and that the reference used to define it is important, since it provides different estimates.
- Childhood Obesity Surveillance Initiative: COSI Portugal 2008Publication . Rito, Ana Isabel; Paixão, Eleonora; Carvalho, Maria Ana; Ramos, CarlosA obesidade infantil apresenta-se como um dos mais sérios problemas de saúde pública, quer no espaço Europeu, quer no resto do mundo. A taxa de crescimento desta doença tem -se mantido constante, acrescentando 400,000 crianças por ano, aos já existentes 45 milhões de crianças com excesso de peso. A Organização Mundial da Saúde (OMS), no seguimento da aprovação da Carta Europeia de Luta Contra a Obesidade1, lançou uma iniciativa a pedido dos Estados -Membros da Região Europeia com a intenção de instalar um sistema de vigilância da obesidade infantil. O WHO – European Childhood Obesity Surveillance Initiative, constitui o primeiro Sistema Europeu de Vigilância Nutricional Infantil. Portugal assumiu a coordenação Europeia desta iniciativa e a nível nacional este estudo denomina -se “COSI – Portugal”. Sendo Portugal um dos países com maior prevalência de obesidade infantil com a morbilidade e mortalidade associada e ainda os elevados custos que a determinam, o combate a esta doença e a sua prevenção constituem -se como uma prioridade política, nomeadamente do Ministério da Saúde. Neste contexto, houve a necessidade de se estabelecer a implementação de um sistema de vigilância simples, padronizado, harmonizado e sustentável constituindo uma medida claramente importante para corrigir a lacuna que existe na obtenção de informação sobre o estado nutricional e avaliação e monitorização da prevalência de obesidade em crianças, permitindo também identificar grupos em risco. O COSI Portugal tem como principal objectivo criar uma rede de informação sistemática (a cada 2 anos) comparável entre os países da Europa, sobre as características do estado nutricional infantil de crianças dos 6 aos 8 anos. No primeiro ano de avaliação (2007/2008) participaram 13 países dos 22 inscritos. Em Portugal este projecto foi articulado com as Administrações Regionais de Saúde do Norte, Centro, Lisboa e Vale do Tejo, Algarve, Alentejo e com as Direcções Regionais de Saúde dos Açores e da Madeira. De acordo com a listagem oficial das escolas do 1.º ciclo do Ensino Básico (2007/2008) do Ministério de Educação, foi seleccionada uma amostra representativa nacional. O estudo em questão baseia -se no modelo da epidemiologia descritiva do tipo transversal, tendo sido avaliadas 3765 crianças dos 6 aos 8 anos (média de idades: 7,0 anos ± 0,7 DP) do 1.º ano e 2.º ano de 181 escolas. A metodologia aplicada seguiu o protocolo comum a todos os países participantes. As crianças foram avaliadas através de parâmetros antropométricos (peso e estatura) por 74 examinadores que receberam o mesmo treino de uniformização e qualidade de procedimentos. Para a classificação do estado nutricional foram utilizados os 3 critérios internacionalmente reconhecidos (IOTF2, CDC3 e OMS4). Foram ainda aplicados mais dois questionários compreendo variáveis relativas à família e ao ambiente escolar. É de notar que a participação neste estudo foi superior a 80% dos inicialmente inscritos, designadamente 95,8% de escolas; 81,0% de crianças e 83,8% de famílias.
- Childhood Obesity Surveillance Initiative: COSI Portugal 2010Publication . Rito, Ana Isabel; Paixão, Eleonora; Carvalho, Maria Ana; Ramos, CarlosA obesidade infantil apresenta-se como um dos mais sérios problemas de saúde pública, quer no espaço Europeu, quer no resto do mundo. A taxa de crescimento desta doença tem-se mantido constante, acrescentando 400000 crianças por ano, aos já existentes 40-50 milhões de crianças com excesso de peso. A Organização Mundial da Saúde (OMS), no seguimento da aprovação da Carta Europeia de Luta Contra a Obesidade, lançou uma iniciativa a pedido dos Estados-Membros da Região Europeia com a intenção de instalar um sistema de vigilância da obesidade infantil. O WHO - European Childhood Obesity Surveillance Initiative, constitui o primeiro Sistema Europeu de Vigilância Nutricional Infantil. Portugal assumiu a coordenação Europeia desta iniciativa em 2007 e a nível nacional este estudo denomina-se “COSI – Portugal". Sendo Portugal um dos países com maior prevalência de obesidade infantil com a morbilidade e mortalidade associada e ainda os elevados custos que a determinam, o combate a esta doença e a sua prevenção constituem-se como uma prioridade política, nomeadamente do Ministério da Saúde. Neste contexto, houve a necessidade de se estabelecer a implementação de um sistema de vigilância simples, padronizado, harmonizado e sustentável constituindo uma medida claramente importante para corrigir a lacuna que existe na obtenção de informação sobre o estado nutricional e avaliação e monitorização da prevalência de obesidade em crianças, permitindo também identificar grupos em risco. O COSI-Portugal tem como principal objetivo criar uma rede de informação sistemática, comparável entre os países da Europa, sobre as características do estado nutricional infantil de crianças dos 6 aos 8 anos de idade. No primeiro ano de avaliação (2007/2008) participaram 13 países dos 22 inscritos. No segundo ano de avaliação (2009/2010) juntaram-se quatro novos países aos 13 já participantes: Grécia, Hungria, Macedónia e Espanha. Em Portugal este projeto foi articulado com as Administrações Regionais de Saúde do Norte, Centro, Lisboa e Vale do Tejo, Algarve, Alentejo e com as Direcções Regionais de Saúde dos Açores e da Madeira. De acordo com a listagem oficial das escolas do 1º ciclo do Ensino Básico (2007/2008) do Ministério de Educação, foi seleccionada uma amostra representativa nacional, na qual a unidade amostral é a escola. O estudo em questão baseia-se no modelo da epidemiologia descritiva, com amostras transversais repetidas de avaliação do estado nutricional de crianças do 1º ciclo do ensino básico português. As escolas seleccionadas constituem a “Rede de Escolas Sentinelas” onde decorre o COSI-Portugal a cada 2-3 anos. Foram avaliadas 4064 crianças dos 6 aos 8 anos (média de idades: 6,97 anos ± 0,72) do 1º e 2º ano de 176 escolas. A metodologia aplicada seguiu o protocolo comum a todos os países participantes. As crianças foram avaliadas através de parâmetros antropométricos (peso e estatura) por 164 examinadores que receberam o mesmo treino de uniformização e qualidade de procedimentos. Para a classificação do estado nutricional foram utilizados os 3 critérios internacionalmente reconhecidos (IOTF, CDC e OMS). Foram ainda aplicados mais dois questionários compreendo variáveis relativas à família e ao ambiente escolar. É de notar que a participação neste estudo foi de 78,6% das crianças inicialmente inscritas, 93,1% de escolas e 84,2% de famílias.
- Demographic variables and childhood obesity community-based programme in PortugalPublication . Baptista, Patrícia; Silva, Ana Lúcia; Ramos, Carlos; Carvalho, Maria Ana; Rito, AnaBACKGROUND: It is well known that obesity is one of the most Public Health’s concerns especially among children. Recent data reports that childhood obesity in Portugal increased in the last years, representing nowadays 32.1% of overweight and 14.5% of obesity (1). Family, as the primary children source of social learning, habits and behaviors’ influence and exposure have shown a basic determinant to food and physical activity children’ choices (2,3,4). The role of family and parental factors in childhood obesity suggests that single-parent, no siblings and small family size are associated with larger increases in BMI (2,3,5,6). Family provides social and interpersonal support that is instrumental in shaping and maintaining eating and physical activity behaviors, community-based health programmes focus also on family educational policies and strategies have been developed in some European Countries, showing relevant impact on health patterns and a decrease on childhood obesity prevalence’s (7,8). METHODS: This study is framed from a longitudinal municipal project (MUNSI), which included 3173 children (6-9 years old) from 167 public schools conducted on five municipalities (Viana do Castelo, Fundão, Oeiras, Seixal and Montijo). Childhood nutritional status was assessed by anthropometric parameters (weight and height) considering the CDC growthcharts criteria percentiles of BMI. Children’s food habits, socioeconomic condition and parent’s level education were collected by a family questionnaire. The Odds Ratio was calculated with a 95% Confidence Intervals. RESULTS: Prevalence of childhood overweight (BMI≥P85) was 32.1%, and 14.3% for obesity (BMI≥P95). According to family characteristics the data showed that a small family size is associated with larger increases in BMI (OR=1.6; 95%CI: 1.1-2.3). It was also observed that having a lower level of education, a lower socioprofessional status and a household income of less than €1500 were risk factors statistically significant (p <0.05) for the development of childhood obesity, with an inversely association with the prevalence of childhood obesity. CONCLUSION: The data have shown that obesity was not independent from parent's socioeconomic and educative level, where these two conditions seem to be more likely to develop childhood Overweight. This knowledge identifies additional childhood obesity causes that could be useful as effective interventions at local level in order to reverse the obesity trends in Portuguese children and promote a future healthy life style.
- Demographic variables and childhood obesity in a community-based program in PortugalPublication . Silva, Ana Lúcia; Ramos, Carlos; Carvalho, Maria Ana; Rito, AnaINTRODUCTION: The prevalence of overweight and obesity have been increasing consistently throughout the European Union, especially in Portugal, affecting everyday a higher number of children and adolescents. A community-based program in health promotion can identify the main areas of action for the protection of the population against health threats and the promotion of guidelines that can lead to healthier life-styles. Adequate urban environments could be one of the main areas of action for obesity prevention. METHODS: This study is framed from a longitudinal municipal project (MUNSI), which included 3173 children (6-9 years old) from 167 public schools. Childhood obesity was assessed by anthropometric parameters (weight and height) considering the Centers for Disease and Control and Prevention (CDC) growthcharts criteria of percentiles of Body Mass Index (BMI). Demographic variables (typology of urban area and familiy household) were collected by a self-response family questionnaire. The Odds Ratio was calculated with a 95% Confidence Intervals. RESULTS: Children who lived in urban areas showed higher obesity prevalence (14.6%) compared with those residing in rural areas (13.3%) associated also with higher odds (OR= 1.15; 0.8-1.66). According to Family household, single child families showed higher obesity prevalence (17.1%) with a OR=1.6 (1.1 - 2.3) compared to families who had more than one child. CONCLUSION: Environmental factors such the typology of urban area and family household should be considered important contributing factors for childhood obesity. Future research should attempt to quantify and elucidate, more precisely, the epidemiology of these conditions.
- Efeito de um projeto de base comunitária e familiar nos conhecimentos sobre alimentação e nutrição e atitudes alimentares em crianças com excesso de pesoPublication . Gonçalves, Ricardo; Carvalho, Maria Ana; Ramos, Carlos; Breda, João; Rito, Ana IsabelIntrodução: A obesidade infantil apresenta cada vez maiores prevalências em todo o mundo. Alguns projetos, de base comunitária, têm apresentado resultados positivos na prevenção desta problemática. A carência em conhecimentos sobre alimentação e nutrição e as atitudes alimentares parecem aumentar o risco para o desenvolvimento da obesidade infantil. Objectivo: Avaliar o efeito de um projeto de base comunitária e familiar – o Projecto Obesidade Zero (POZ) - nos conhecimentos e nas atitudes alimentares bem como no estado nutricional de crianças com excesso de peso em idade escolar. Métodos: O POZ foi desenvolvido durante o ano de 2009 em cinco municípios de Portugal (Beja, Cascais, Mealhada, Melgaço e Silves), com articulação entre as cinco câmaras municipais e os respectivos Centros de Saúde. Compreendeu as seguintes fases de desenvolvimento: 1) Consultas individuais de obesidade infantil; 2) Workshops de Cozinha Saudável; 3) Sessões de Aconselhamento Alimentar em grupo dirigidas às crianças; 4) Sessões de Aconselhamento Alimentar em grupo dirigidas às famílias. Para a classificação do estado nutricional foram utilizadas as curvas de Percentis de Índice de Massa Corporal (IMC) para o sexo e a idade, segundo os critérios do Center for Disease Control and Prevention (2000) e os dados sobre asvariáveis em estudoforam retiradas do questionário dirigido às crianças na primeira e na quarta consulta de obesidade infantil. Foram realizadas estatísticas descritivas e analíticas. O nível de significância estabelecido foi de p<0,05. Resultados: Das 293 crianças que participaram no POZ, 80,4% diminuíram o seu Percentil de IMC/idade (p<0,05). Após a intervenção, verificou-se uma melhoria dos conhecimentos sobre alimentação e nutrição da primeira para a quarta consulta de obesidade infantil (M1=51,7 e M4=57,6, respectivamente). Para além disso, observou-se que a maioria das crianças (81,8%) que diminuíram o seu Percentil de IMC/idade foram aquelas que registaram melhores níveis de conhecimentos sobre alimentação e nutrição. No que respeita às atitudes alimentares, o grau de contentamento face a alimentos saudáveis (alface, brócolos, cenoura, fruta, leite, pão escuro, peixe, sopa, tomate) aumentou da primeira para a quarta consulta de obesidade infantil (M1= 6,4 e M4= 7,6, respectivamente). Conclusão: Este estudo parece confirmar a eficácia dos projetos de base comunitária e familiar na abordagem da obesidade infantil, enfatizando a importância da promoção de conhecimentos sobre alimentação e nutrição e de atitudes alimentares saudáveis, na melhoria do estado nutricional das crianças.
- Fruit and Vegetable consumption and overweight among school-age children within the “COSI” Portuguese StudyPublication . Rito, Ana Isabel; Carvalho, Maria Ana; Ramos, Carlos; Breda, JoãoIntroduction: Overweight among children has increased dramatically in the last few years and various environmental, genetic and social factors have been associated with weight gain. Promoting fruit and vegetable consumption among children might be useful strategy for weight management in children. However evidence for the association between fruit and vegetable consumption and being overweight in childhood are inconsistent. The present study aims to describe fresh fruit, “100% Juice”, vegetables and soup (FJVS) consumption among children and examine whether low consumption of FJVS is associated with overweight in a sample of Portuguese schoolchildren. Methods: Children´s overweight and obesity prevalence estimate was obtained from the first data collection (2008) of the new National Nutritional Surveillance System- “COSI Portugal” among the seven geographic Regions (North, Centre, Lisbon and Tagus Valley, Alentejo, Algarve, Azores and Madeira). Children’s dietary intake was measured using a semi-quantitative Food Frequency Questionnaire completed by the parents. Overall, 3225 questionnaires were returned. Height and weight were measured according to international standards, and BMI was calculated. To determine the magnitude of the association between FJVS consumption and overweight, crude Odds Ratio estimates, including CI, were computed using unconditional logistic regression. Results: 3812 children were included in the analyses (50,3% boys with a mean age (±SD) of 7,03 years ±0,72). Using Portuguese Health General Directorate terminology which uses CDC (2000) criteria for defining nutritional status 32,1% children were overweight (IMC ≥P85) , 14,5% were obese (IMC ≥P95) and 2,2% were underweight(IMC≤P5) . According to children’s FJVS consumption only 2%, 3,5% and 1,8% ate fresh fruit, vegetables and soup every day, respectively. Otherwise, 21,6% children consume 100% fruit juice every day. There was no difference between FJVS consumption among boys and girls, except for the soup consumption that was higher in girls (p=0,01). There were also no differences between FJVS consumption among age groups. Normal weight children ate FJVS more frequently than overweight and this differences were statistically significant for fresh fruit consumption (p=0,012). With regard to FJVS consumption (≥4 times/week and <4 times/week), no differences between overweight and non-overweight children were found for fresh fruit (<4 times/week: OR=1,03, 95% CI 0,86-1,24), 100% juice (≥4 times/week: OR=1,11, 95% CI 0,93-1,32) and soup consumption (<4 times/week: OR=1,12, 95% CI 0,91-1,38). However the consumption of vegetables less than 4 times a week shown to be a risk factor for overweight children (OR=1,20, 95% CI 1,02-1,40). Conclusions: The low intake of vegetables was associated with increased risk of overweight in Portuguese schoolchildren.
- Fruit and Vegetable consumption and overweight among school-age children within the “COSI” Portuguese StudyPublication . Rito, Ana Isabel; Carvalho, Maria Ana; Ramos, Carlos; Breda, JoãoIntroduction: Overweight among children has increased dramatically in the last few years and various environmental, genetic and social factors have been associated with weight gain. Promoting fruit and vegetable consumption among children might be useful strategy for weight management in children. However evidence for the association between fruit and vegetable consumption and being overweight in childhood are inconsistent. The present study aims to describe fresh fruit, “100% Juice”, vegetables and soup (FJVS) consumption among children and examine whether low consumption of FJVS is associated with overweight in a sample of Portuguese schoolchildren. Methods: Children´s overweight and obesity prevalence estimate was obtained from the first data collection (2008) of the new National Nutritional Surveillance System- “COSI Portugal” among the seven geographic Regions (North, Centre, Lisbon and Tagus Valley, Alentejo, Algarve, Azores and Madeira). Children’s dietary intake was measured using a semi-quantitative Food Frequency Questionnaire completed by the parents. Overall, 3225 questionnaires were returned. Height and weight were measured according to international standards, and BMI was calculated. To determine the magnitude of the association between FJVS consumption and overweight, crude Odds Ratio estimates, including CI, were computed using unconditional logistic regression. Results: 3812 children were included in the analyses (50,3% boys with a mean age (±SD) of 7,03 years ±0,72). Using Portuguese Health General Directorate terminology which uses CDC (2000) criteria for defining nutritional status 32,1% children were overweight (IMC ≥P85) , 14,5% were obese (IMC ≥P95) and 2,2% were underweight(IMC≤P5) . According to children’s FJVS consumption only 2%, 3,5% and 1,8% ate fresh fruit, vegetables and soup every day, respectively. Otherwise, 21,6% children consume 100% fruit juice every day. There was no difference between FJVS consumption among boys and girls, except for the soup consumption that was higher in girls (p=0,01). There were also no differences between FJVS consumption among age groups. Normal weight children ate FJVS more frequently than overweight and this differences were statistically significant for fresh fruit consumption (p=0,012). With regard to FJVS consumption (≥4 times/week and <4 times/week), no differences between overweight and non-overweight children were found for fresh fruit (<4 times/week: OR=1,03, 95% CI 0,86-1,24), 100% juice (≥4 times/week: OR=1,11, 95% CI 0,93-1,32) and soup consumption (<4 times/week: OR=1,12, 95% CI 0,91-1,38). However the consumption of vegetables less than 4 times a week shown to be a risk factor for overweight children (OR=1,20, 95% CI 1,02-1,40). Conclusions: The low intake of vegetables was associated with increased risk of overweight in Portuguese schoolchildren.
- Hábitos de pequeno-almoço em crianças portuguesas dos 6 aos 8 anosPublication . Duarte, Daniela; Carvalho, Maria Ana; Ramos, Carlos; Rito, Ana IsabelIntroduction: Breakfast is considered the most important meal of the day. Given the association of childhood obesity with less frequent breakfast consumption and since Portuguese studies on this subject are still scarce, the present study assesses breakfast consumption among Portuguese school age children and its association with obese and overweight children. Methods: The analysis was undertaken on data from the COSI Portugal 2010 study. Breakfast consumption (defined as the consumption of food, and beverage taken before school time) and place where it was held was obtained from 4064 children aged between 6 to 8 years from a National representative sample of 176 schools. IOTF criteria was used to classify children´s nutritional status. For this study, descriptive and analytic statistics were used. The significance level was set at p <0.05. Results: 95.1% of the children had breakfast every day at home. Most children took breakfast at home (95.9%). Concerning the food eaten in this meal, the study showed that most of the children (87.7%) consumed milk/yogurt/cheese, and only 2.0% had fruit. Children, who did not have breakfast, had higher prevalence of overweight and obesity (33.2% and 14.8%, respectively) compared with the ones that took breakfast (26.0% and 9.0%, respectively). These differences were statistically significant (p <0.05). Conclusion: This study suggests that children who do not consume breakfast, appears, itself, to be associated positively with obesity. Given rising obesity rates in children, public health advocates would do well to renew their emphasis on the importance of a good breakfast and the risks of regular morning fasting.
- Influence of child and maternal variables on childhood obesity in the municipalities of Fundão, Montijo, Oeiras, Seixal and Viana do CasteloPublication . Coelho, Filipa; Silva, Ana Lúcia; Ramos, Carlos; Carvalho, Maria Ana; Rito, AnaBACKGROUND: Childhood obesity has been considered a global epidemic and its prevalence has increased worldwide in the last decades. Such trends as gain special interest in the scientific community and their causes have been large studied. In this context it is recognized the importance of more study on obesity’ influences. According to the literature childhood obesity is linked with some child and maternal features. This study aims to evaluate the relationship between child and maternal variables and childhood obesity in school aged children from Fundão, Montijo, Oeiras, Seixal and Viana do Castelo municipalities. METHODS: Longitudinal study developed into three periods (2008-2011). The present data results from the first stage. 167 public schools were selected from the 5 municipalities, where 3851 children were included. The nutritional status was evaluated according the Centers for Disease Control and Prevention (CDC, 2000) growthcharts criteria percentiles of Body Mass Index (BMI) and the child and maternal variables was obtained from a self-response family’ questionnaire. The statistics analysis was obtained through descriptive analysis and Binomial Logistic Regression Model was used and the odds ratios for confidence intervals were set at 95 %. RESULTS: 3173 children was evaluated, 50.6% were female with a mean age of 7.5 years (± dp=0.8). The prevalence of overweight was 32.1% (BMI≥P85) and 14.3% was obese (BMI≥P95). Childhood breastfeeding occurred in almost children (90.1%) and showed a protective association with childhood obesity (childhood not-breastfeeding OR=1.6; 95%CI: 1.1-2.2). High children birthweight was positively associated with childhood obesity (OR=2.5; 95%CI: 1.3-4.6). The durability of breastfeeding, maternal weight, gestational age and maternal age did not show relevant link with childhood obesity. CONCLUSION: The child and maternal variables are associated with the development of childhood obesity, however in the present study, just not-breastfeeding and children birth weight showed a statistic link with childhood obesity. Furthermore investigation is useful in order to validate these results, and better understand the influence of child and maternal factors on child development.