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Background: The double burden of obesity and underweight is increasing in developing countries and simple methods for the assessment of fat mass in children are needed. Aim: To develop and validate a new anthropometric predication equation for assessment of fat mass in children. Subjects and methods: Body composition was assessed in 145 children aged 9.8 ± 1.3 (SD) years from São Paulo, Brazil using dual energy X-ray absorptiometry (DEXA) and skinfold measurements. The study sample was divided into development and validation sub-sets to develop a new prediction equation for FM (PE). Results: Using multiple linear regression analyses, the best equation for predicting FM ( R2 == 0.77) included body weight, triceps skinfold, height, gender and age as independent variables. When cross-validated, the new PE was valid in this sample ( R2 == 0.80), while previously published equations were not. Conclusion: The PE was more valid for Brazilian children that existing equations, but further studies are needed to assess the validity of this PE in other populations. [ABSTRACT FROM AUTHOR]

Previous studies by our group and others have suggested that nutritional stunting may increase the risk of obesity. To investigate mechanisms that could explain a link between stunting and obesity, a 22-mo follow-up study was conducted in two groups of shantytowns school girls (7-11 y old) in São Paulo, Brazil. One group (n = 15) had mild stunting (defined using a cutoff of -1.4 Z-scores of height-for-age) but normal weight-for-height; the control group (n = 15) had normal weight and height. Similar energy intake, dietary macronutrient composition and energy expenditure were observed in the two groups. Both groups showed comparable levels of IGF-1 that were below the normal range. A significant and positive association between baseline IGF-1 and the change in height-for-age during follow-up was found in all subjects combined (P = 0.044). A significant association was found between the baseline percentage of dietary energy supplied by fat and the gain in weight-for-height during follow-up in girls with mild stunting (P = 0.048), but not in the nonstunted control girls (P = 0.245); however, the slopes of these relationships were not significantly different. This study raises the question of whether a diet high in fat may increase the susceptibility to excess body fat gain in children who are mildly stunted. Further studies are need to explore this issue and to examine the possible etiological role of low levels of IGF-1. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to determine whether central fat distribution varies between children who were growth retarded as young children and normal-height children from the same impoverished communities of São Paulo, Brazil., Methods: A prospective study of 50 stunted and normal-height children in São Paulo, Brazil was conducted in which children were measured for changes in fat mass (FM) and fat distribution (using dual-energy X-ray absorptiometry and anthropometry) and Tanner stage over a 4-y period. Statistical analyses included multiple linear regression to control for confounding factors and Student's t test was used to estimate group differences., Results: At follow-up, stunted children were shorter, weighed less, and had less total FM compared with control children. There were no differences between the two groups with respect to percent FM or percent truncal FM (%TrFM). Linear regression analyses were used to determine that stunted children had 1) increased TrFM (independent of FM); 2) increased %TrFM (independent of FM, gender, and Tanner stage), and 3) a borderline significantly greater change in TrFM (independent of FM, gender, and Tanner stage)., Conclusion: Stunted children are more likely to deposit fat centrally when entering puberty, a significant risk factor for chronic diseases. Our results may explain part of the association between early growth retardation and later risk for metabolic diseases.

Obesity, cardiovascular disease, and type 2 diabetes mellitus are now prevalent among adults living in developing countries; these chronic diseases affect socioeconomically disadvantaged adults living in impoverished families with undernourished children. This review summarizes data from Brazil--a developing country undergoing the nutrition transition--suggesting an association between childhood undernutrition and obesity and chronic degenerative disease. Potential mechanisms for the association include long-term effects of childhood undernutrition on energy expenditure, fat oxidation, regulation of food intake, susceptibility to the effects of high-fat diets, and altered insulin sensitivity. The combination of childhood undernutrition and adult chronic degenerative disease results in enormous social and economic burdens for developing countries. Further research is urgently needed to examine the effect of childhood undernutrition on risk of obesity and chronic degenerative diseases; one goal of such research would be to determine and provide low-cost methods for prevention and treatment.