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1.  The association of birth order with later body mass index and blood pressure: a comparison between prospective cohort studies from the UK and Brazil 
Previous studies have found greater adiposity and cardiovascular risk in first born children. The causality of this association is not clear. Examining the association in diverse populations may lead to improved insight.
We examine the association between birth order and body mass index (BMI), systolic and diastolic blood pressure (SBP/DBP) in the 2004 Pelotas cohort from southern Brazil and the Avon Longitudinal Study of Parents and Children (ALSPAC) from Bristol, south west England, restricting analysis to families with two children in order to remove confounding by family size.
No consistent differences in BMI, SBP or DBP were observed comparing first and second born children. Within the Pelotas 2004 cohort, first born females were thinner, with lower SBP and DBP; e.g. mean difference in SBP comparing first with second born was -0.979 (95% confidence interval -2.901 to 0.943). In ALSPAC, first born females had higher BMI, SBP and DBP. In both cohorts, associations tended to be in the opposite direction in males, although no statistical evidence for gender interactions was found.
The findings do not support an association between birth order and BMI or blood pressure. Differences to previous studies may be explained by differences in populations and/or confounding by family size in previous studies.
PMCID: PMC4024316  PMID: 24097298
ALSPAC; birth order; blood pressure; body mass index; cardiovascular; obesity; Pelotas; siblings
2.  Socioeconomic Trajectories From Birth to Adolescence and Risk Factors for Noncommunicable Disease: Prospective Analyses 
The Journal of Adolescent Health  2012;51(6):S32-S37.
To evaluate the associations between family socioeconomic trajectories from 0 to 11 years of age and risk factors for noncommunicable disease at 15 years.
Individuals born in the city of Pelotas, Brazil, in 1993 are part of a birth cohort study. Socioeconomic position, collected at birth and at 11 years of age, was our main exposure. Risk factors for chronic disease were collected at 15 years. Body mass index was transformed into Z score using the World Health Organization standard. Transport and leisure-time physical activity, smoking, and alcohol consumption were assessed by self-report. Blood pressure was measured using a digital sphygmomanometer.
Of 5,249 cohort members, 85.7% were located at the 15-year follow-up visit. Rich adolescents were more likely to be overweight, be obese, and not use active modes of transport to school. Poor adolescents were more likely to smoke. In relation to socioeconomic trajectories, the odds of obesity were 46% higher among those who were “always rich” compared with those who were “always poor”; the odds of use of an inactive mode of transportation were 326% greater among the “always rich” than the “always poor,” whereas the reverse was observed for smoking (odds of 200%). The “always rich” had one-half the odds of walking or cycling to school compared with those who became wealthy in the studied period.
Adolescent socioeconomic position is a stronger determinant of risk factors for noncommunicable diseases than socioeconomic trajectories. However, trajectories do matter, particularly in terms of use of active transportation to school.
PMCID: PMC3508416  PMID: 23283158
Socioeconomic factors; Poverty; Adolescent; Chronic diseases
3.  Physical activity levels in three Brazilian birth cohorts as assessed with raw triaxial wrist accelerometry 
Background: Data on objectively measured physical activity are lacking in low- and middle-income countries. The aim of this study was to describe objectively measured overall physical activity and time spent in moderate-to-vigorous physical activity (MVPA) in individuals from the Pelotas (Brazil) birth cohorts, according to weight status, socioeconomic status (SES) and sex.
Methods: All children born in 1982, 1993 and 2004 in hospitals in the city of Pelotas, Brazil, constitute the sampling frame; of these 99% agreed to participate. The most recent follow-ups were conducted between 2010 and 2013. In total, 8974 individuals provided valid data derived from raw triaxial wrist accelerometry. The average acceleration is presented in milli-g (1 mg = 0.001g), and time (min/d) spent in MVPA (>100 mg) is presented in 5- and 10-min bouts.
Results: Mean acceleration in the 1982 (mean age 30.2 years), 1993 (mean age 18.4 years) and 2004 (mean age 6.7 years) cohorts was 35 mg, 39 mg and 60 mg, respectively. Time spent in MVPA was 26 [95% confidence interval (CI) 25; 27], 43 (95% CI 42; 44) and 45 (95% CI 43; 46) min/d in the three cohorts, respectively, using 10-min bouts. Mean MVPA was on average 42% higher when using 5-min bouts. Males were more active than females and physical activity was inversely associated with age of the cohort and SES. Normal-weight individuals were more active than underweight, overweight and obese participants.
Conclusions: Overall physical activity and time spent in MVPA differed by cohort (age), sex, weight status and SES. Higher levels of activity in low SES groups may be explained by incidental physical activity.
PMCID: PMC4276065  PMID: 25361583
Activity monitor; cohort studies; motor activity; movement
4.  Physical Activity during Pregnancy and Offspring Neurodevelopment and IQ in the First 4 Years of Life 
PLoS ONE  2014;9(10):e110050.
Maternal physical activity during pregnancy could alter offspring's IQ and neurodevelopment in childhood.
Children belonging to a birth cohort were followed at 3, 12, 24 and 48 months of age. Physical activity during pregnancy was assessed retrospectively at birth. Neurodevelopment was evaluated by Battelle's Development Inventory (12, 24 and 48 months) and IQ by the Weschler's Intelligence Scale (48 months). Neurodevelopment was based on Battelles' (90th percentile) and also analyzed as a continuous outcome. IQ was analyzed as a continuous outcome. Potential confounders were: family income, mother's age, schooling, skin color, number of previous births and smoking; and newborns': preterm birth, sex and low birth weight.
From birth to 48 months, sample size decreased from 4231 to 3792. Crude analysis showed that IQ at 48 months was slightly higher (5 points) among children from active women. The Battelle's score at 12 and 24 months was higher among offspring from active mothers. After controlling for confounders, physical activity during pregnancy was positively associated to the Battelle's Inventory at 12 months IQ, however, at 48 months no association was observed.
Physical activity during pregnancy does not seem to impair children's neurodevelopment and children from active mothers presented better performance at 12 months.
PMCID: PMC4211660  PMID: 25350666
5.  Time trends of physical activity and television viewing time in Brazil: 2006-2012 
Despite recent advances in surveillance of physical activity, data on time trends of physical activity in low and middle-income countries are lacking. This study describes time trends in physical activity and television viewing between 2006 and 2012 among Brazilian adults.
Data from 371,271 adult participants (18 + years) in the Surveillance System for Risk and Protective Factors for Chronic Illnesses using Telephone Survey (VIGITEL) were analysed. Time trends in leisure-time physical activity (≥ 5 days/wk; ≥ 30 min/day), transportation physical activity (using bicycle or walking for ≥ 30 minutes per day as a means of transportation to/from work) and proportion of participants spending more than three hours per day watching television were analysed. Annual changes according to sex, age and years of schooling were calculated.
There was an increase in leisure-time physical activity from 12.8% in 2006 to 14.9% in 2012 (annual increase of 1.9%; p < 0.001). This increase was more marked in younger participants and those with high-school education. Transportation physical activity decreased 12.9% per year (p < 0.001) from 2006 to 2008 and 5.8% per year from 2009 to 2012 (p < 0.001). The annual decline in television viewing time was 5% (p < 0.001) between 2006 and 2009 and 2% (p = 0.16) between 2010 and 2012.
National survey data from Brazil indicate that leisure-time physical activity appears to be increasing, while television viewing time appears to be decreasing in recent years. However, transportation physical activity has been declining. These data are important for informing national public health policies.
PMCID: PMC4149267  PMID: 25124462
Physical activity; Trends; Surveillance; Epidemiology; Developing countries
6.  Active Commuting Throughout Adolescence and Central Fatness before Adulthood: Prospective Birth Cohort Study 
PLoS ONE  2014;9(5):e96634.
Active commuting is a good opportunity to accumulate physical activity (PA) across the lifespan that potentially might influence central body fat. We aimed to examine the prospective associations of active commuting at 11, 15 and 18 years of age with central body fat at 18 years.
Participants were part of a large birth cohort study in Pelotas, Brazil (n = 3,649 participants). Active commuting, leisure-time PA and income were self-reported at 11, 15 and 18 years. Waist circumference and trunk fat mass were collected at 18 years with the use of a 3-dimensional photonic scanner and dual-energy X-ray absorptiometry, respectively.
Active commuting at 11 years was not prospectively associated with central body fat. However, we found that active commuting at 15 and 18 years were prospectively and cross-sectionally associated with central body fat variables, respectively, in boys but not in girls. Also, boys in the highest tertile of accumulated active commuting (i.e., average of active commuting at 11, 13 and 18 years) were associated with −2.09 cm (95%CI: −3.24; −0.94) of waist circumference and −1.11 kg (95%CI: −1.74; −0.48) of trunk fat mass compared to boys in the lowest tertile. Analyses on changes in tertiles of active commuting from 11 and 15 years to 18 years with central body fat variables at 18 years showed that boys who remained consistently in the highest tertile or moved to a higher tertile had lower levels of central body fat compared to those consistently in the lowest tertile.
Active commuting throughout adolescence in boys, especially during middle and late adolescence, is associated with lower levels in central fatness before adulthood.
PMCID: PMC4008595  PMID: 24791780
7.  Cohort Profile update: The 1993 Pelotas (Brazil) Birth Cohort follow-up visits in adolescence 
In this paper we update the profile of the 1993 Pelotas (Brazil) Birth Cohort Study, with emphasis on a shift of priority from maternal and child health research topics to four main categories of outcome variables, collected throughout adolescence: (i) mental health; (ii) body composition; (iii) risk factors for non-communicable diseases (NCDs); (iv) human capital. We were able to trace 81.3% (n = 4106) of the original cohort at 18 years of age. For the first time, the 18-years visit took place entirely on the university premises, in a clinic equipped with state-of-the-art equipment for the assessment of body composition. We welcome requests for data analyses from outside scientists. For more information, refer to our website ( or e-mail the corresponding author.
PMCID: PMC4121560  PMID: 24729426
8.  Brazilian Adults' Sedentary Behaviors by Life Domain: Population-Based Study 
PLoS ONE  2014;9(3):e91614.
There is rapidly-emerging evidence on the harmful health effects of sedentary behaviors. The aim of this paper was to quantify time in sedentary behaviors and document socio-demographic variations in different life domains among adults.
A population-based survey was carried out in 2012 through face-to-face interviews with Brazilian adults aged 20+ years (N = 2,927). Information about time spent sedentary in a typical weekday was collected for five different domains (workplace, commuting, school/university, watching TV, and computer use at home). Descriptive and bivariate analyses examined variations in overall and domain-specific sedentary time by gender, age, educational attainment and socioeconomic position.
On average, participants reported spending 5.8 (SD 4.5) hours per day sitting. The median value was 4.5 (interquartile range: 2.5–8) hours. Men, younger adults, those with higher schooling and from the wealthiest socioeconomic groups had higher overall sedentary scores. TV time was higher in women, older adults and among those with low schooling and socioeconomic position. Sedentary time in transport was higher in men, younger adults, and participants with high schooling and high socioeconomic position. Computer use at home was more frequent among young adults and those from high socioeconomic groups. Sitting at work was higher in those with higher schooling and from the wealthiest socioeconomic groups. Sedentary behavior at school was related inversely to age and directly to schooling.
Patterns of sedentary behavior are different by life domains. Initiatives to reduce prolonged sitting among Brazilian adults will be required on multiple levels for different life domains.
PMCID: PMC3950247  PMID: 24619086
9.  Epidemiology, management, complications and costs associated with type 2 diabetes in Brazil: a comprehensive literature review 
With an estimated 74% of all deaths attributable to non-communicable diseases (NCDs) in 2010, NCDs have become a major health priority in Brazil. The objective of the study was to conduct a comprehensive literature review on diabetes in Brazil; specifically: the epidemiology of type 2 diabetes, the availability of national and regional sources of data (particularly in terms of direct and indirect costs) and health policies for the management of diabetes and its complications.
A literature search was conducted using PubMed to identify articles containing information on diabetes in Brazil. Official documents from the Brazilian government and the World Health Organization, as well as other grey literature and official government websites were also reviewed.
From 2006 to 2010, an approximate 20% increase in the prevalence of self-reported diabetes was observed. In 2010, it was estimated that 6.3% of Brazilians aged 18 years or over had diabetes. Diabetes was estimated to be responsible for 278,778 years of potential life lost for every 100,000 people. In 2013, it is estimated that about 7% of patients with diabetes has had one or more of the following complications: diabetic foot ulcers, amputation, kidney disease, and fundus changes. The estimated annual direct cost of diabetes was USD $3.952 billion in 2000; the estimated annual indirect cost was USD $18.6 billion. The two main sources of data on diabetes are the information systems of the Ministry of Health and surveys. In the last few years, the Brazilian Ministry of Health has invested considerably in improving surveillance systems for NCDs as well as implementing specific programmes to improve diagnosis and access to treatment.
Brazil has the capacity to address and respond to NCDs due to the leadership of the Ministry of Health in NCD prevention activities, including an integrated programme currently in place for diabetes. Strengthening the surveillance of NCDs is a national priority along with recognising the urgent need to invest in improving the coverage and quality of mortality data. It is also essential to conduct regular surveys of risk factors on a national scale in order to design effective preventive strategies.
PMCID: PMC4220809  PMID: 24299125
Diabetes; Brazil; Costs; Epidemiology
10.  Nutritional status of adolescents: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study 
Cadernos de saude publica  2010;26(10):1895-1903.
We evaluate the influence of demographic, socioeconomic, and maternal variables on the nutritional status of adolescents aged 11 years. We conducted a prospective cohort study including 4,452 adolescents born in Pelotas, Southern Brazil, in 1993, accounting for 87.5% of the original cohort. Nutritional status was evaluated based on World Health Organization criteria. Subjects were classified according to nutritional status into thin, normal, overweight and obese. Independent variables analyzed included skin color, socioeconomic status, maternal schooling, and maternal body mass index (BMI). Analyses were stratified by sex, and multivariable regression was performed using the multinomial logistic approach. Overall, 7% of adolescents were classified as thin, 11.6% as overweight, and 11.6% as obese. Among boys, thinness was inversely associated with maternal schooling and maternal BMI. Among girls, thinness was directly associated with maternal BMI. Overweight and obesity were directly associated with socioeconomic status and maternal BMI, the former showing the strongest association with nutritional status among adolescents.
PMCID: PMC3836176  PMID: 20963286
Nutritional Status; Adolescent; Cohort Studies
11.  Happiness and Depression in Adolescence after Maternal Smoking during Pregnancy: Birth Cohort Study 
PLoS ONE  2013;8(11):e80370.
Prenatal cigarette smoke exposure may have adverse psychological effects on offspring. The objective was to assess the association between parental smoking during pregnancy and offspring happiness at age 18, as well as depression.
Participants were part of a birth cohort study in Pelotas, Brazil (5,249 participants). Happiness was measured by the Subjective Happiness Scale, a Likert-like scale with four questions generating a score from 1 to 7, with ≥ 6 indicating "happiness". Depression was measured using the Mini International Psychiatric Interview.
About one third of mothers reported having smoked during pregnancy and 4.6% reported smoking 20 or more cigarettes a day. The prevalence of happiness was 32.2% (95% CI 30.8; 33.7), depression 6.8% (95% CI 6.1; 7.6), and simultaneous happiness and depression less than 1%. The prevalence of offspring happiness decreased as smoking in pregnancy increased, even after control for confounding variables, showing an OR = 0.79 [95% CI 0.55; 1.13]. The opposite happened to depression; the prevalence of offspring depression increased as smoking in pregnancy increased (<20 cigarettes/day OR = 1.38 [95% CI 1.03; 1.84] and ≥20 cigarettes/day OR = 2.11[95% CI 1.31; 3.40]. Smoking by the partner was associated with decreased offspring happiness after adjustment for confounders, but did no show association with offspring depression.
Offspring were less likely to be happy and more likely to be depressed if their mother smoked during pregnancy, and less likely to be happy if their father smoked during mother’s pregnancy. Although we can not affirm that this is a “causal pathway”, public policies to reduce smoking in pregnancy could improve the health of the offspring in the short and long term.
PMCID: PMC3827230  PMID: 24265817
12.  Energy Expenditure Compared to Physical Activity Measured by Accelerometry and Self-Report in Adolescents: A Validation Study 
PLoS ONE  2013;8(11):e77036.
Physical inactivity is responsible for 5.3 million deaths annually worldwide. To measure physical activity energy expenditure, the doubly labeled water (DLW) method is the gold standard. However, questionnaires and accelerometry are more widely used. We compared physical activity measured by accelerometer and questionnaire against total (TEE) and physical activity energy expenditure (PAEE) estimated by DLW.
TEE, PAEE (TEE minus resting energy expenditure) and body composition were measured using the DLW technique in 25 adolescents (16 girls) aged 13 years living in Pelotas, Brazil. Physical activity was assessed using the Actigraph accelerometer and by self-report. Physical activity data from accelerometry and self-report were tested against energy expenditure data derived from the DLW method. Further, tests were done to assess the ability of moderate-to-vigorous intensity physical activity (MVPA) to predict variability in TEE and to what extent adjustment for fat and fat-free mass predicted the variability in TEE.
TEE varied from 1,265 to 4,143 kcal/day. It was positively correlated with physical activity (counts) estimated by accelerometry (rho  = 0.57; p = 0.003) and with minutes per week of physical activity by questionnaire (rho  = 0.41; p = 0.04). An increase of 10 minutes per day in moderate-to-vigorous intensity physical activity (MVPA) relates to an increase in TEE of 141 kcal/day. PAEE was positively correlated with accelerometry (rho  = 0.64; p = 0.007), but not with minutes per week of physical activity estimated by questionnaire (rho  = 0.30; p = 0.15). Physical activity by accelerometry explained 31% of the vssariability in TEE. By incorporating fat and fat-free mass in the model, we were able to explain 58% of the variability in TEE.
Objectively measured physical activity significantly contributes to the explained variance in both TEE and PAEE in Brazilian youth. Independently, body composition also explains variance in TEE, and should ideally be taken into account when using accelerometry to predict energy expenditure values.
PMCID: PMC3817188  PMID: 24223707
13.  Hospital admissions from birth to early adolescence and early-life risk factors: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study 
Cadernos de saude publica  2010;26(10):1980-1989.
The aim of this prospective analysis was to describe the cumulative incidence of hospital admissions in the first year of life and between 1 and 11 years of age and to explore associated factors. Hospital admissions were collected through regular monitoring in the first year of life, and through maternal report on admissions between 1 and 11 years. Analyses were stratified by sex and adjusted for confounding factors. 18.1% of children were hospitalized in the first year of life, and 30.7% between ages 1 and 11 years. Among boys, hospital admission in the first year was associated with low family income, paternal smoking during pregnancy, preterm delivery, and low birthweight. Among girls, in addition to the variables described for boys, black/mixed skin color was also a risk factor for hospital admission. For admissions between 1 and 11 years of age, low family income and gestational age ≥ 37 weeks were found to be significant risk factors.
PMCID: PMC3795331  PMID: 20963296
Hospitalization; Adolescent; Child; Cohort Studies
14.  Oral health follow-up studies in the 1993 Pelotas (Brazil) birth cohort study: methodology and principal results 
Cadernos de saude publica  2010;26(10):1990-1999.
The aim of this study was to describe oral health follow-up studies nested in a birth cohort. A population-based birth cohort was launched in 1993 in Pelotas, Rio Grande do Sul State, Brazil. Two oral health follow-up studies were conducted at six (n = 359) and 12 (n = 339) years of age. A high response rate was observed at 12 years of age; 94.4% of the children examined at six years of age were restudied in 2005. The mean DMF-T index at age 12 was 1.2 (SD = 1.6) for the entire sample, ranging from 0.6 (SD = 1.1) for children that were caries-free at age six, 1.3 (SD = 1.5) for those with 1-3 carious teeth at six years, and 1.8 (SD = 1.8) for those with 4-19 carious teeth at six years (p < 0.01). The number of individuals with severe malocclusions at 12 years was proportional to the number of malocclusions at six years. Oral health problems in early adolescence were more prevalent in individuals with dental problems at six years of age.
PMCID: PMC3794421  PMID: 20963297
Oral Health; Cohort Studies; Child; Adolescent
15.  Intake of fat and fiber-rich foods according to socioeconomic status: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study 
Cadernos de saude publica  2010;26(10):1904-1911.
This study describes the food intake of adolescents participating in the 1993 birth cohort from Pelotas, Southern Brazil, according to socioeconomic position. We carried out a cross-sectional analysis of data collected in the 2004-2005 follow-up visit. Food intake in the previous year was evaluated using the Block questionnaire. Socioeconomic status was evaluated based on an assets index, divided into quintiles. Foods with the highest frequency of daily intake were white bread (83%), butter or margarine (74.6%), beans (66.4%) and milk (48.5%). Intake of butter or margarine, bread, and beans was more frequent among poorer adolescents, and the inverse was true for milk. Intake of fruits and vegetables was low in all socioeconomic strata, but particularly low among the poor. In early adolescence, all socioeconomic groups showed high consumption of foods rich in fat and low consumption of foods rich in fiber.
PMCID: PMC3794422  PMID: 20963287
Eating; Food Habits; Socioeconomic Factors; Adolescent; Cohort Studies
16.  Concurrent determinants of blood pressure among adolescents: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study 
Cadernos de saude publica  2010;26(10):1972-1979.
The aim of this study was to evaluate concurrent risk factors for high blood pressure in adolescents. This is a prospective cohort study including 4,452 adolescents born in Pelotas, Rio Grande do Sul State, Brazil, in 1993. Blood pressure was measured before and after the interview, and the mean value was used in the analyses. Mean systolic blood pressure was 101.9mmHg (SD = 12.3) and mean diastolic pressure was 63.4mmHg (SD = 9.9). Adolescents with black skin had higher blood pressure than those with white skin. Mean systolic pressure among subjects in the top quartile of body mass index (BMI) was 11.6mmHg higher than among those in the lowest quartile. Mean systolic pressure among postmenarcheal girls was 5.4mmHg higher than among premenarcheal girls. Similar trends were found for diastolic arterial pressure. Our findings suggest that blood pressure control must begin already in childhood and adolescence.
PMCID: PMC3794424  PMID: 20963295
Blood Pressure; Adolescent; Cohort Studies
17.  Bidirectional cross-sectional and prospective associations between physical activity and body composition in adolescence: Birth cohort study 
Journal of Sports Sciences  2011;30(2):185-192.
The aim of this study was to investigate the cross-sectional and prospective associations between physical activity and body composition in adolescence. This is a prospective study, including 4,103 adolescents belonging to the Pelotas (Brazil) 1993 birth cohort, who were followed up at the mean ages of 11.3 and 14.7 years. Subsample analyses included 511 individuals with accelerometry and deuterium dilution data at 13.3 years. Sum of skinfolds at age 11.3 years was highly correlated with skinfolds at age 14.7 years (rho = 0.74, P < 0.001). More than 85% of participants remained in the same quintile or changed by not more than one quintile during the 3.4 year period. Tracking of physical activity was considerably lower, although still significant; the correlation was 0.24 (P < 0.001) and 61.4% of the adolescents moved one or less quintiles. In fully-adjusted models, no significant cross-sectional or longitudinal associations were found between physical activity and body composition, neither in boys nor in girls. These null results were confirmed in the 511 individuals with accelerometry and deuterium data. We provide evidence of tracking of physical activity and particularly body composition during adolescence. Our results do not support the hypothesis that physical activity and fatness are strongly related in adolescents.
PMCID: PMC3413903  PMID: 22141438
motor activity; fatness; epidemiology; adolescence
18.  Cross-Sectional and Longitudinal Associations Between Physical Activity and Blood Pressure in Adolescence: Birth Cohort Study 
To explore cross-sectional and longitudinal associations between self-reported and accelerometry-based physical activity (PA) and blood pressure (BP) between 11 and 14 years of age.
Prospective birth cohort study in Pelotas, Brazil. Participants were 427 cohort members who were followed up with at 11, 12, and 14 years of age, and had questionnaire data on PA and BP at 11 and 14 years, as well as accelerometry and questionnaire data on PA at 12 years. Outcome measures were continuous systolic and diastolic BP at 14 years, and change in BP from 11 to 14 years.
PA was unrelated to systolic BP in any analyses. PA measured by accelerometry at 12 years, but not questionnaire-derived PA, was inversely associated with diastolic BP at 14 years of age in fully adjusted models. Those who exceeded the 300-minutes PA threshold at all 3 visits had a 2.6 mmHg lower mean increase in DBP from 11 to 14 years compared with those classified below the threshold in all visits.
Accelerometry-based PA was longitudinally inversely associated with diastolic BP. This finding was not evident when analyzing self-reported PA at a given age, suggesting a possible underestimation of the association when using subjective data.
PMCID: PMC3672951  PMID: 21597118
motor activity; adolescence; prospective studies
20.  A Longitudinal Evaluation of Physical Activity in Brazilian Adolescents: Tracking, Change and Predictors 
Pediatric exercise science  2012;24(1):58-71.
This study aimed to: 1) describe the change in leisure-time physical activity (LTPA) during early-to-mid adolescence; 2) analyze the tracking of LTPA; 3) identify the predictors of LTPA change. 4,120 adolescents were from 11 to 15 years old. Outcome was self-reported LTPA (min/wk). Boys increased their LTPA level over the four years (mean: 75 min/wk; 95%CI: 49,100), whereas a decrease was observed among girls (mean: −42 min/wk; 95%CI: −57,−28). Likelihood to be active at 15 years of age was 50% higher (95%CI: 39–62) among those who were active at 11 years. The main predictor of LTPA change was the number of physical activities performed at baseline. Regular physical activity early in life can predict this behavior afterward.
PMCID: PMC3650301  PMID: 22433265
21.  Validity of Partial Protocols to Assess the Prevalence of Periodontal Outcomes and Associated Sociodemographic and Behavior Factors in Adolescents and Young Adults 
Journal of periodontology  2011;83(3):369-378.
Most studies comparing prevalence of periodontal disease and risk factors by using partial protocols were performed in adult populations, with several studies being conducted in clinical settings. The aim of this study is to assess the accuracy of partial protocols in estimating the prevalence of periodontal outcomes in adolescents and young adults from two population-based birth cohorts from Pelotas, Brazil, and to assess differences in the estimation and strength of the effect measures when partial protocols are adopted compared to full-mouth examination.
Gingival bleeding at probing among adolescents (n = 339) and young adults (n = 720) and dental calculus and periodontal probing depth among young adults were assessed using full-mouth examinations and four partial protocols: Ramfjord teeth (RT), community periodontal index (CPI), and two random diagonal quadrants (1 and 3, 2 and 4). Socioeconomic, demographic, and periodontal health-related variables were also collected. Sensitivity, absolute and relative bias, and inflation factors were calculated. Prevalence ratio for each periodontal outcome for the risk factors was estimated.
Two diagonal quadrants showed better accuracy; RT had the worst, whereas CPI presented an intermediate pattern when compared to full-mouth examination. For bleeding assessment in adolescence, RT and CPI underestimated by 18.4% and 16.2%, respectively, the true outcome prevalence, whereas among young adults, all partial protocols underestimated the prevalence. All partial protocols presented similar magnitude of association measures for all investigated periodontal potential risk factors.
Two diagonal quadrants protocol may be effective in identifying the risk factors for the most relevant periodontal outcomes in adolescence and in young adulthood.
PMCID: PMC3605763  PMID: 21859320
Data collection; epidemiologic studies; periodontal index
22.  Physical Activity Interventions in Latin America 
Systematic reviews of public health interventions are useful for identifying effective strategies for informing policy and practice. The goals of this review were to (1) update a previous systematic review of physical activity interventions in Latin America which found that only school-based physical education had sufficient evidence to recommend widespread adoption; (2) assess the reporting of external validity elements; and (3) develop and apply an evidence typology for classifying interventions.
Evidence acquisition
In 2010–2011, community-level, physical activity intervention studies from Latin America were identified, categorized, and screened based on the peer-reviewed literature or Brazilian theses published between 2006 and 2010. Articles meeting inclusion criteria were evaluated using U.S. Community Guide methods. External validity reporting was assessed among a subset of articles reviewed to date. An evidence rating typology was developed and applied to classify interventions along a continuum based on evidence about their effectiveness in the U.S. context, reach, adoption, implementation, institutionalization, and benefits and costs.
Evidence synthesis
Thirteen articles published between 2006 and 2010 met inclusion criteria and were abstracted systematically, yet when combined with evidence from articles from the previous systematic review, no additional interventions could be recommended for practice. Moreover, the reporting of external validity elements was low among a subset of 19 studies published to date (median=21% of elements reported). By applying the expanded evidence rating typology, one intervention was classified as evidence-based, seven as promising, and one as emerging.
Several physical activity interventions have been identified as promising for future research and implementation in Latin America. Enhanced reporting of external validity elements will inform the translation of research into practice.
PMCID: PMC4217143  PMID: 23415133
23.  Birth weight, postnatal weight gain and adult body composition in five low and middle income countries 
Evaluate associations between birth weight (BW), infancy and childhood weight gain and adult body composition.
Subjects included participants of five birth cohort studies from low and middle income nations (Brazil, Guatemala, India, Philippines, South Africa; n=3432). We modeled adult body composition as a function of BW and conditional weight gain (CW), representing changes in weight trajectory relative to peers, in three age intervals (0-12m, 12-24m, 24m-mid childhood).
In 34 of 36 site- and sex-specific models, regression coefficients associated with BW and CWs were higher for adult fat-free than for fat mass. The strength of coefficients predicting fat-free mass relative to those predicting fat mass was greatest for birth weight, intermediate for CWs through 24 months, and weaker thereafter. However, because fat masses were smaller and showed larger variances than fat-free masses, weaker relationships with fat mass still yielded modest but significant increases in adult % body fat (PBF). CW at 12 months and mid-childhood tended to be strongest predictors of PBF, while BW was generally the weakest predictor of PBF. For most early growth measures, a 1 SD change predicted less than a 1% change in adult body fat, suggesting that any health impacts of early growth on changes in adult body composition are likely to be small in these cohorts.
Birth weight and weight trajectories up to 24 months tend to be more strongly associated with adult fat-free mass than with fat mass, while weight trajectories in mid-childhood predict both fat mass and fat-free mass.
PMCID: PMC3541478  PMID: 22121058
body fat; cohort studies; developing countries; DOHaD; obesity
24.  Prospective Findings From the 1993 Pelotas (Brazil) Birth Cohort Study 
PMCID: PMC3508406  PMID: 22794527
25.  Incidence of School Failure According to Baseline Leisure-Time Physical Activity Practice: Prospective Study 
The Journal of Adolescent Health  2012;51(6):S22-S26.
To evaluate the prospective association between leisure-time physical activity practice at 11 years of age and incidence of school failure from 11 to 15 years of age.
The sample comprised >4,300 adolescents followed up from birth to 15 years of age participating in a birth cohort study in Pelotas, Brazil. The incidence of school failure from age 11 to 15 years was calculated by first excluding from the analyses all subjects who experienced a school failure before 11 years of age, and then categorizing as “positive” all those who reported repeating a grade at school from 11 to 15 years of age. Leisure-time physical activity was measured using a validated questionnaire.
The incidence of school failure was 47.9% among boys and 38.2% among girls. Adolescents in the top quartile of leisure-time physical activity practice at 11 years of age had a higher likelihood of school failure (OR: 1.36; 95% CI: 1.06, 1.75) compared with the least active adolescents. In adjusted analyses stratified by sex, boys in the top quartile of leisure-time physical activity practice at 11 years of age were also more likely to have failed at school from age 11 to 15 years (OR: 1.60; 95% CI: 1.09, 2.33).
Adolescents allocating >1,000 min/wk to leisure-time physical activity were more likely to experience a school failure from 11 to 15 years of age. Although this finding does not advocate against physical activity promotion, it indicates that excess time allocated to physical activity may jeopardize school performance among adolescents.
PMCID: PMC3508407  PMID: 23283155
School achievement; Adolescents; Cohort; Physical activity

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