Gisela Soares Brunken

Bio: Gisela Soares Brunken is an academic researcher from Universidade Federal de Mato Grosso. The author has contributed to research in topics: Population & Anemia. The author has an hindex of 15, co-authored 28 publications receiving 808 citations. Previous affiliations of Gisela Soares Brunken include University of São Paulo.

ERICA: prevalences of hypertension and obesity in Brazilian adolescents

Abstract: OBJECTIVE To estimate the prevalence of arterial hypertension and obesity and the population attributable fraction of hypertension that is due to obesity in Brazilian adolescents. METHODS Data from participants in the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA), which was the first national school-based, cross-section study performed in Brazil were evaluated. The sample was divided into 32 geographical strata and clusters from 32 schools and classes, with regional and national representation. Obesity was classified using the body mass index according to age and sex. Arterial hypertension was defined when the average systolic or diastolic blood pressure was greater than or equal to the 95th percentile of the reference curve. Prevalences and 95% confidence intervals (95%CI) of arterial hypertension and obesity, both on a national basis and in the macro-regions of Brazil, were estimated by sex and age group, as were the fractions of hypertension attributable to obesity in the population. RESULTS We evaluated 73,399 students, 55.4% female, with an average age of 14.7 years (SD = 1.6). The prevalence of hypertension was 9.6% (95%CI 9.0-10.3); with the lowest being in the North, 8.4% (95%CI 7.7-9.2) and Northeast regions, 8.4% (95%CI 7.6-9.2), and the highest being in the South, 12.5% (95%CI 11.0-14.2). The prevalence of obesity was 8.4% (95%CI 7.9-8.9), which was lower in the North region and higher in the South region. The prevalences of arterial hypertension and obesity were higher in males. Obese adolescents presented a higher prevalence of hypertension, 28.4% (95%CI 25.5-31.2), than overweight adolescents, 15.4% (95%CI 17.0-13.8), or eutrophic adolescents, 6.3% (95%CI 5.6-7.0). The fraction of hypertension attributable to obesity was 17.8%. CONCLUSIONS ERICA was the first nationally representative Brazilian study providing prevalence estimates of hypertension in adolescents. Regional and sex differences were observed. The study indicates that the control of obesity would lower the prevalence of hypertension among Brazilian adolescents by 1/5.

The study of cardiovascular risk in adolescents – ERICA: rationale, design and sample characteristics of a national survey examining cardiovascular risk factor profile in Brazilian adolescents

Abstract: The Study of Cardiovascular Risk in Adolescents (Portuguese acronym, “ERICA”) is a multicenter, school-based country-wide cross-sectional study funded by the Brazilian Ministry of Health, which aims at estimating the prevalence of cardiovascular risk factors, including those included in the definition of the metabolic syndrome, in a random sample of adolescents aged 12 to 17 years in Brazilian cities with more than 100,000 inhabitants. Approximately 85,000 students were assessed in public and private schools. Brazil is a continental country with a heterogeneous population of 190 million living in its five main geographic regions (North, Northeast, Midwest, South and Southeast). ERICA is a pioneering study that will assess the prevalence rates of cardiovascular risk factors in Brazilian adolescents using a sample with national and regional representativeness. This paper describes the rationale, design and procedures of ERICA.

Determinantes da amamentação no primeiro ano de vida em Cuiabá, Mato Grosso

Abstract: OBJETIVO: Avaliar os fatores de risco para a interrupcao de aleitamento materno e desmame em criancas menores de um ano. METODOS: Estudo transversal analitico com criancas menores de um ano de idade que compareceram aos postos de vacinacao do municipio de Cuiaba, Mato Grosso, em 2004, acompanhadas de seus responsaveis. Para definicao da amostra, foram sorteadas as unidades de vacinacao, seguindo-se o sorteio das criancas em cada unidade, de forma sistematica. Para coleta de dados, aplicou-se um questionario semi-estruturado aos acompanhantes das criancas, investigando variaveis caracteristicas sociodemograficas, referentes ao nascimento da crianca e maternas, uso de chupeta e alimentacao no primeiro dia em casa. Foram realizadas analise descritiva e regressao logistica dos fatores de risco para cada faixa etaria, apresentadas em odds ratio e intervalos de confianca. RESULTADOS: No total, 920 criancas menores de um ano foram avaliadas, das quais 205 menores de 120 dias e 275 menores de 180 dias. Verificou-se que usar chupeta, tomar cha no primeiro dia em casa, ter mae com escolaridade ate o primeiro ou segundo graus ou primipara, representam maior risco de nao estar em amamentacao exclusiva aos 120 dias de vida. Tais fatores se mostraram significativos tambem para menores de 180 dias, com excecao do consumo de cha, que nao foi indagado para essa faixa etaria. Nos menores de um ano, o uso de chupeta foi a unica variavel que manteve significância estatistica. CONCLUSOES: Fatores socioculturais mostraram-se determinantes da situacao de aleitamento materno. Ressalta-se a importância da instrucao e conscientizacao maternas, que refletem sobre as praticas que podem prejudicar a amamentacao.

ERICA: prevalence of metabolic syndrome in Brazilian adolescents

Abstract: OBJECTIVE To determine the prevalence of metabolic syndrome and its components in Brazilian adolescents. METHODS We evaluated 37,504 adolescents who were participants in the Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional, school-based, national study. The adolescents, aged from 12 to 17 years, lived in cities with populations greater than 100,000 inhabitants. The sample was stratified and clustered into schools and classes. The criteria set out by the International Diabetes Federation were used to define metabolic syndrome. Prevalences of metabolic syndrome were estimated according to sex, age group, school type and nutritional status. RESULTS Of the 37,504 adolescents who were evaluated: 50.2% were female; 54.3% were aged from 15 to 17 years, and 73.3% were from public schools. The prevalence of metabolic syndrome was 2.6% (95%CI 2.3-2.9), slightly higher in males and in those aged from 15 to 17 years in most macro-regions. The prevalence was the highest in residents from the South macro-region, in the younger female adolescents and in the older male adolescents. The prevalence was higher in public schools (2.8% [95%CI 2.4-3.2]), when compared with private schools (1.9% [95%CI 1.4-2.4]) and higher in obese adolescents when compared with nonobese ones. The most common combinations of components, referring to 3/4 of combinations, were: enlarged waist circumference (WC), low HDL-cholesterol (HDL-c) and high blood pressure; followed by enlarged WC, low HDL-c and high triglycerides; and enlarged WC, low HDL-c, high triglycerides and blood pressure. Low HDL was the second most frequent component, but the highest prevalence of metabolic syndrome (26.8%) was observed in the presence of high triglycerides. CONCLUSIONS ERICA is the first Brazilian nation-wide study to present the prevalence of metabolic syndrome and describe the role of its components. Despite the prevalence of Metabolic Syndrome being low, the high prevalences of some components and participation of others in the syndrome composition shows the importance of early diagnosis of this changes, even if not grouped within the metabolic syndrome.

Anemia in children under 3 years of age in public day care centers

Abstract: OBJECTIVE: To study the prevalence of anemia in children aged less than 36 months in public day care centers in the city of Cuiaba, state of Mato Grosso, Brazil. METHODS: Cross-sectional study with all children (n=271) less than 36 months of age who attended public day care centers in mid-1997. Children were evaluated as to their hemoglobin levels (venous blood, analyzed at the Central State Laboratory) and anthropometric indicators (weight/age, height/age, weight/height). RESULTS: A high prevalence (63%) of anemia associated with age, weight and height deficit, and time of admittance at kindergarten was observed. The prevalence of malnutrition was 0.8% according to the weight/height ratio, 5.0% according to weight/age deficit, and showed an inadequacy of 10.3% as to the height/age ratio. Thus, the percentage of anemic children was six times higher than the height deficit and twelve times higher than the weight deficit. Malnutrition was not in fact associated with anemia, but at extreme anthropometric cut-off points of height and weight for age (< -2 z score), there is an association between these conditions. CONCLUSION: The high prevalence of anemia is regarded as a severe public health problem among preschool children in the city of Cuiaba.

Iron Deficiency in Infancy and Childhood

Abstract: Despite the rapid accumulation of advanced information governing iron nutrition, the diversity of dietary practices and economic circumstances have resulted in iron deficiency in developing as well as in affluent countries.

The importance of milk and other animal-source foods for children in low-income countries.

Abstract: BACKGROUND: Milk and other animal-source foods are concentrated dietary sources of macro- and micronutrients. Despite a global increase in milk production and consumption over the past decades milk and other animal-source foods are often lacking in the diets of children in developing countries. OBJECTIVE: To evaluate the importance of milk and other animal-source food intake in promoting the growth development and health of children in low-income countries. METHODS: Original research articles describing observational and intervention studies with unfortified milk fortified milk and other animal-source foods in children were identified by searching the PubMed database. RESULTS: Consumption of milk and other animal-source foods by undernourished children improves anthropometric indices and cognitive function and reduces the prevalence of biochemical and functional nutritional deficiencies reducing morbidity and mortality. Unfortified and fortified milk used in supplementation trials has been well tolerated and widely accepted by parents and children. CONCLUSIONS: To improve the dietary quality of children in low-income countries and further the effort to eradicate extreme poverty and hunger in accordance with the United Nations Millennium Development Goals additional research is necessary to identify and implement programs and policy supporting increased intake of milk and other animal-source foods.

Determinants of exclusive breastfeeding practices in Ethiopia

Abstract: Background: Despite the demonstrated benefits of breast milk, the prevalence of breastfeeding, in-particular exclusive breastfeeding (EBF), in many developing countries including Ethiopia is lower than the international recommendation of EBF for the first six months of life Objective: To assess the practice of EBF and explore its determinants in Ethiopia and provide policy makers and NGOs with relevant information for future planning and interventions. Methods: Raw data collected from nine regions and two city administrations using stratified cluster sampling method by the Ethiopian Demographic Health Survey (EDHS) 2005 were used to study the practice and determinants of EBF countrywide. Analysis was based on children whose age was less than six months and alive at the time of interview that was extracted from the women’s database. Results: The overall rates of exclusive and full breastfeeding were 49.0% and 68.2% respectively. Maternal education, marital status, wealth index and age of the child were closely associated with EBF practices, nonetheless, in the hierarchical analysis; being not married, middle/ richer/ richest wealth index, and child age 0-1and 2-3 month were retained as the predictors of EBF (P Conclusion: A range of maternal and child health attributes such as marital status, economical status and child age were found to influence the practice of EBF in Ethiopia. Actions to empower women and promotion of EBF campaign are recommended to achieve the fourth millennium development goal.

Prevalence and Predictors of Maternal Anemia during Pregnancy in Gondar, Northwest Ethiopia: An Institutional Based Cross-Sectional Study.

Abstract: Background. Anaemia is a global public health problem which has an eminence impact on pregnant mother. The aim of this study was to assess the prevalence and predictors of maternal anemia. Method. A cross-sectional study was conducted from March 1 to April 30, 2012, on 302 pregnant women who attended antenatal care at Gondar University Hospital. Interview-based questionnaire, clinical history, and laboratory tests were used to obtain data. Bivariate and multivariate logistic regression was used to identify predictors. Result. The prevalence of anemia was 16.6%. Majority were mild type (64%) and morphologically normocytic normochromic (76%) anemia. Anemia was high at third trimester (18.9%). Low family income (AOR [95% CI] = 3.1 [1.19, 8.33]), large family size (AOR [95% CI] = 4.14 [4.13, 10.52]), hookworm infection (AOR [95% CI] = 2.72 [1.04, 7.25]), and HIV infection (AOR [95% CI] = 5.75 [2.40, 13.69]) were independent predictors of anemia. Conclusion. The prevalence of anemia was high; mild type and normocytic normochromic anemia was dominant. Low income, large family size, hookworm infection, and HIV infection were associated with anemia. Hence, efforts should be made for early diagnosis and management of HIV and hookworm infection with special emphasis on those having low income and large family size.

ERICA: prevalences of hypertension and obesity in Brazilian adolescents

Abstract: OBJECTIVE To estimate the prevalence of arterial hypertension and obesity and the population attributable fraction of hypertension that is due to obesity in Brazilian adolescents. METHODS Data from participants in the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA), which was the first national school-based, cross-section study performed in Brazil were evaluated. The sample was divided into 32 geographical strata and clusters from 32 schools and classes, with regional and national representation. Obesity was classified using the body mass index according to age and sex. Arterial hypertension was defined when the average systolic or diastolic blood pressure was greater than or equal to the 95th percentile of the reference curve. Prevalences and 95% confidence intervals (95%CI) of arterial hypertension and obesity, both on a national basis and in the macro-regions of Brazil, were estimated by sex and age group, as were the fractions of hypertension attributable to obesity in the population. RESULTS We evaluated 73,399 students, 55.4% female, with an average age of 14.7 years (SD = 1.6). The prevalence of hypertension was 9.6% (95%CI 9.0-10.3); with the lowest being in the North, 8.4% (95%CI 7.7-9.2) and Northeast regions, 8.4% (95%CI 7.6-9.2), and the highest being in the South, 12.5% (95%CI 11.0-14.2). The prevalence of obesity was 8.4% (95%CI 7.9-8.9), which was lower in the North region and higher in the South region. The prevalences of arterial hypertension and obesity were higher in males. Obese adolescents presented a higher prevalence of hypertension, 28.4% (95%CI 25.5-31.2), than overweight adolescents, 15.4% (95%CI 17.0-13.8), or eutrophic adolescents, 6.3% (95%CI 5.6-7.0). The fraction of hypertension attributable to obesity was 17.8%. CONCLUSIONS ERICA was the first nationally representative Brazilian study providing prevalence estimates of hypertension in adolescents. Regional and sex differences were observed. The study indicates that the control of obesity would lower the prevalence of hypertension among Brazilian adolescents by 1/5.