Newton001 Breakfast, diabetes and poverty in Brazil

Lead Research Organisation: Liverpool School of Tropical Medicine
Department Name: Clinical Sciences

Abstract

This proposal will be implemented through a partnership between the Federal University of Sergipe and the Liverpool School of Tropical Medicine (LSTM), UK.

Professors Gurgel and Cuevas have maintained more than 15 years collaborations on research on infectious diseases, including diarrhoea, respiratory infections and tuberculosis.
This award will provide an opportunity for their institutes to develop new research interests in chronic non-communicable diseases, which are increasingly recognised as emerging diseases in Brazil.

The partnership proposed, will expand the expertise of the applicants and provide an opportunity to initiate research in chronic diseases within a different context to the UK.
We will combine our research expertise with nutritional expertise at the University of Sergipe and on health inequalities within the Department of Public Health, University of Liverpool (UoL), who have accepted to support the implementation of this proposal.

Technical Summary

The prevalence of diabetes mellitus (DM) is increasing worldwide and studies have reported that adults missing breakfast have a higher prevalence of markers of DM. Children missing breakfast have higher glycated haemoglobin (HbA1c) levels and body mass index (BMI) than regular breakfast takers. However these associations are complex, as missing breakfast is often preceded or followed by large meals and their causal roles are debatable.

DM diabetes is increasing in Brazil as is widely perceived as a disease of affluence. However lifestyle changes and obesity are also common among low income populations. Poor populations have food insecurity, miss breakfast and consume low cost, energy-dense foods with low nutritional value. Therefore, the increase in DM may reflect different causal pathways among affluent and low income populations and result in different health outcomes and health inequalities.

We will conduct a cross sectional survey of children aged 9-12 years attending primary schools in Sergipe, followed by a case control study of parents whose children have abnormal metabolic markers of DM. Children attending free and fee-paying private schools will be enrolled after selecting a random sample of schools in Aracaju and Laranjeiras. We will document breakfast frequency, undertake measurements of body composition, fasting measurements of blood lipids, insulin, glucose, and HbA1c, and a prospective 48-hour dietary diary. Anthropometry will include height, weight, BMI and body fat derived from bioelectrical impedance. Dietary information will be collected with 48-hour diaries. A selection of children will undergo measurements of physical activity over one full day to measure their activity. Parents of children with risk markers of DM and control parents will undergo the same measurements, to explore whether abnormal the risk markers of DM in their children are associated with an increased frequency of abnormal markers in parents.

Planned Impact

N/A

Publications

10 25 50
 
Title Collecting objective data on levels of physical activity 
Description We are collecting objective data on levels of activity of 200 children and their parents in the Brazilian Town of Lagarto with and without metabolic markers of diabetes/insulin resistance to associate sedentary patterns to obesity and diabetes/insulin resistance 
Type Of Material Database/Collection of data 
Provided To Others? No  
Impact Will generate data on levels of activity of children and parents (in progress). 
 
Title a case control study of parents of children attending primary government and private schools in the Brazilian Town of Lagarto, Sergipe 
Description A total of 250 parents of children with and without metabolic markers of insulin resistance or diabetes were enrolled to obtain dietary patterns, anthropometry and metabolic markers of diabetes/insulin resistance. The data is complete and is being analysed for reporting 
Type Of Material Database/Collection of data 
Provided To Others? No  
Impact To identify the proportion of children with metabolic markers of insulin resistance or diabetes and its association to dietary patterns. Preliminary data indicate the prevalence of obesity is extremely high and a high proportion of children have metabolic markers of diabtes/pre-diabetes. 
 
Title cross sectional survey of children 
Description We have conducted a cross sectional survey of children attending primary government and private schools in the Brazilian Town of Lagarto, Sergipe. A total of 900 children have been interviewed and undertook anthropometric examinations and biochemical investigations to establish overweight/obesity, diabetes and pre-diabetes patterns. Data is being cleaned and analysed for publication 
Type Of Material Database/Collection of data 
Provided To Others? No  
Impact Data is being cleaned and analysed for publication 
 
Description Collaboration with the University of Riberao Preto, Sao Paulo State 
Organisation University of Sao Paulo
Department Ribeirão Preto School of Medicine
Country Brazil 
Sector Academic/University 
PI Contribution We have established collaboration with the University of Riberao Preto, Sao Paulo State to explore collaborative research projects on diabetes in children and young adults. RPU has a long standing interest in the long term follow up of cohorts.
Collaborator Contribution A major interest research group on the evaluation of determinants of diabetes and insulin resistance.
Impact A major interest of this research group is the evaluation of determinants of diabetes and insulin resistance.
Start Year 2015