Newton001 Breakfast, diabetes and poverty in Brazil

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.

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.

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