Birth weight influence and maternal nutritional status in student’s body composition Influencia del peso al nacer y el estado nutricional materno en la composición corporal de los escolares Recebido: 01/04/2020 | Revisado: 02/04/2020 | Aceito: 17/04/2020 | Publicado: 18/04/2020

Objective: This paper aims to evaluate birth weight and maternal nutritional status in children’s body composition aging from 7 to 9 years old. Methods: Transversal study composed of collecting interviewee’s socio economic and anthropometrical variables in which 41 children and their mothers were evaluated in the city of Picos in Piaui state. The following mother’s anthropometrical parameters were investigated: weight, height, and waist circumference. In addition, the following student’s anthropometrical variables were collected: born and current weight, height, waist circumference (WC), arm circumference (AC), subscapular skinfold (SS), and triceps skinfold (TS). Results: Birth weight relates positively and significantly with some anthropometrical variables of children, such as: waist circumference (WC; p=0.02), arm circumference (AC; p=0.03), subscapular skinfold (SS; p=0.02), and percentage of body fat (%BF; p=0.05). A statistically positive correlation between children’s current weight and mother’s current weight (p=0,04) was observed. Besides, a lower, but more significant inverse correlation between mother’s height and variables referring to children’s body composition was found. Conclusion: The following paper suggests that born weight correlates with children’s current bodily composition and that, no matter what the born weight is, mother’s weight is relevant to the children’s current weight, demonstrating the importance of continuous screening of nutritional status between mother and children.


Introduction
Among early health indicators, one of the most important is the born weight (BW). If inadequate, this parameter defines concern towards public health, due to its association with morbidity and mortality increase within the first year of life and higher risk of developing illnesses during adult life. Excess weight and lower born weight values are associated with higher risks of developing systemic arterial hypertension, obesity, dyslipidemia, and also diabetes and obesity, in case of macrosomia (Araújo et al., 2006;Pereira-Freire et al., 2015;Kelishadi & Heidari-Beni, 2019).
A child's nutritional status plays a fundamental role in a progressive growth and helps the them to develop social and psychomotor abilities. Nutritional variations that provoke deficits or surplus expose those children to potential health risks, as well as future interpersonal and functional relations issues (Lynch et al., 2018;Bull & Willumsen, 2019).
Excess weight in children represents a significant public and global health burden, and is a predictor of adult obesity (Kelishadi & Heidari-Beni, 2019).
There is controversial evidence on the associations between anthropometric measures with clustering of cardiovascular disease risk factors in pediatric ages. However, anthropometrical measurements are widely used to evaluate infant's health and nutritional risk, taking into account the relationship between nutrition and body dimensions during growth and developing process, from intrauterine life until adult age. Anthropometrical indexes provide nutritional risk and quality of life indicators in a practical and low cost way Research, Society andDevelopment, v. 9, n. 6, e100963403, 2020 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v9i6.3403 5 (Pereira-Freire et al., 2015;Meghan et al., 2020). Growth and nutritional status evaluation sets up as an important health indicator within individual and collective levels (Li et al., 2020).
Studies show a crucial role of mother's nutritional status -such as gestational weight gain -on fetal growth and born weight. Although, studies that aim to identify the relation between current children's and mother's nutritional status are incipient. By understanding the importance of such investigations, a goal was set to inquire possible correlations of born weight from the investigated children (secondary data) with mother's body mass index (BMI), as well as evaluate the relation of BW with children's current body composition, ranging from 7 to 9 years old.

Methods
This is a descriptive study with a retrospective, transversal method and quantitative approach (Pereira et al., 2018). It was carried out in 41 students from public city schools, both genders, ages 7 to 9. All children whose responsible were their biological mothers, who had their born weight information, and agreed to participate took part in the study. Therefore, the studied sample was determined by convenience, capable of detecting correlation coefficients of "0.25 or higher" with test power of 80%, and an alpha of 0.05. It is also capable of detecting prevalence up to 30% with absolute precision of 8 percentage points and reliability interval equal to 95%.
Data collection took place during the period from march to october of 2010. It consisted of collecting demographic socio-economic variables (age, gender, household income, marital statusof mother and children) and anthropometrical (weight, height, waist circumference -of mother and children). To evaluate children's body composition, measurements were made of arm circumference, subscapular skinfold (SS) and triceps skinfold (TS). Born weight information was collected by an interview and form filling by the mothers.
Children's waist circumference was measured following Mccarthy, Jarrett, and Crawley's (2001) recommendation. To calculate body fat percentage, the children were evaluated by skinfold thickness sum according to Slaughter, Lohman, And Boileau's (2004) protocol. Every other maternal and children's anthropometrical measurements were taken following Ministry of Health's (2007) (NHC, 1996).

Results
The characteristics socio demographic and anthropometrical of the children included in this study (n=41) are presented in Table 1. The variables are described with values expressed in mean ± standard deviation, minimum and maximum, as well as Confidence intervale 95% (CI 95%). It is highlighted that 41 students participated in the study; 53.66% (n=22) males, the age was approximately 92 months. The average income of the researched group is low and the average birth weight was 3,304 g ± 0.48. In addition, it is worth noting that the mean current weight (Kg) was 27 Kg ± 4.52; mean and standard deviation the waist circumference was 55.94 ± 3.79, as well as Body Fat percent 13.3% (Table 1).  (2007). BMI remains useful for monitoring excess weight, however its limitations as a marker of chronic disease risk are increasingly recognized. Therefore, recent studies recognized that BMI and waist circumference are not accurate measures of body fat, especially in children. Concerning the maternal characterization regarding nutritional status and cardio metabolic complication risks, the Table 3 shows the classification conform BMI and WC in percent. The study of the correlation between weight and birth and the current anthropometric variables of children, including BMI, waist circumference and body fat are presented in Table   4. The correlation between birth weight and children's current anthropometrical variables analysed, WC, AC, triceps skinfold and body fat showed a weak correlation with birth weight.
The study of correlation between mother's anthropometrical variables and children's current anthropometrical measurements are presented in Table 5. The correlation between mother's anthropometrical variables and children's current anthropometrical are variables analysed, Weigth infant current showed a weak correlation with mother's weight (r = 0.32; p<0.05).

Child's variables
Mother's variables. On the other hand, current maternal weight presented positive relation with children's current weight (r = 0.32; p<0.05); it was also observed an inverse correlation between maternal height and variables that indicate the composition of children's subscapular skinfold fat (SS) (r = -0.40; p<0.05), and total body fat (%BF) (r = -0.34; p< 0.05) ( Table 5). There were significant main effects for maternal obesity and children's current anthropometrical variables.

Discussion
Child's nutritional status is decisive to a progressive growth and the development of social and psychomotor skills. Nutritional shortage or excess expose those children to potential risks of health harm such as born underweight, which is considered a death risk within first year of life (Brasil, 2011).
The prevalence of overweightness within student's population was 48.8%, considered high and similar to that found in other studies made in Brazil (Ramos;Dumith;César, 2014), demonstrating that the evaluated group follows the tendency of nutritional transition identified within the last few years in the country. In contrast with the overweightness observed in the mentioned study, 4.9% of children were presented underweight, proportion like the one found in the reference population of WHO's standard, indicating population's low exposure to malnourishment, at least in its acute form (Harder, 2005).
Research, Society andDevelopment, v. 9, n. 6, e100963403, 2020 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v9i6.3403 Waist circumference is considered an excellent evaluation indicator of abdominal fat tissue and an important parameter for general body composition (Santos & Leão, 2008). Still, due to the fact that until the time this paper has been written, there are no international standardization of specific cut spots for abdominal adiposity classification in the pediatric group, its function as a strong tool in public health's recommendations has been limited (Schincagalia, 2015).
This study found the average born weight among the evaluated students to be adequate according to WHO's reference standards (WHO, 2000). Besides, born weight presented significant and positive correlation with child's current HC, AC, SS, TS, and % of Body Fat. Similar results were reported by Guilherme et al. (2015) that found born weight to be responsible for a small variation is sub skin fat distribution during school age. In a study made by Pereira et al. (2010) in children aging from 5 to 8 years old in the city of Jundiaí, São Paulo, it was observed that born weight was positively associated with Body Mass Index (BMI), waist circumference (HC), and arm muscular area (AMA) (Meghan et al., 2020).
Other researchers verify that newborns with low weight presented more fat storage and suggested that these body composition differences could be a connection between fetal growth disturb and chronic adulthood diseases associated with fat storage (Committee on Nutritions, 2003). Recently, a study demonstrated that increased birth weight and maternal BMI are significant risk factors for obesity in children living in Istanbul, Turkey (Vehapoglu et al., 2017).
In this current study the correlation between born and current weight in students wasn't verified. According to a research made by Ferreira & Luciano (2010), high born weight is a predictive factor to obesity, while some other authors related this high BW to more prevalence of insulin resistance, while arterial hypertension was associated with low born weight (Pereira-Freire, 2015;Pereira, 2010). Faster prenatal and postnatal growth was associated with a higher BMI in childhood in a population with a recent history of rapid economic growth and relatively low birth weight, suggesting that maximum growth may increase cardiometabolic risk. However, there may be an association between birth weight, development of metabolic risk and other variables, such as maternal nutritional status (Li et al., 2020).
It is important to mention that adequate born weight was referred as a protector against future obesity, although for Araújo et al. (2006) there is no association, confirming what was found in this paper. However, it is relevant to emphasize that average born weight of evaluated children was adequate. Besides, for this current study this BW variable was referred by children's parents, with due conference in the child's booklet, which could be considered a limitation to the study, due to the impossibility and difficulty of performing study of cohort in the semi-arid region of Piauí. Considering that a cohort study, despite expensive, would make it possible for a higher control of variables such as BW. Therefore, the non-conclusion about BW's real influence on the current anthropometrical parameters could be related to the differentiated lineation of scientific researches.
Faced with academic inconsistencies over the influences of BW to current weight, an investigation to other possible variables, such as maternal's, should be done, as this current study proposes. When investigating correlation of maternal data to the children's, it was observed that mother height correlated negatively to SS and %BF of their children, showing that the lower the mother height, the higher the child's total body fat will be. This is an important result that should be more explored and broaden the field of study in Brazil's northeast about it, as these data are pioneers in the region. Amorim et al. (2010) observed 8 years old children and related an important contribution to height, mother's BMI, and socio-economic conditions in the variation of these nutritional indicators. More studies should be done to broaden the comprehension of these results. Silveira et al. (2010) statistically proved that, no matter the mother's nutritional status, low height is directly related to child's malnourishment.
It was still observed that there is a positive and significant correlation between child's current weight and mother's weight. Pereira-Freire et al. (2015) pointed out that mothers with children with overweightness presented elevated BMI, when compared to those mothers with children with lower weight. Studies showed evidences that mothers with overweightness have higher probabilities to have offspring, also, with overweight (WHO, 2007;Ramos;Dumith;César, 2014).
For some decades there has been documented that if one of the parents is overweight, the chance of the children develop it too is of 40%, but, if both parents are obese that chance goes up to 80%. It is proved in the academic that genetic information as well as socio economic and environmental conditions provided by the parents have a repercussion on the nutritional status of their offspring (Amorim et al., 2010). It is noted, consequently, that the information found in our research contributed to a better understanding and to evidence that parent's overweight interferes negatively to their children's nutritional status.
To better analyze current children's body composition, the correlation between their current anthropometrical variables were investigated. It is noted that WC presented strong correlation to skinfold (SS and TS), and with total body fat percentage. Researches detected strong association of BMI to WC in children and teenagers, from both genders (Slaughter;Lohman;Boileau, 2004;Rodrigues, 2006). The information found showed similar results to those found on other national and international researches (WHO, 2000;Luciano, 2010). Medina et al. (2014) noted in their studies that the competent teams related few actions about anthropometrical evaluations in school age. In that way, it is necessary to perform more investigations in the area, mainly for the reason to WC be utilized and adopted as an evaluation parameter to body composition in that age gap, due to its easiness and measurement practicality.

Conclusion
This paper shows that birth weight correlates with children's current body composition, and that, no matter the birth weight, mother weight correlates with children's current weight. These results suggest there is direct relation between children's and mother's current nutritional status, probably due to the fact that it is during that phase the child is fed, in which is mostly done by the mother, which results in the food habits by the mothers in the children.
Therefore, nutritional supervision of nutritional status in the mother-child relation, not only under the aspect of protein-energetic malnourishment and during pregnancy but regarding overweigh during all phases of life, will allow to offer aids to support decision making in public politics, as well as evaluate efficiency of performed actions, with focus on improving health status and nourishment of the Brazilian population.
Based on the notions of birth weight in this research, it is suggested that future studies explore the relationship between the socio-anthropometric factors of the mother-child binomial and the onset of underlying diseases in schoolchildren and the conditioning factors for situational intervention.