Saúde dos adolescentes da coorte de nascimentos de São Luís, Maranhão, Brasil, 1997/1998

Do childhood depressive symptoms interfere with intelligence in adulthood?

OBJECTIVE

To investigate the effects of depressive symptoms in childhood on the intellectual development of young adults.

METHODS

Study conducted with a birth cohort of São Luís, Maranhão, Brazil, composed of 339 participants evaluated between 7 and 9 years and between 18 and 19 years. Structural equation modeling (young adult education, sex, race/color) and childhood variables (nutritional status, depressive symptoms, cognitive function, head of household's and mother's education, family income) were used. In addition, head of household's occupation, mother's age, and presence of partner were tested as determinants of adults' intelligence quotient (IQ).

RESULTS

Presence of depressive symptoms in childhood triggered a reduction of 0.342 in standard deviation (SD) and -3.83 points in the average IQ of adults (p-value < 0.001). Cognitive function in childhood had a total and direct positive effect (standardized coefficient [SC] = 0.701; p-value < 0.001) on IQ, increasing 7.84 points with each increase in level. A positive indirect effect of child nutritional status (SC = 0.194; p-value = 0.045), head of household's (SC = 0.162; p-value = 0.036), and mother's education was identified, the latter mediated by cognitive function in childhood (SC = 0.215; p-value = 0.012) on the IQ of young people.

CONCLUSION

Presence of depressive symptoms in childhood triggered a long-term negative effect on intelligence, reducing the IQ score in adulthood.

Modifiable behavioral risk factors for NCDs and sleep in Brazilian adolescents

OBJECTIVE

To analyze the association between modifiable behavioral risk factors for non-communicable diseases and sleep parameters in Brazilian adolescents.

METHODS

This was a cross-sectional study that used data from the RPS Cohort Consortium, São Luís, Brazil for the follow-up of adolescents aged 18-19 years (n = 2,515). The outcomes were excessive daytime sleepiness (Epworth Sleepiness Scale - ESS) and sleep quality (Pittsburgh Sleep Quality Index - PSQI). The exposures of interest were the behavioral risk factors for non-communicable diseases (NCDs): screen time, physical inactivity, alcohol, smoking, illicit drugs, caffeine intake, and consumption of sugar-sweetened beverages. Excess weight was considered a possible mediator of this association between the exposures of interest and the outcomes. The models were analyzed by modeling with structural equations.

RESULTS

Physical inactivity (standardized coefficient, SC = 0.112; p = 0.001), higher consumption of alcohol (SC = 0.168; p = 0.019) and of sugar-sweetened beverages (SC = 0.128; p < 0.001) were associated with excessive daytime sleepiness in adolescents; better socioeconomic status was also associated with this outcome (SC = 0.128; p < 0.001). Physical inactivity (SC = 0.147; p < 0.001) and higher consumption of sugar-sweetened beverages (SC = 0.089; p = 0.003) were also associated with poor sleep quality. Overweight was neither a mediator nor associated with sleep quality or excessive daytime sleepiness.

CONCLUSIONS

The main modifiable behavioral risk factors for NCDs are associated with worse sleep parameters already in adolescence, which serves as a warning toward the accumulation of risks for sleep disorders in the future.

Prevalence of metabolic syndrome in adolescents based on three diagnostic definitions: a cross-sectional study

Objective

There is no consensus as to the best criterion for the evaluation of metabolic syndrome (MS), impairing the estimation of its prevalence. This study aims to compare MS estimates using three recommended definitions for adolescents based on a cross-sectional study nested in the Consortium of Brazilian Birth Cohorts in São Luís, Maranhão.

Subjects and methods

A total of 2,515 adolescents aged between 18 and 19 years were evaluated. The criteria of International Diabetes Federation (IDF) and National Cholesterol Education Program Panel III (NCEP-ATP) modified by Cook and cols. (2003) and De Ferranti and cols. (2004) defined SM. To compare the estimates of MS prevalence, the chi-square, Fisher´s exact and Cohen´s Kappa index tests were used.

Results

Among the 2,064 participants evaluated in the final sample. The prevalence of MS ranged from 4.2% (95% CI: 3.3-5.1) to 10.2% (95% CI: 8.8-11.4). When comparing the estimates of MS prevalence in the total sample and by sex, a statistically significant difference was observed. The agreement between the criteria ranged from 0.42 (CI 95%: 0.35-0.49) to 0.55 (CI 95%: 0.48-0.62) in the total sample, 0.33 (CI 95%: 0.24-0.42) to 0.59 (95%CI: 0.47-0.71) among boys and 0.39 (95% CI: 0.26-0.52) to 0.54 (95% CI: 0.44-0.64) among girls.

Conclusion

Different criteria provide different estimates for the prevalence of MS in adolescents, reflecting the importance of establishing a consensus.

Is There an Association between Food Consumption According to the Degree of Processing and Body Image (Dis)satisfaction in Adolescents?

(1) Background: Adolescence is characterized by changes in eating habits, with increased consumption of ultra-processed foods and reduced intake of unprocessed or minimally processed foods, which can affect body image satisfaction. Thus, this study aims to verify the association of food consumption according to the degree of processing with body image (dis)satisfaction in adolescents from the 1997/1998 birth cohort of São Luís, Maranhão. (2) Methods: A cross-sectional study was conducted with 2515 adolescents aged between 18 and 19. Food consumption was stratified based on the NOVA classification in culinary preparations, processed foods, and ultra-processed foods, categorized into tertiles. Body image (dis)satisfaction was evaluated based on the Stunkard Body Scale and was classified as satisfaction, dissatisfaction with thinness, and dissatisfaction with excess weight. Multinomial logistic regression was used for associations. (3) Results: Among the adolescents, 77% considered themselves dissatisfied with their body image, with 42.8% dissatisfied with being thin and 34.2% dissatisfied with excess weight. However, food consumption, according to the degree of processing, was not associated with body image (dis)satisfaction. (4) Conclusion: This work highlighted the prevalence of body image dissatisfaction among adolescents but found no association between body (dis)satisfaction and food consumption according to the degree of processing.

Chronic diseases and health conditions in adolescents: Sex inequalities

OBJECTIVE

To estimate the prevalence of chronic diseases and health conditions in adolescents from Campinas (São Paulo), investigating sex differences according to age group.

METHODS

This population-based study analyzed data from the ISACamp 2014/15 health survey, with a total of 1,022 adolescents interviewed. The interviewees consisted of 517 boys and 505 girls; 492 of them in the ten to 14 age group and 530 in the 15 to 19 age group. We verified the associations using the χ2 test with Rao Scott adjustment and estimated prevalence ratios (PR) with multiple Poisson regression adjusted for age. Analyses were also stratified by age group.

RESULTS

Respiratory diseases, such as rhinitis (25.3%), sinusitis (15.7%), and asthma (10.9%), were the most prevalent among adolescents. Health complaints were high, especially headaches (39.5%), emotional conditions (34.5%), allergies (27.5%), and back pain (21.3%). More than 22.0% of adolescents reported having three or more health conditions. Girls declared a higher number of health conditions (three or more) than boys (PR=2.27).

CONCLUSION

The study showed that adolescents presented a significant number of health conditions, particularly regarding complaints, indicating the need for clinical care and public policies aimed at controlling and preventing these diseases in this age group.

Chronic diseases and health conditions in adolescents: Sex inequalities

ABSTRACT Objective: To estimate the prevalence of chronic diseases and health conditions in adolescents from Campinas (São Paulo), investigating sex differences according to age group. Methods: This population-based study analyzed data from the ISACamp 2014/15 health survey, with a total of 1,022 adolescents interviewed. The interviewees consisted of 517 boys and 505 girls; 492 of them in the ten to 14 age group and 530 in the 15 to 19 age group. We verified the associations using the χ2 test with Rao Scott adjustment and estimated prevalence ratios (PR) with multiple Poisson regression adjusted for age. Analyses were also stratified by age group. Results: Respiratory diseases, such as rhinitis (25.3%), sinusitis (15.7%), and asthma (10.9%), were the most prevalent among adolescents. Health complaints were high, especially headaches (39.5%), emotional conditions (34.5%), allergies (27.5%), and back pain (21.3%). More than 22.0% of adolescents reported having three or more health conditions. Girls declared a higher number of health conditions (three or more) than boys (PR=2.27). Conclusion: The study showed that adolescents presented a significant number of health conditions, particularly regarding complaints, indicating the need for clinical care and public policies aimed at controlling and preventing these diseases in this age group.

Are Fat Mass and Lean Mass Associated with Grip Strength in Adolescents?

Background: The interaction between lean body mass (LBM) and fat mass index (FMI) with grip strength (GS) has not been explored in the same analysis model in adolescents. This study thus aims to analyze the association between FMI and LBM with GS. Methods: This cross-sectional study was conducted with data from the 2016 follow-up of the 1997/98 Birth Cohort of São Luís. Grip strength was assessed by the Jamar Plus + dynamometer. The LBM and FMI indexes were assessed [ratio of the mass (lean or fat-kg) to height (m2)]. The confounding variables identified for the relationship between FMI and LBM with GS in the same analysis model, by directed acyclic graph (DAG), were sex, age, race, work, alcohol consumption, smoking, physical activity, and consumption of ultra-processed foods and culinary preparations, used in the adjusted analysis. Results: A total of 2339 adolescents (52.5% girls) were analyzed. The boys have a higher GS than the girls. In the adjusted analysis, with each increase of 1 kg/m2 in the FMI, GS was reduced by 0.72 kgf for boys and 0.35 kgf for girls. At each increase of 1 kg/m2 in the LBM, GS increased by 2.18 kgf for boys and 1.26 kgf for girls. Conclusions: FMI was associated with lower GS regardless of the LBM. LBM was associated with higher GS regardless of the FMI.

Association between sleep duration and cardiometabolic factors in adolescents

Background

The sleep reduction can change healthy people's hemodynamic control and cardiovascular regulation through increased inflammatory response and altered endothelial function. The objective the study to analyze the association between sleep duration and cardiometabolic risk factors in adolescents in the birth cohort of São Luís (1997/98).

Methods

This is a cross-sectional study with adolescents participating in the birth cohort of São Luís (1997/98). Sleep duration was evaluated using accelerometer data (Actigraph wGT3X-BT). Glycemia, systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c) and triglycerides were considered cardiometabolic factors. The Directed Acyclic Graph (DAG) was used to identify the minimum set of adjustment for confounding.

Results

Out of 1,268 adolescents, 50.3% of them were male. The prevalence of sleep duration of less than 6 h per day was 31.1%. The mean glycemia value was 91.8 mg/dL (± 15.9), DBP was 71.3 mmHg (± 7.5), SBP was 114.9 mmHg (± 12.3), HDL was 48.5 mg/dL (± 11.6), LDL was 89.0 mg/dL (± 25.7), the total cholesterol was 156.0 mg/dL (± 31.1), and triglycerides was 93.6 mg/dL (± 47.2). The crude analysis showed an association between sleep duration and SBP and LDL-c. In the adjusted analysis, the associations did not remain.

Conclusion

Our study showed no association between sleep duration and cardiometabolic outcomes in adolescents.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13119-7.

Agreement of adolescents’ self-perception of their body image with the analysis on the three-dimensional body image

Abstract Objectives: to verify the agreement among adolescents’ perception of their own body image and the health professionals’ analysis based on three-dimensional body image and the inter-rater agreement. Methods: a cross-sectional study was carried out with 1,662 adolescents, aged 18 to 19 years old, from the 1997/98 birth cohort in São Luís, Maranhão. Self-perception of body image was assessed using the Stunkard’s body image scale. Three nutritionists evaluated the three-dimensional body image obtained by the Photonic Scanner (3D Body Scanner) and classified according to the Stunkard’s scale. The agreement between raters was verified by using weighted Kappa. Results: the analysis of agreement between raters in the general group and when stratified by sexwas considered moderate to good by Kappa. Regarding the intraclass correlation (ICC), good and excellent correlation values were observed both in the general group, males and females. There was a greater perception of overweight by all raters, when compared with the adolescents’ self-assessments. When stratified by sex, examiner 1 had the same perception as male self-assessments, as for females the perception of overweight was more frequent, as well as raters 2 and 3, for both sexes. Conclusion: agreement between raters and self-assessments was considered weak/moderate in Kappa and good/excellent in ICC.

Influence of excessive daily sleeping and sleep quality on BDNF and NGF serum levels in adolescents

INTRODUCTION

The brain-derived neurotrophic factor (BDNF) and neural growth factor (NGF) are widely expressed in the brain and play an important role in neuroplasticity, neurogenesis, and increased neuronal connections. Previous studies have shown that reduced serum levels of these proteins are associated with disorders in human sleep.

OBJECTIVE

Current study evaluates the prevalence in adolescents of excessive daytime sleepiness (EDS) and sleep quality, and analyzes the influence of these factors on BDNF and NGF serum levels.

METHODS

A cross-section population-based study was conducted with data from a Brazilian birth cohort, with a sample of five hundred and thirteen 18-19-year-old adolescents. Sleep quality was assessed by the Pittsburgh Sleep Quality Index and EDS by Epworth Sleepiness Scale. Neurotrophins serum levels were measured by Luminex™ technology kits. Analysis consisted of marginal structural models which compared people who were exposed and not exposed to sleep quality and EDS.

RESULTS

Poor sleep quality and EDS were detected in 62.57% and 36.35% of the sample. Adolescents with poor sleep quality and EDS had -0.39 (p-value = 0.049) and -0.51 pg/ml in NGF (p-value = 0.009). Individuals with self-reported sleep disorder had lower serum levels of NGF (Coef. -0.41, p-value = 0.045).

CONCLUSION

High prevalence of EDS and low sleep quality in a population of adolescents were evidenced. Poor sleep quality and EDS were associated with lower NGF levels, whilst adolescents with self-reported sleep disorder had lower serum levels of NGF.

Analysis of the AUDIT factor structure in adolescents between 18 and 19 years

OBJECTIVE

To determine the factor structure of the instrument Alcohol Use Disorders Identification Test (AUDIT) in a representative sample of adolescents aged 18 to 19 years.

METHODS

Cross-sectional study performed with adolescents born in São Luís (MA). The internal consistency of the instrument was determined by the Cronbach's alpha coefficient, and the validity of the construct was assessed by Confirmatory Factor Analysis (CFA). The Kaiser-Meyer-Olkin (KMO) was estimated to analyze the adequacy of the sample. The fit quality of the factor model was analyzed according to the indexes of the Chi-square adjustment test, comparative fit index (CFI), Tucker-Lewis index (TLI) and root mean square error of approximation (RMSEA).

RESULTS

The sample of the study was composed of 1,002 adolescents aged from 18 to 19 years, being 56.8% girls, 68.5% with 18 years, 63.3% brown, 48.6% belonging to class C, 15.4% did not work or did not study, and 52.1% had divorced parents. The sample was suitable for confirmatory factor analysis (KMO = 0.79); Cronbach's alpha coefficient was 0.70, demonstrating satisfactory internal consistency with factor loads above 0.5, except for item 9, "was injured or someone else was injured due to drinking." Confirmatory factor analysis revealed the validity of the three-factor model for the studied sample based on the indices of psychometric adjustments.

CONCLUSION

The three-factor AUDIT factor structure was confirmed for the population of adolescents between 18 and 19 years old living in São Luís, ratifying the original conceptual domains proposed by the World Health Organization. AUDIT proved to be a reliable instrument to identify the consumption of alcohol.

Birth by cesarean section and mood disorders among adolescents of a birth cohort study in northern Brazil

The increasing number of cesarean sections worldwide has encouraged research on the long-term effects of this birth type on the offspring's mental health. The objective of this study was to investigate whether there is an association between birth by cesarean section and the development of mood disorders (depression and bipolar disorders) in adolescents. A cohort study was carried out with 1603 adolescents from 18 to 19 years old who participated in the third phase of a birth cohort study in São Luís, MA, in 2016. Information on birth type and weight, prematurity, mother's age and schooling, parity, marital status, and smoking behavior during pregnancy, were collected at birth. The study outcomes were depression, bipolar disorder, and "mood disorder" construct. A Directed Acyclic Graph (DAG) was developed to select the variables for minimal adjustment for confounding and collision bias. Associations were estimated through propensity score weighting using a two-step estimation model, and confounders for cesarean birth were used in the predictive model. There was no significant association in the relationship between birth type and depression (95%CI: -0.037 to 0.017; P=0.47), bipolar disorder (95%CI: -0.019 to 0.045; P=0.43), and mood disorder (95%CI: -0.033 to 0.042; P=0.80) in adolescents of both sexes. Birth by cesarean section was not associated with the development of mood disorders in adolescents.

Body image dissatisfaction and symptoms of depression disorder in adolescents

The objective of this study was to evaluate the effect of body image dissatisfaction on symptoms of depressive disorder in adolescents. This is a cross-sectional study that included 2,162 adolescents ages 18-19 born in São Luís, Maranhão, Brazil, which was part of the joint RPS cohort (Brazilian birth cohorts of Ribeirão Preto-SP, Pelotas-RS, and São Luís-MA). Socioeconomic characteristics, nutritional status, mental health, and body image characteristics were evaluated. Body image was assessed by Stunkard’s silhouettes scale. The presence of symptoms indicative of depressive disorder was investigated through a diagnostic interview MINI (Mini International Neuropsychiatric Interview). A theoretical model was built in a Directed Acyclic Graph (DAG) in order to investigate the relationship between the variables of the study. The relationship was estimated weighting the inverse probability of selection for the variables of adjustment: sex and nutritional status. Among the dissatisfied adolescents due to overweight, 66.54% were girls, 32.85% were overweight, and 11.99% were obese (P<0.01). There was a significant association between dissatisfaction due to overweight and symptoms of depressive disorder (P=0.01), and there was no evidence of the same association with dissatisfaction due to thinness. Therefore, only dissatisfaction due to overweight was associated with the symptoms of depressive disorder in the evaluated adolescents.