[Cardiovascular risk and associated factors in schoolchildren in Belém, Pará State, Brazil]

Total cholesterol and low-density lipoprotein alterations in children and adolescents from Brazil: a prevalence meta-analysis

Objective

The aim of the present study was to evaluate the prevalence of total cholesterol (TC) and low-density lipoprotein (LDL) alterations in children and adolescents in Brazil.

Subjects and methods

A systematic review and meta-analysis of prevalence. The search for articles was carried out in the databases: Medline (PubMed), Embase, Scientific Electronic Library Online (SciELO), Latin American and Caribbean Literature in Health Sciences (Lilacs). The meta-analysis was performed using the random effects model. The I² test was used to identify heterogeneity.

Results

The present metanalysis revealed a significant prevalence of altered lipid profile in children and adolescents in Brazil. Regarding lipoprotein fractions, the prevalence of altered TC level was 27.47% (95% CI 24.36-30.82), and a smaller prevalence was observed for LDL cholesterol (19.29% - 95% CI 15.21-24.16). The models revealed high heterogeneity (I² = 99%; p < 0.01), however the precise source of it was not identified; although type of school, age group, year and the region of Brazil appeared to influence the estimations of altered lipid profiles.

Conclusion

An important prevalence of lipid alterations was observed among Brazilian children and adolescents. Those results reinforce the importance of knowing the lipid profile of children and adolescents to perform early interventions for this public.

Circunferência do pescoço e fatores de risco cardiovascular em crianças e adolescentes

Objetivos: Investigar a associação entre a circunferência do pescoço (CP) e fatores de risco cardiovascular em crianças e adolescentes atendidos ambulatorialmente em um hospital universitário na cidade de Recife, PE, Brasil.Métodos: Foram coletados dados sociodemográficos, antropométricos, bioquímicos, histórico familiar e estilo de vida. A amostra foi por conveniência, composta por crianças e adolescentes acompanhados de seus responsáveis, que aceitassem participar da pesquisa, no período de abril a setembro de 2018, no ambulatório de nutrição/pediatria.Resultados: A amostra foi composta por 144 pacientes com idade média de 11,0±3,0 anos, sendo 73 do sexo masculino (51,4%). 54 (37,6%) pacientes apresentaram CP elevada, dentre eles 59 (41,1%) eram do sexo masculino. Foi visto que 102 (71,5%) pacientes apresentaram tempo de tela elevado. Houve associação entre CP e estado nutricional e 13 (24,8%) indivíduos que tinham CP elevada apresentaram também excesso de peso. Foi observado correlação entre circunferência do pescoço com índice de massa corporal e perfil lipídico.Conclusão: Observou-se que há associação significativa entre CP e algumas medidas antropométricas como IMC e CC, sendo útil para identificação de risco de sobrepeso e de risco cardiovascular. Algumas limitações no estudo podem ser citadas como o limitado número de participantes por ser uma pesquisa transversal, não podendo assim ser estabelecidas medidas de causa e efeito.

Effects of Cashew Nut (Anacardium occidentale L.) Seed Flour in Moderately Malnourished Children: Randomized Clinical Trial

The monitoring and combined use of dietary supplements to restore adequate growth are paramount and highly recommended in child malnutrition, an important public health problem. The objective of this study was to analyze the effects of cashew nut seed flour in children with moderate malnutrition, treated at primary healthcare services. This is a randomized clinical trial conducted from April to October 2017 in the city of Imperatriz, Brazil. The sample comprised 30 children born at term, aged between 2 and 5 years, and newly diagnosed with malnutrition (60 days or less), randomized into experimental and control groups. The intervention consisted of daily intake of cashew nut seed flour. There was intragroup statistically significant difference in the glucose levels of children who were assigned to the control group (p=0.02) and in the glycated hemoglobin in the experimental group (p < 0.01). Intergroup analysis of glycated hemoglobin levels showed statistically significant differences in favor of the experimental group (p=0.01). HDL and LDL had, respectively, increased and decreased in the experimental group. The use of cashew nut seed flour in a 24-week period had positive effects on glycated hemoglobin, HDL, and LDL parameters in moderately malnourished children.

Dyslipidemia prevalence in adolescents in public schools

OBJECTIVE

To evaluate the prevalence of dyslipidemia in adolescents enrolled in the state public education system of the city of Montes Claros, state of Minas Gerais, and compare to a Brazilian population-based study.

METHOD

This is an epidemiological, cross-sectional, and analytical study with a population of 77,833 students from 63 schools, representing four geographic areas of the city. After a sample calculation, information on 635 adolescents from 10 to 16 years of age was assessed and blood collection was conducted for the analysis of biochemical parameters of total cholesterol, triglycerides, LDL-c, and HDL-c.

RESULTS

Among the adolescents, 26.8% showed high levels of total cholesterol, 15.7% of triglycerides, and 6.5% of LDL-c, and 40.8% had low HDL-c levels.

CONCLUSION

Except for HDL-c levels, dyslipidemia prevalence and means in adolescents from Montes Claros, Minas Gerais, were above the levels found in the Brazilian population-based study used as parameter.

Subjetividades de los adolescentes con respecto a la promoción de la salud: contribuciones a la enfermería

Introducción: Los adolescentes representan una parte importante de la población con particularidades relacionadas con el estilo de vida, por lo que es necesario promover acciones que fomenten hábitos saludables. En esta perspectiva, comprender las subjetividades que influencian los comportamientos de salud típicos de la adolescencia se vuelve esencial para la salud y la atención de enfermería, ya que las opciones de autocuidado están marcadas de singularidades. Objetivo: Exponer las subjetividades de los adolescentes sobre el autocuidado en el contexto de la promoción de la salud y la enfermería. Materiales y Métodos: Enfoque de investigación fenomenológica heideggeriana con 17 adolescentes de una escuela pública en Minas Gerais realizada entre octubre y diciembre de 2016. El movimiento analítico hermenéutico permitió la aparición del fenómeno en estudio. Resultados: Sobre el autocuidado, los adolescentes expresaron que van al médico sólo cuando se necesita; saben que tienen que cuidar su salud, pero no hacer ejercicio o comer de forma saludable y cuidar su salud ahora, sino porque en el futuro puede convertirse en un problema. De los participantes, el 68% reportó haber desarrollado actividad física durante las clases de educación física y el 30% informó haber consumido alcohol. Discusión y Conclusiones: Al comprender las subjetividades de los adolescentes sobre el autocuidado, las enfermeras encuentran mayores elementos para realizar acciones de salud dirigidas a estimular comportamientos saludables que resultarán una mejor calidad de vida en el presente y a futuro. Como citar este artigo: Paula JA, Melo MCSC, Amorim TV, Salimena AMO, Paiva ACPC, Nascimento RCN. Subjetividades de adolescentes face à promoção da saúde: contribuições para a enfermagem. Rev Cuid. 2020; 11(1): e895. http://dx.doi.org/10.15649/cuidarte.895

Prevalence of dyslipidemia in children from 2 to 9 years old

ABSTRACT Objective: Analyze the occurrence of dyslipidaemia and associated factors in children aged 2 to 9 years. Method: Cross-sectional study, carried out with 700 children, in a region of Northeast Brazil. For comparison of means, Student’s t test was used; and, for the comparison of medians, the Mann-Whitney test. Results: A prevalence of dyslipidaemia of 68.4% was found. In isolation, the majority had a level of: total desirable cholesterol (386; 55.1%), undesirable lipoprotein cholesterol (376; 53.7%), low density lipoproteins - desirable cholesterol (514; 73.4%) and desirable triglyceride (509; 72.7%). In the final multivariate model, only the variable “preschool age” was significant (prevalence ratio = 1.14), indicating that these children are more likely to have dyslipidaemia than those of school age. Conclusion: An association was found between dyslipidaemia and preschool age. The need for programs and strategies to better understand this problem is indicated, in addition to preventing early coronary diseases.

Processo educativo do núcleo ampliado de saúde da família na atenção à hipertensão e diabetes

Resumo Objetivou-se avaliar o processo educativo realizado pelo Núcleo Ampliado de Saúde da Família e Atenção Básica na atenção à hipertensão arterial sistêmica e diabetes mellitus em Recife, Pernambuco. Foi realizada uma pesquisa avaliativa orientada pela teoria educacional de Paulo Freire, com elaboração de um modelo teórico. Participaram do estudo quatro profissionais do Núcleo Ampliado de Saúde da Família e Atenção Básica, onze profissionais da Estratégia Saúde da Família e dez usuários com hipertensão e/ou diabetes. Foram realizados grupos focais e os dados coletados, entre novembro de 2018 e fevereiro de 2019, foram submetidos à análise de conteúdo. Evidenciou-se a coexistência do uso pelos profissionais das concepções bancária e problematizadora. Foram identificadas práticas verticalizadas e pouco dialogadas pelos profissionais, bem como uma visão curativista e medicalocêntrica nos discursos dos usuários. Observou-se também ações transformadoras no processo de trabalho dos profissionais e relatos de melhorias das condições de saúde dos usuários participantes dos grupos educativos. Além disso, o incentivo pela busca de direitos durante as ações educativas levou à conquista da implantação do Programa Academia da Cidade no território. Esses achados revelam o poder de transformação das ações educativas quando se tornam participativas e construídas com base nas experiências e necessidades da população.

Prevalence of cardiometabolic risk factors in a nationally representative sample of Iranian children and adolescents: the CASPIAN-V Study

Introduction: This study presents the prevalence of cardiometabolic risk factors in a nationally representative sample of Iranian children and adolescents. Methods: This multi-centric study was conducted in 2015 among 4200 students aged 7-18 years. They were selected by multistage cluster sampling from 30 provinces of Iran. Anthropometric indices, biochemical and clinical parameters were measured. Results: The mean of weight, height, waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting blood glucose (FBG) was higher in boys than in girls (P < 0.05). The mean of triglyceride (TG), total cholesterol (TC) and low-density lipoprotein (LDL) levels were higher in girls than in boys (P < 0.05). The mean of weight, height, WC, SBP, DBP, alanine transaminase (ALT) and body mass index (BMI) was higher in urban than in rural residents (P < 0.05). Overall, 16.1%, 9.4% and 11.4% were underweight, overweight and obese. Abdominal obesity was documented in 21.6% of boys and 20.5% of girls. Low HDL-C was the most prevalent abnormality of lipid profile (29.5%) followed by high serum TGs (27.7%). Low HDL-C was more prevalent in boys than in girls (32.7% vs. 26%, respectively, P < 0.05). Prevalence of obesity and overweight were higher in girls than in boys (P < 0.05). The prevalence of obesity and overweight, abdominal obesity, and low HDL-C were higher in urban than in rural residents (P < 0.05). Conclusion: We found considerably high prevalence of some cardiometabolic risk factors including overweight and obesity, low HDL-C and hypertriglyceridemia in Iranian children and adolescents. The current findings underscore the necessity of intensifying health interventions for primordial and primary prevention of non-communicable diseases from early life.

Adolescentes: comportamento e risco cardiovascular

Contexto

Os benefícios para a saúde decorrentes da prática regular de atividade física estão bem documentados. Entretanto, são raros os estudos associando essa prática ao comportamento sedentário e ao risco cardiovascular em adolescentes.

Objetivos

Pretende-se avaliar a prática de atividade física, o comportamento sedentário e a associação com o risco cardiovascular mensurado pelo escore Pathobiological Determinants of Atherosclerosis in Youth (PDAY).

Métodos

Estudo transversal desenvolvido nas escolas públicas estaduais de Campina Grande, PB, Brasil, com 576 adolescentes de 15 a 19 anos, incluindo variáveis socioeconômicas, demográficas, de estilo de vida e clínicas. Os dados foram coletados através de formulário validado, antropometria, aferição da pressão arterial e exames laboratoriais. Foram utilizadas medidas descritivas, teste do qui-quadrado de Pearson e regressão logística binomial. Trabalhou-se com o SPSS 22.0 se adotou intervalo de confiança de 95%.

Resultados

A idade média foi de 16,8 anos. A maioria dos adolescentes era do sexo feminino (66,8%), não branco (78.7%) e pertencente às classes C, D e (69,1%). Quanto ao sedentarismo e à insuficiência de atividade física, as prevalências foram de 78,1% e 60,2%, respectivamente. De acordo com o escore PDAY, 10,4% dos adolescentes apresentaram alto risco cardiovascular; 31,8% risco intermediário; e 57,8%, risco baixo. Verificou-se que PDAY esteve associado ao sexo e à adiposidade abdominal.

Conclusões

Ficou comprovado que adiposidade abdominal e sexo masculino representam importantes fatores de risco cardiovascular em adolescentes. Considerando-se a presença de um fator de risco modificável, medidas preventivas voltadas ao estilo de vida são essenciais.

Prevalence of hypertension among adolescents: systematic review and meta-analysis

OBJECTIVE

To estimate the prevalence of hypertension among adolescent Brazilian students.

METHODS

A systematic review of school-based cross-sectional studies was conducted. The articles were searched in the databases MEDLINE, Embase, Scopus, LILACS, SciELO, Web of Science, CAPES thesis database and Trip Database. In addition, we examined the lists of references of relevant studies to identify potentially eligible articles. No restrictions regarding publication date, language, or status applied. The studies were selected by two independent evaluators, who also extracted the data and assessed the methodological quality following eight criteria related to sampling, measuring blood pressure, and presenting results. The meta-analysis was calculated using a random effects model and analyses were performed to investigate heterogeneity.

RESULTS

We retrieved 1,577 articles from the search and included 22 in the review. The included articles corresponded to 14,115 adolescents, 51.2% (n = 7,230) female. We observed a variety of techniques, equipment, and references used. The prevalence of hypertension was 8.0% (95%CI 5.0–11.0; I² = 97.6%), 9.3% (95%CI 5.6–13.6; I² = 96.4%) in males and 6.5% (95%CI 4.2–9.1; I² = 94.2%) in females. The meta-regression failed to identify the causes of the heterogeneity among studies.

CONCLUSIONS

Despite the differences found in the methodologies of the included studies, the results of this systematic review indicate that hypertension is prevalent in the Brazilian adolescent school population. For future investigations, we suggest the standardization of techniques, equipment, and references, aiming at improving the methodological quality of the studies.

[Association between dietary intake, physical activity, socioeconomic factors and body fat percentage among schoolchildren]

The scope of this article was to assess the association between dietary intake, physical activity and socioeconomic factors associated with body fat percentage in 7 to 14-year-old schoolchildren. It is a cross-sectional study with a probability sample of 2,481 students from public and private schools in Florianópolis, Santa Catarina, Brazil. Body fat percentage was investigated by measuring triceps and subscapular skin folds. Poisson regression was performed to test the association between excess body fat and independent variables, estimating prevalence ratios and 95% confidence intervals. The prevalence of excess body fat was 23.9%, though there was no significant difference between sex (p = 0.359) and age (p = 0.202). Excess body fat was associated with different factors in 11 to 14-year-old schoolchildren, namely eating less than three meals a day (OR = 1.62, CI: 1.38 to 1.91) and consumption of high-risk food more than 3 times a day (OR = 0.61 CI: 0.47 to 0.79). No significant difference was observed with physical activity. The high prevalence of excess body fat detected reveals the need for fostering the adoption of healthier behavioral practices (in relation to nutrition and physical activity) by schoolchildren.

[Epidemiological survey in schoolchildren: determinants and prevalence of cardiovascular risk factors]

This study focused on the prevalence of dyslipidemia, high blood glucose, and high blood pressure in scho-olchildren and the associations with demographic, socioeconomic, biological, and behavior factors using a cross-sectional design with 1,139 schoolchildren from six to 18 years of age in Amargosa, Bahia State, Brazil. Prevalence ratio (PR) was used as the measure of association. Prevalence rates for dyslipidemia, high blood glucose, and high blood pressure were 62.1%, 6.6%, and 27%, respectively. Dyslipidemia was associated with the school's geographic location (PR = 1.52) and child's waist circumference (PR = 1.20), and high blood glucose with the school's geographic location (PR = 3.41) and child's peripheral adiposity (PR = 3.13). High blood pressure was associated with age bracket (PR = 2.34), waist-for-height ratio (PR = 1.62), sexual ma-turation (PR = 2.06), and physical activity (PR = 1.32). Intervention programs are needed to change life habits in schoolchildren.

ERICA: prevalences of hypertension and obesity in Brazilian adolescents

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.

Predictive capacity of anthropometric indicators for dyslipidemia screening in children and adolescents

OBJECTIVE

To analyze the predictive capacity of anthropometric indicators and their cut-off values for dyslipidemia screening in children and adolescents.

METHODS

This was a cross-sectional study involving 1139 children and adolescents, of both sexes, aged 6-18 years. Body weight, height, waist circumference, subscapular, and triceps skinfold thickness were measured. The body mass index and waist-to-height ratio were calculated. Children and adolescents exhibiting at least one of the following lipid alterations were defined as having dyslipidemia: elevated total cholesterol, low high-density lipoprotein, elevated low-density lipoprotein, and high triglyceride concentration. A receiver operating characteristic curve was constructed and the area under the curve, sensitivity, and specificity was calculated for the parameters analyzed.

RESULTS

The prevalence of dyslipidemia was 62.1%. The waist-to-height ratio, waist circumference, subscapular, body mass index, and triceps skinfold thickness, in this order, presented the largest number of significant accuracies, ranging from 0.59 to 0.78. The associations of the anthropometric indicators with dyslipidemia were stronger among adolescents than among children. Significant differences between accuracies of the anthropometric indicators were only observed by the end of adolescence; the accuracy of waist-to-height ratio was higher than that of subscapular (p=0.048) for females, and the accuracy of waist circumference was higher than that of subscapular (p=0.029) and body mass index (p=0.012) for males. In general, the cut-off values of the anthropometric predictors of dyslipidemia increased with age, except for waist-to-height ratio. Sensitivity and specificity varied substantially between anthropometric indicators, ranging from 75.6 to 53.5 and from 75.0 to 50.0, respectively.

CONCLUSIONS

The anthropometric indicators studied had little utility as screening tools for dyslipidemia, especially in children.

Efectividad de una intervención educativa sobre nutrición y actividad física en una población de adolescentes. Prevención de factores de riesgo endocrino-metabólicos y cardiovasculares

Objetivo: verificar una mejora del estado nutricional y la adopción de hábitos alimentarios y de actividad física saludables en una población de estudiantes tras una intervención educativa en salud. Materiales y métodos: población compuesta por 90 adolescentes entre 15 y 17 años de edad, 46 hombres (51,1 %) y 44 mujeres (48,9 %), pertenecientes a un centro educativo público de la ciudad de Almería (España). El estudio se realizó en tres fases. La primera fase contempló valoración del estado nutricional; la segunda, intervención educativa sobre alimentación saludable y actividad física; la tercera, evaluación de la eficacia de dicha intervención. Resultados: estadísticamente hubo mejoría (p < 0,000) en el estado nutricional de los alumnos valorados con independencia de su sexo. Respecto de la adopción de hábitos saludables, se observaron diferencias significativas en las puntuaciones del test Kreceplus (p < 0,000), aunque no para la actividad física tras la intervención (p = 0,568). Conclusiones: los resultados muestran la efectividad de los procedimientos aplicados en esta intervención para modificar hábitos alimentarios. Con todo ello, la práctica de ejercicio físico continúa siendo una asignatura pendiente entre los adolescentes.