Anabel Nunes Rodrigues

Cardiovascular risk factors, their associations and presence of metabolic syndrome in adolescents

OBJECTIVE To evaluate the occurrence of metabolic syndrome (MS) and independent associated risk factors in adolescents in the city of Vitória, Brazil. METHODS We assessed 380 adolescents aged 10 to 14 years attending public schools. Body mass index and blood pressure at rest were measured. Fasting plasma concentrations of total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides and glucose were also obtained. RESULTS The prevalence of overweight was 9.6% for boys and 7.4% for girls, while obesity was found in 6.2 and 4.9%, respectively. Triglyceride concentrations were borderline or high in 6.8 and 3.4% of the boys and in 11.8 and 5.9% of the girls. HDL-cholesterol was below recommended levels in 8.5% of the boys and in 9.9% of the girls. Blood pressure at rest was borderline for 5.1% of the boys and 7.9% of the girls, while 3.4% of both boys and girls were hypertensive. Fasting glycemia was high in 0.6% of the boys and in 0.5% of the girls. In the group studied, 2.8% of the boys and 2.5% of the girls had two risk factors associated with MS. Prevalence of MS was 1.1% for boys and 1.5% for girls, and overall prevalence was 1.3%. CONCLUSIONS MS and associated cardiovascular risk factors are serious clinical conditions in this age group. A significant number of adolescents showed borderline results, which may increase the prevalence of MS or independent risk factors in the short term. More investments should be made in primary prevention, considering that early diagnosis is an issue of fundamental importance.

Maximum oxygen uptake in adolescents as measured by cardiopulmonary exercise testing: a classification proposal

OBJECTIVE The identification of populational levels of maximum oxygen uptake (VO(2max)) is an aid to studies that propose to relate physical fitness to cardiovascular risk, and also for prescribing exercise and analyzing the effects of training. To date, there is no information with which this parameter can be classified in samples of adolescents from the Brazilian population. This study is, therefore, the first to propose the determination of mean VO(2max) levels in a sample of the Brazilian population. METHODS A sample of 380 schoolchildren (177 boys and 203 girls, aged 10 to 14 years) was selected at random from public schools in Vitória, ES. After anthropometric assessment they underwent cardiopulmonary exercise testing, VO(2max) was measured directly and results were classified according to quintiles calculated from the study sample. RESULTS The mean VO(2max) values observed ranged from 42.95 to 49.55 mL x kg(-1) x min(-1) for boys and from 36.76 to 38.29 mL x kg(-1) x min(-1) for girls. CONCLUSION This paper proposes mean VO(2max) ranges as a classification parameter for cardiorespiratory fitness, in addition to contributing to a definition of normal values for the Brazilian population. This classification will also be of use for establishing cutoff points in future studies.

Cardiovascular risk factor investigation: a pediatric issue

Objectives To correlate cardiovascular risk factors (e.g., hypertension, obesity, hypercholesterolemia, hypertriglyceridemia, hyperglycemia, sedentariness) in childhood and adolescence with the occurrence of cardiovascular disease. Sources A systematic review of books and selected articles from PubMed, SciELO and Cochrane from 1992 to 2012. Summary of findings Risk factors for atherosclerosis are present in childhood, although cardiovascular disease arises during adulthood. This article presents the main studies that describe the importance of investigating the risk factors for cardiovascular diseases in childhood and their associations. Significant rates of hypertension, obesity, dyslipidemia, and sedentariness occur in children and adolescents. Blood pressure needs to be measured in childhood. An increase in arterial blood pressure in young people predicts hypertension in adulthood. The death rate from cardiovascular disease is lowest in children with lower cholesterol levels and in individuals who exercise regularly. In addition, there is a high prevalence of sedentariness in children and adolescents. Conclusions Studies involving the analysis of cardiovascular risk factors should always report the prevalence of these factors and their correlations during childhood because these factors are indispensable for identifying an at-risk population. The identification of risk factors in asymptomatic children could contribute to a decrease in cardiovascular disease, preventing such diseases as hypertension, obesity, and dyslipidemia from becoming the epidemics of this century.

Cardiovascular risk factors in a population of Brazilian schoolchildren

Epidemiological and clinical evidence suggests that a judicious diet, regular physical activity and blood pressure (BP) monitoring must start in early childhood to minimize the impact of modifiable cardiovascular risk factors. This study was designed to evaluate BP and metabolic parameters of schoolchildren from Vitória, Espírito Santo State, Brazil, and correlate them with cardiovascular risk factors. The study was conducted on 380 students aged 10-14 years (177 boys, 203 girls) enrolled in public schools. Baseline measurements included body mass index, BP and heart rate. The students were submitted to exercise spirometry on a treadmill. VO2max was obtained from exercise testing to voluntary exhaustion. Fasting serum total cholesterol (TC), LDL-C, HDL-C, triglycerides (TG), and glucose were measured. Nine point nine percent of the boys and 11.7% of the girls were hypertensive or had pre-hypertensive levels. There was no significant correlation between VO2max and TC, LDL-C, or TG in prepubertal children, but a slight negative correlation was detected in post-pubertal boys for HDL-C and TG. In addition, children with hypertension (3.4%) or pre-hypertensive levels (6.6%) also had comorbidity for overweight and blood lipid abnormalities (14% for triglycerides, 44.7% for TC, 25.9% for LDL-C, 52% for low HDL-C). The present study shows for the first time high correlations between prehypertensive blood pressure levels and the cardiovascular risk factors high TC, high LDL-C, low HDL-C in schoolchildren. These are important for the formulation of public health policies and strategies.

Resposta da pressão arterial ao esforço em adolescentes: influência do sobrepeso e obesidade

BACKGROUND: The acute blood pressure response to physical exertion has been used as an indicator of the risk of developing hypertension. The factors associated with this response need to be clarified for timely intervention in preventing hypertensive disease. OBJECTIVE: To describe the response of cardiovascular variables to acute physical exertion in overweight adolescents using cardiopulmonary exercise testing. METHODS: The sample consisted of 104 adolescents (56 boys and 48 girls), divided into two groups: the obese/overweight group (OOG) and the eutrophic group (EG). The following variables were measured: anthropometric (weight, height, and BMI), body composition (skin fold thickness), as well as hemodynamic variables such as systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and heart rate (HR), at rest and at maximal physical exertion during the cardiopulmonary test. RESULTS: In the male group, the greatest values of systolic arterial pressure at rest were recorded in the OOG as compared to the EG (113 ± 13 vs 106 ± 8 mmHg; p = 0.009), pre-exertion SAP (120 ± 14 vs 109 ± 10 mmHg; p = 0.003), and SAP during maximal exertion conditions (156 ± 20 vs 146 ± 14 mmHg; p = 0.03). In the female group, only pre-exertion SAP was higher in the overweight group as compared to the eutrophic girls (114 ± 11 vs 106 ± 10 mmHg; p = 0.009). CONCLUSION: The response of arterial blood pressure during physical exercise was most exacerbated in obese adolescents as compared to eutrophic teens, suggesting greater reactivity to physical exertion.

Stiffness of the large arteries in individuals with and without Down syndrome.

Background: Down syndrome is known to cause premature aging in several organ systems. However, it remains unclear whether this aging effect also affects the structure and function of the large arterial trunks. In this controlled study, the possibility of changes in the large arteries due to aging was evaluated in patients with Down syndrome. Methods: Eighty-two subjects of both genders were selected. The Down syndrome group had 41 active subjects consisting of 19 males and 22 females (mean age 21 ± 1, range 13–42 years) without cardiovascular complications and who did not use vasoactive drugs. The control group consisted of 41 healthy individuals without trisomy 21 of the same gender and age as the Down syndrome group and who did not use vasoactive medication. Carotid–femoral pulse wave velocity was obtained as an index of aortic stiffness using an automatic noninvasive method. Results: Individuals with Down syndrome had significantly lower blood pressure than those in the control group. Systolic blood pressure for the Down syndrome group and control group was 106 ± 2 mmHg vs 117 ± 2 mmHg (P < 0.001), respectively; diastolic blood pressure was 66 ± 2 mmHg vs 77 ± 2 mmHg (P < 0.001); and mean arterial pressure was 80 ± 1 mmHg vs 90 ± 1 mmHg (P < 0.001). Only age and systolic blood pressure were shown to correlate significantly with pulse wave velocity, but the slopes of the linear regression curves of these two variables showed no significant difference between the two study groups. Pulse wave velocity, which was initially significantly lower in the Down syndrome group (7.51 ± 0.14 m/s vs 7.84 ± 0.12 m/s; P <0.05), was similar between the groups after systolic blood pressure adjustment (7.62 ± 0.13 m/s vs 7.73 ± 0.13 m/s). Conclusion: Despite evidence in the literature that patients with Down syndrome undergo early aging, this process does not seem to affect the large arterial trunks, given that values of carotid-femoral pulse wave velocity were similar in individuals with or without trisomy 21. Considering that Down syndrome presents with chronic hypotension, it is reasonable to propose that the prolonged reduction of arterial distending pressure may contribute to functional preservation of the arteries in patients with Down syndrome.

Valores de consumo máximo de oxigênio determinados pelo teste cardiopulmonar em adolescentes: uma proposta de classificação

OBJECTIVE: The identification of populational levels of maximum oxygen uptake (VO2max) is an aid to studies that propose to relate physical fitness to cardiovascular risk, and also for prescribing exercise and analyzing the effects of training. To date, there is no information with which this parameter can be classified in samples of adolescents from the Brazilian population. This study is, therefore, the first to propose the determination of mean VO2max levels in a sample of the Brazilian population. METHODS: A sample of 380 schoolchildren (177 boys and 203 girls, aged 10 to 14 years) was selected at random from public schools in Vitoria, ES. After anthropometric assessment they underwent cardiopulmonary exercise testing, VO2max was measured directly and results were classified according to quintiles calculated from the study sample. RESULTS: The mean VO2max values observed ranged from 42.95 to 49.55 mL.kg-1.min-1 for boys and from 36.76 to 38.29 mL.kg-1.min-1 for girls. CONCLUSIONS: This paper proposes mean VO2max ranges as a classification parameter for cardiorespiratory fitness, in addition to contributing to a definition of normal values for the Brazilian population. This classification will also be of use for establishing cutoff points in future studies.

Changes in retinal microvascular diameter in patients with diabetes.

Background and objectives Diabetic retinopathy is the main microvascular complication in diabetes mellitus and needs to be diagnosed early to prevent severe sight-threatening retinopathy. The purpose of this study was to quantify the retinal microvasculature pattern and analyze the influence of blood glucose level and the duration of diabetes mellitus on the retinal microvasculature. Methods Two groups were analyzed: patients with diabetes (N=26) and patients without diabetes, ie, controls (N=26). A quantitative semiautomated method analyzed retinal microvasculature. The diameters of arterioles and venules were measured. The total numbers of arterioles and venules were counted. The ratio of arteriole diameter to venule diameter was calculated. The retinal microvasculature pattern was related to clinical and biochemical parameters. Results Patients with diabetes exhibited larger venule diameters in the upper temporal quadrant of the retina compared to the lower temporal quadrant (124.85±38.03 µm vs 102.92±15.69 µm; P<0.01). Patients with diabetes for 5 or more years had larger venule diameters in the upper temporal quadrant than patients without diabetes (141.62±44.44 vs 112.58±32.11 µm; P<0.05). The degree of venodilation in the upper temporal quadrant was positively correlated with blood glucose level and the estimated duration of diabetes mellitus. Interpretation and conclusion The employed quantitative method demonstrated that patients with diabetes exhibited venule dilation in the upper temporal quadrant, and the duration of diabetes mellitus was positively correlated with blood glucose level. Therefore, the early assessment of retinal microvascular changes is possible prior to the onset of diabetic retinopathy.

Cardiovascular Risk Investigation: When Should It Start?

Childhood can be considered the period of structuring of life, where patterns such as diet and lifestyle are built. Although atherosclerotic disease (AD) becomes symptomatic at a later period of life, early identification and modification of risk factors may further reduce their incidence (Kelishadi et al., 2002). Thus, several studies demonstrate the importance of investigating the presence of risk factors for atherosclerotic disease at this stage as it may result from profound implications for the risk of developing diseases in adulthood (Lenfant & Savage, 1995; Purath et al., 1995; Gerber & Zielinsky, 1997; Akerblom et al., 1999).

Limiar anaeróbico ventilatório em adolescentes brasileiros de ambos os sexos

In order to compare the cardiorespiratory responses in ventilatory anaerobic threshold (VAT) in relation to gender, age and published data, were evaluated 289 adoles- cents of both sexes, between 10 and 14 years, who underwent a cardiopulmonary test using a ramp protocol on treadmill. The VAT was identified by the methods of the V-slope and/or ventilatory equivalent of oxygen. The results showed that oxygen consumption (VO2 VAT) absolute was higher in boys at 13 and 14 years. The VO2 VAT relative to body weight was different only between genders aged 14 years old, and being higher in boys than girls. We conclude that there is loss of aerobic fitness in adolescents of both sexes from the age of 12. The VO2 VAT was lower when compared with the literature.