Carla Campos Muniz Medeiros

Association of uric acid levels with components of metabolic syndrome and non-alcoholic fatty liver disease in overweight or obese children and adolescents

OBJECTIVE To investigate the association between serum uric acid concentration according to the presence or absence of non-alcoholic fatty liver disease (NAFLD) and/or metabolic syndrome (MS) in overweight or obese children and adolescents. METHODS This was a cross-sectional study conducted from April of 2009 to March of 2010, including 129 children and adolescents treated at the Center for Childhood Obesity. Anthropometric data, blood pressure measurements, and laboratory test results were obtained, and NAFLD diagnosis was made by ultrasound. The diagnosis of MS was made using the criteria of the National Cholesterol Education Program/Adult Treatment Panel III, adapted to age range. The chi-squared test or or Fishers test were used to evaluate the association of uric acid with the groups, with a 95% confidence interval. One-way analysis of variance (ANOVA) was used for comparison of means. Multiple logistic regression was used for adjustment of variables. The data were analyzed with the Statistical Package for Social Sciences (SPSS), release 17. RESULTS High levels of uric acid were significantly associated with adolescence, MS, and systolic blood pressure. The highest quartile of uric acid showed significantly higher values of body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, triglycerides, total cholesterol, and homeostatic model assessment index (HOMA-IR), and lower mean values of HDL cholesterol. In the final model, only age range and the presence of MS remained associated with uric acid levels. CONCLUSIONS High levels of uric acid were associated with MS and adolescence, which was not observed with NAFLD.

Acanthosis nigricans and insulin resistance in overweight children and adolescents.

BACKGROUND Studies have suggested an association between the presence of acanthosis nigricans (AN) and the development of diabetes. OBJECTIVE To investigate the association between AN and insulin resistance (IR) in overweight children and adolescents receiving care at the Center for Childhood Obesity, Campina Grande, PB. METHODS This cross-sectional study was conducted between April 2009 and April 2010 including 194 individuals of 2 to 18 years of age receiving care within the Brazilian national health network. The presence of acanthosis nigricans was verified and anthropometric measurements were taken. The following tests were performed: insulin, triglycerides, HDL-cholesterol, glucose and homeostasis model of assessment - insulin resistance (HOMA-IR). Statistical analyses were performed using the SPSS software program, version 17.0. RESULTS There was a greater prevalence of females (66%), brown-skinned individuals (63.4%), adolescents (61.3%) and severely obese individuals (66.5%). Acanthosis nigricans was identified in 58.2% and IR in 42.7% of the participants. Acanthosis nigricans was associated with being non-white (p = 0.003), with being an adolescent (p = 0.003) and with IR (p = 0.001). Non-white individuals, adolescents and those with insulin resistance were 5.4, 2.47 and 2.66 times more likely to have acanthosis nigricans, respectively. CONCLUSION The results of this study indicate a need to train healthcare professionals to identify acanthosis nigricans, since this condition is associated with IR. Identifying acanthosis nigricans in childhood permits the safe and timely treatment of cardiometabolic disorders through careful monitoring and appropriate treatment.

Resistência insulínica e sua relação com os componentes da síndrome metabólica

BACKGROUND Individuals with insulin resistance are more prone to the development of metabolic syndrome (MS), Type 2 Diabetes Mellitus and Cardiovascular Disease (CVD) OBJECTIVE: To evaluate the association between insulin resistance (IR) and metabolic syndrome components. METHODS Cross-sectional study of 196 individuals between 2 and 18 years, treated at the Brazilian Public Healthcare system. The association of IR with the MS components was evaluated by Chi-square test, adopting the Homeostasis model assessment-insulin resistance (HOMA-IR) value > 2.5, and by analysis of variance (ANOVA) and Tukeys test, by comparing the means of the components in the HOMA-IR quartiles. Statistical analysis was performed using SPSS 17.0 software and significance level was set at 5%. RESULTS IR was observed in 41.3% of the studied population and was associated with age between 10-18 years (p = 0.002 PR = 3.2), to MS in both sexes [Male (p = 0.022 PR = 3.7) and female (p = 0.007 PR = 2.7)] and altered triglycerides (p = 0.005 PR = 2.9) in females. The mean values of the MS components differed significantly between HOMA-IR quartiles (p <0.01), except for HDL-cholesterol. CONCLUSION Insulin resistance can be considered a marker of cardiovascular risk.

C-reactive protein and its relation to high blood pressure in overweight or obese children and adolescents.

OBJECTIVE To investigate the association between C-reactive protein (CRP) and high blood pressure (BP) in overweight or obese children and adolescents. METHODS Cross-sectional study with 184 overweight or obese children and adolescents aged from two to 18 years old, from April, 2009 to April, 2010. The classification of nutritional status used the body mass index (BMI). Based on the Centers for Disease Control and Prevention curve, individuals were classified as: overweight (BMI between the 85th-95th percentiles), obesity (BMI between 95th-97th percentiles) and severe obesity (BMI >97th percentile). Abnormal values were considered for systolic BP (SBP) and/or diastolic (DBP) if ≥90th percentile of the BP curve recommended for children and adolescents in the V Brazilian Guidelines on Hypertension, for waist circumference (WC) if ≥90th percentile of the curve established by the National Cholesterol Education Program, and for high sensitive CRP (hs-CRP) if >3mg/dL. To evaluate the association of inadequate values of CRP and the studied groups, chi-square test and analysis of variance were applied, using the Statistical Package for the Social Sciences version 17.0 and adopting a significance level of 5%. RESULTS Among the evaluated sample, 66.3% were female, 63.5%, non-white, 64.1% had severe obesity, 78.3% had altered WC and 70.6% presented high BP. There was a significant association of CRP high levels with altered WC and BMI ≥97th percentile. In adolescents, high CRP was related to high SBP. CRP mean values were higher in individuals with elevated SBP. CONCLUSIONS Inadequate values of hs-CRP were associated with severe obesity and high SBP in the studied population. These markers can be used to identify children and adolescents at higher risk for developing atherosclerosis.ABSTRACT Objective : To investigate the association between C-reactive protein (CRP) and high blood pressure (BP) in overweight or obese children and adolescents. Methods: Cross-sectional study with 184 overweight or obese children and adolescents aged from two to 18 years old, from April, 2009 to April, 2010. The classification of nutritional status used the body mass index (BMI). Based on the Centers for Disease Control and Prevention curve, individuals were classified as: overweight (BMI between the 85 th –95 th percentiles), obesity (BMI between 95 th –97 th percentiles) and severe obesity (BMI >97 th percentile). Abnormal values were considered for systolic BP (SBP) and/ Endereco para correspondencia:Anajas da Silva CardosoRua Treze de Maio, 221 CEP 58400-290 – Campina Grande/PB E-mail: anajascardoso@gmail.comFonte financiadora: Fundacao de Apoio a Pesquisa do Estado da Paraiba (Fapesq) e Universidade Estadual da Paraiba (UEPB), sob concessao de ajuda de custo mediante aprovacao da pesquisa em editalConflito de interesse: nada a declararRecebido em: 5/10/2010Aprovado em: 14/2/2013

Sleep quality and metabolic syndrome in overweight or obese children and adolescents

Objective To assess sleep quality and its association with metabolic syndrome and its components. Methods This cross-sectional study was conducted from June 2011 to March 2012 at the Childhood Obesity Center, Campina Grande, Paraiba , Brazil, with 135 overweight or obese children and adolescents. Sleep quality was assessed by the Pittsburgh Sleep Quality Index. Metabolic syndrome diagnosis was based on abdominal circumference, blood pressure, glycemia, high density lipoprotein-cholesterol, and triglycerides. The data were treated by the software Statistical Package for the Social Sciences version 22.0 at a significance level of 5%. Results The prevalence of poor sleep quality or sleep disorder according to the Pittsburgh Sleep Quality Index was 40.7%, and females had higher mean global Pittsburgh Sleep Quality Index score. Metabolic syndrome prevalence was 63.0%. Females also had higher daytime dysfunction. Poor sleep quality was associated with high diastolic blood pressure (OR=2.6; p =0.015) and waist circumference (OR=3.17; p =0.024) after adjusting for sex and age. Conclusion Girls had higher global Pittsburgh Sleep Quality Index score, which was associated with daytime dysfunction. Poor sleep quality was a predictor of high diastolic blood pressure in the study sample.

Fibrinogen: cardiometabolic risk marker in obese or overweight children and adolescents ☆ ☆☆

OBJECTIVES To determine the prevalence of increased serum fibrinogen levels and its association with cardiometabolic risk factors in overweight or obese children and adolescents. METHODS Cross-sectional study with 138 children and adolescents (overweight or obese) followed at a reference outpatient clinic of the public health care network. Fibrinogen concentration was divided into quartiles, and values above or equal to the third quartile were considered high. The association between high fibrinogen values and cardiometabolic risk factors was assessed using Pearsons chi-squared test or Fishers exact test, as necessary. Logistic regression was used to adjust variables predictive of fibrinogen levels. Analyses were performed using SPSS version 22.0 and SAS software, considering a confidence interval of 95%. RESULTS Serum fibrinogen levels were elevated in 28.3% of individuals, showing association with the presence of high CRP (p=0.003, PR: 2.41, 95% CI: 1.30-4.46) and the presence of four or more risk factors (p=0.042; PR: 1.78, 95% CI: 1.00-3.17). After a logistic regression, only elevated CRP remained associated with altered fibrinogen levels (p=0.024; PR: 1.32; 95% CI: 1.09-5.25). CONCLUSIONS Increased fibrinogen was prevalent in the study population and was associated with ultrasensitive C-reactive protein and the presence of four or more cardiovascular risk factors; it should be included in the assessment of individuals at risk.

Changes in the frequency of food intake among children and teenagers: monitoring in a reference service

Objetivo: identificar modificaciones en la frecuencia alimenticia de ninos y adolescentes con exceso de peso, tratadas en un servicio de referencia. Metodo: estudio de cohorte, realizado entre abril de 2010 y abril de 2011; participaron 109 ninos y adolescentes obesos o con sobrepeso; la poblacion fue dividida en dos grupos de acuerdo con el tiempo de permanencia en el tratamiento (>6 meses y <6 meses de alejamiento del tratamiento); se efectuaron las pruebas Chi-cuadrado y regresion logistica. Resultados: el grupo con mayor tiempo de alejamiento tiende a consumir mas refrescos, masas y frituras y menos frutas y legumbres; el grupo con menor tiempo de alejamiento presento mejoria en lo relacionado a la reduccion del consumo de refrescos y golosinas; se verifico un aumento del riesgo para el consumo de refrescos, masas y golosinas, asi como para el alejamiento del tratamiento en la adolescencia. Conclusiones: el grupo con mayor tiempo de acompanamiento modifico positivamente la frecuencia alimenticia. La principal contribucion del estudio es indicar que el tratamiento multiprofesional, incluyendo los cuidados de enfermeria, es eficaz para modificar, de forma progresiva, la frecuencia alimenticia de ninos y adolescentes con exceso de peso.PURPOSE to identify changes in the food intake patterns among overweight children and teenagers, treated at a reference medical centre. METHOD the method used is that of a cohort study, between April 2010 and April 2011. A total of 109 children and teenagers, either obese or overweight, took part in the study. The population was divided into two subgroups depending on the permanence period (more than 6 months, and less than 6 months off the treatment). The chi-square test and logistic regression were carried out. RESULTS the group which had been longer off the treatment tended to consume more soft drinks, pasta and fried foods, and less fruit and vegetables. The group with less time showed an improvement, with a reduction of consumption of soft drinks and other goodies. There was confirmation of an increased risk for consumption of soft drinks, pasta and goodies in general, as also detachment from the treatment in adolescence. CONCLUSIONS The group with a longer period of monitoring has had a positive change in food intake frequency. The main contribution made by this study is that of showing that multiprofessional treatment, including some nursing care, is efficient in progressively changing the food intake of children and adolescents who are overweight.

C-reactive protein and cardiometabolic risk factors in overweight or obese children and adolescents

OBJECTIVE:To investigate the relationship between ultrasensitive C-reactive protein and cardiometabolic risk factors in overweight or obese childrenand adolescents.METHODS:Cross-sectional study conducted at the Center for Childhood Obesity in the period from April 2009 to April 2010, involving 185 overweight children and adolescents aged 2 to 18 years. Measures of ultrasensitive C-reactive protein according to age, nutritional status, gender, race, cardiometabolic risk factors (waist circumference, lipid profile, impaired fasting glucose, high blood pressure and presence of insulin resistance) were compared through the Chi-square test and analysis of variance. All analyses were performed using the Statistical Package for the Social Sciences software version 17.0, adopting a significance level of 5%.RESULTS:Altered high-density lipoprotein was the most frequent cardiometabolic risk factor, and there was a significant association between altered ultrasensitive C-reactive protein values and severe obesity (p=0.005), high waist circumference (p<0.001), hypertriglyceridemia (p=0.037) and insulin resistance (p=0.002), as well as significantly higher body mass index (p=0.000), waist circumference (p=0.001), insulin (p=0.005) and index of glucose homeostasis values(p=0.005).CONCLUSION:High prevalence of altered ultrasensitive C-reactive protein and significant association with severe obesity, waist circumference, hypertriglyceridemia and insulin resistance were observed.

Risk factors associated with treatment abandonment by overweight or obese children and adolescents

OBJECTIVE To evaluate the risk factors associated with treatment abandonment by overweight or obese children and adolescents. METHODS A cross-sectional study, conducted in 2011, at the Childhood Obesity Center, in Campina Grande, Brazil, with the records of 208 children and adolescents, between three and 18 years of age, divided into two groups: Group I included those who abandoned treatment, and Group II included those who did not abandon treatment. RESULTS Non-adherence was significantly associated with higher income (OR=5.8), high maternal education (OR=2.4), white skin color (OR=2.9), and obesity (OR=3.6). CONCLUSION Despite the new academic-care approach, the non-adherence to treatment rate was high, and was associated with sociodemographic and nutritional factors.

Modificação na frequência alimentar de crianças e adolescentes: acompanhamento em serviço de referência

Objetivo: identificar modificaciones en la frecuencia alimenticia de ninos y adolescentes con exceso de peso, tratadas en un servicio de referencia. Metodo: estudio de cohorte, realizado entre abril de 2010 y abril de 2011; participaron 109 ninos y adolescentes obesos o con sobrepeso; la poblacion fue dividida en dos grupos de acuerdo con el tiempo de permanencia en el tratamiento (>6 meses y <6 meses de alejamiento del tratamiento); se efectuaron las pruebas Chi-cuadrado y regresion logistica. Resultados: el grupo con mayor tiempo de alejamiento tiende a consumir mas refrescos, masas y frituras y menos frutas y legumbres; el grupo con menor tiempo de alejamiento presento mejoria en lo relacionado a la reduccion del consumo de refrescos y golosinas; se verifico un aumento del riesgo para el consumo de refrescos, masas y golosinas, asi como para el alejamiento del tratamiento en la adolescencia. Conclusiones: el grupo con mayor tiempo de acompanamiento modifico positivamente la frecuencia alimenticia. La principal contribucion del estudio es indicar que el tratamiento multiprofesional, incluyendo los cuidados de enfermeria, es eficaz para modificar, de forma progresiva, la frecuencia alimenticia de ninos y adolescentes con exceso de peso.PURPOSE to identify changes in the food intake patterns among overweight children and teenagers, treated at a reference medical centre. METHOD the method used is that of a cohort study, between April 2010 and April 2011. A total of 109 children and teenagers, either obese or overweight, took part in the study. The population was divided into two subgroups depending on the permanence period (more than 6 months, and less than 6 months off the treatment). The chi-square test and logistic regression were carried out. RESULTS the group which had been longer off the treatment tended to consume more soft drinks, pasta and fried foods, and less fruit and vegetables. The group with less time showed an improvement, with a reduction of consumption of soft drinks and other goodies. There was confirmation of an increased risk for consumption of soft drinks, pasta and goodies in general, as also detachment from the treatment in adolescence. CONCLUSIONS The group with a longer period of monitoring has had a positive change in food intake frequency. The main contribution made by this study is that of showing that multiprofessional treatment, including some nursing care, is efficient in progressively changing the food intake of children and adolescents who are overweight.