Cecília Lacroix de Oliveira

ERICA: prevalence of asthma in Brazilian adolescents

ABSTRACT OBJECTIVE To describe the prevalence of asthma and physician-diagnosed asthma in Brazilian adolescents. METHODS Cross-sectional, national, school-based study with adolescents from 12 to 17 years old, participants in the Study of Cardiovascular Risks in Adolescents (ERICA). The study stratified the sample by region and grouped according to schools and classes with representativeness to the set of cities with more than 100,000 inhabitants of the Country, macro-regions, capitals, and Federal District. A questionnaire collected data through a self-filled in method. We calculated the prevalences and their confidence intervals of 95% (95%CI) according to sex, age group, type of school and skin color. RESULTS Between 2013 and 2014, 74,589 adolescents were evaluated, 55.3% of the female sex. The total prevalence of active asthma was of 13.1% (95%CI 12.1-13.9), being higher in girls (14.8%; 95%CI 13.7-16.0) when compared to boys (11.2%; 95%CI 10.3-12.2) in all geographical strata examined. It was also higher between students of private schools (15.9%; 95%CI 14.2-17.7) when compared to public ones (12.4%; 95%CI 11.4-13.4). It was higher in the Southeast region (14.5%; 95%CI 12.9-16.1), and in the city of Sao Paulo (16.7%; 95%CI 14.7-18.7). The lowest prevalence was observed in North region (9.7%; 95%CI 9.7-10.5), and in Teresina (6.3%; 95%CI 4.9-7.7). The prevalence of physician-diagnosed asthma was of 8.7% (95%CI 8.2-9.1); higher in the North region (13.5%; 95%CI 12.7-14.2), and in Porto Alegre (19.8%; 95%CI 17.5-22.3). It was lower in the Midwest (6.9%; 95%CI 6.0-7.8), and in Cuiaba (4.8%; 95%CI 3.8-5.9). We found no significant difference in the expression of this rate between the sexes, as well as in other variables evaluated by the study. CONCLUSIONS The prevalence of asthma in Brazilian adolescents is high. Rates of active asthma and physician-diagnosed asthma vary widely in different regions and capitals evaluated by the ERICA. These results may assist in the preparation of preventive programs and policies on health and a better understanding of the factors associated with asthma in this age group.

ERICA: intake of macro and micronutrients of Brazilian adolescents

ABSTRACT OBJECTIVE To describe food and macronutrient intake profile and estimate the prevalence of inadequate micronutrient intake of Brazilian adolescents. METHODS Data from 71,791 adolescents aged from 12 to 17 years were evaluated in the 2013-2014 Brazilian Study of Cardiovascular Risks in Adolescents (ERICA). Food intake was estimated using 24-hour dietary recall (24-HDR). A second 24-HDR was collected in a subsample of the adolescents to estimate within-person variability and calculate the usual individual intake. The prevalence of food/food group intake reported by the adolescents was also estimated. For sodium, the prevalence of inadequate intake was estimated based on the Tolerable Upper Intake Level (UL). The Estimated Average Requirement (EAR) method used as cutoff was applied to estimate the prevalence of inadequate nutrient intake. All the analyses were stratified according to sex, age group and Brazilian macro-regions. All statistical analyses accounted for the sample weight and the complex sampling design. RESULTS Rice, beans and other legume, juice and fruit drinks, breads and meat were the most consumed foods among the adolescents. The average energy intake ranged from 2,036 kcal (girls aged from 12 to 13 years) to 2,582 kcal (boy aged from14 to 17 years). Saturated fat and free sugar intake were above the maximum limit recommended (< 10.0%). Vitamins A and E, and calcium were the micronutrients with the highest prevalence of inadequate intake (> 50.0%). Sodium intake was above the UL for more than 80.0% of the adolescents. CONCLUSIONS The diets of Brazilian adolescents were characterized by the intake of traditional Brazilian food, such as rice and beans, as well as by high intake of sugar through sweetened beverages and processed foods. This food pattern was associated with an excessive intake of sodium, saturated fatty acids and free sugar.

Association between cardiovascular risk factors and carotid intima-media thickness in prepubertal Brazilian children

Abstract Background: Early exposure to cardiovascular risk factors creates a chronic inflammatory state that could damage the endothelium followed by thickening of the carotid intima-media. Objective: To investigate the association of cardiovascular risk factors and thickening of the carotid intima. Subjects/Methods: Media in prepubertal children. In this cross-sectional study, carotid intima-media thickness (cIMT) and cardiovascular risk factors were assessed in 129 prepubertal children aged from 5 to 10 year. Association was assessed by simple and multivariate logistic regression analyses. Results: In simple logistic regression analyses, body mass index (BMI) z-score, waist circumference, and systolic blood pressure (SBP) were positively associated with increased left, right, and average cIMT, whereas diastolic blood pressure was positively associated only with increased left and average cIMT (p<0.05). In multivariate logistic regression analyses increased left cIMT was positively associated to BMI z-score and SBP, and increased average cIMT was only positively associated to SBP (p<0.05). Conclusions: BMI z-score and SBP were the strongest risk factors for increased cIMT.

Waist-to-Height Ratio as a Predictor of C-Reactive Protein Levels

ABSTRACT Background: C-reactive protein is an acute-phase protein that has been found in association with adiposity and cardiovascular disease risk. In this paper, the objective was to assess the relationship of C-reactive protein to four anthropometric measurements: body mass index, waist-to-height ratio, C index, and waist circumference. Methods: A cross-sectional random sample of the Study of Cardiovascular Risk in Adolescents (Portuguese acronym “ERICA”) was included in the study. The analysis was adjusted for the complex sampling design. Poisson regression models with robust variance were used to estimate a multivariate-adjusted prevalence rate ratio expressing the relationship of each anthropometric measure to C-reactive protein. We evaluated adolescents aged 12 to 17 years participating in the capital of Porto Alegre, Brazil. Results: In all, 778 adolescents were included (60% female, 58% aged 15–17 years). Waist-to-height ratio was found to be the strongest adiposity marker associated with C-reactive protein even after adjusting for age, sex, smoking, physical activity, and insulin resistance (prevalence rate ratio = 7.09; 95% confidence interval, 5.01–9.18; p < 0.001). Conclusions: Waist-to-height ratio is a strong predictor of C-reactive protein in adolescents in Porto Alegre, Brazil.

ERICA: ingestão de macro e micronutrientes em adolescentes brasileiros

I Instituto de Estudos em Saúde Coletiva. Universidade Federal do Rio de Janeiro. Rio de Janeiro, RJ, Brasil II Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde. Secretaria de Vigilância em Saúde. Ministério da Saúde. Brasília, DF, Brasil III Programa de Pós-Graduação em Saúde Coletiva. Instituto de Medicina Social. Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil IV Divisão de Nutrição. Hospital Universitário Pedro Ernesto. Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil V Departamento de Nutrição. Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil VI Departamento de Nutrição. Núcleo de Estudos em Saúde Pública. Universidade Federal do Piauí. Teresina, PI, Brasil VII Núcleo de Nutrição. Centro Acadêmico de Vitória. Universidade Federal de Pernambuco. Vitória de Santo Antão, PE, Brasil VIII Departamento de Nutrição. Centro de Ciências da Saúde. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil

Fatty acid intake and metabolic syndrome among overweight and obese women

OBJECTIVE To examine relations between fatty acids intake and metabolic syndrome (MetS) status among overweight and obese women (n = 223). METHODS This was a cross-sectional study. The physical and laboratory tests included anthropometry, body composition evaluation and measurements of blood pressure, fasting blood glucose, insulinemia and lipid profiles. A three-day food diary was used to evaluate fatty acids consumption. Statistical analysis included χ2 test and odds ratio measurements. RESULTS The women had 35.2 (6.9) years old and 15.2% presented MetS. Women with MetS presented higher serum levels of very low-density lipoprotein cholesterol, triglycerides, glucose and insulin in addition to higher diastolic blood pressure in comparison to women without MetS. Overweight women with MetS consumed higher amounts of monounsaturated fatty acids - 24.3 g (24.7 - 36.4) versus overweight women without MetS - 23.9 g (23.8 - 26.8), polyunsaturated fatty acids - 16.7 g (14.6 - 21.1) versus overweight women without MetS - 13.6 g (13.8 - 15.8) and linoleic fatty acids - 15.9 g (6.5) versus overweight women without MetS - 13.1 g (5.1). Among obese women with MetS, higher intake of linoleic fatty acids was also noted - 17.6 g (6.1) versus obese women without MetS - 14.3 g (6.6) in addition to higher consumption of trans fatty acids - 4.7 g (4.8 - 6.3) versus obese women without MetS - 3.9 g (2.9 - 4.6). Increased quartiles of monounsaturated, polyunsaturated, linoleic and trans fatty acid intake were significantly associated with a greater occurrence of MetS. CONCLUSION Lipid intake may be related to MetS, although other factors also need to be considered, such as lifestyle, genetics and metabolism.

Physical activity but not sedentary time is associated with vitamin D status in adolescents: study of cardiovascular risk in adolescents (ERICA)

Background/objectivesThe association between active lifestyle components and vitamin D status in adolescents remains relatively unexplored. We aimed to investigate independent and joint associations of moderate-to-vigorous physical activity (MVPA) and screen time with serum 25-hydroxyvitamin D [25(OH)D] concentrations in adolescents.MethodsThis multicenter cross-sectional study involved 1152 Brazilian adolescents (age 12–17 years). Serum 25(OH)D was measured in a single laboratory and categorized as ≤20, 21–29, or ≥30 ng/mL. Demographic and lifestyle characteristics were assessed by self-reports. Ordered logistic regression was used to investigate potential associations of being physically active (MVPA ≥ 300 min/week) and excessive screen time (>2 h/day) with serum 25(OH)D concentrations.ResultsThe prevalence of higher serum 25(OH)D concentrations (≥30 ng/mL) was 36.4%. In adjusted models, being physically active was associated with higher serum 25(OH)D concentrations only in boys [proportional odds ratio (POR) = 2.04, 95% CI 1.42–2.93], while excessive screen time was not associated with serum 25(OH)D. Adolescents who were physically active and limited their screen time had higher odds of a higher serum 25(OH)D concentration, but the association was significant only for boys (POR = 2.11, 95% CI 1.19–3.74).ConclusionsMVPA may play an important role in increasing serum 25(OH)D concentrations in adolescence, especially for boys, regardless of screen time.

Estimativa das necessidades energéticas em pacientes com doença renal crônica

Estabelecer as necessidades energeticas de pacientes com doenca renal cronica e importante para que se possam tratar os disturbios nutricionais encontrados nessa populacao. Segundo os guias de condutas voltados ao cuidado nutricional de pacientes com essa doenca, a recomendacao energetica pode variar entre 30 e 40kcal/kg/dia. Contudo, trabalhos que avaliaram os componentes do gasto energetico nos pacientes com doenca renal cronica sugerem que as necessidades energeticas dessa populacao podem diferir do valor recomendado acima, a depender da condicao clinica (presenca de comorbidades), da modalidade de tratamento empregado e do nivel de atividade fisica. Dessa forma, o presente trabalho tem como objetivo fazer uma revisao dos estudos sobre o gasto energetico de pacientes com doenca renal cronica, com o intuito de abordar as seguintes questoes: (1) as atuais recomendacoes de energia para pacientes com doenca renal cronica estao adequadas? (2) qual equacao de predicao poderia ser empregada para estimar as necessidades energeticas desse grupo de pacientes? Assim, esta revisao busca auxiliar o nutricionista ao estimar as necessidades energeticas de pacientes com doenca renal cronica.