Danielle Franklin de Carvalho

Perfil lipídico e estado nutricional de adolescentes

OBJETIVOS: Avaliar a associacao entre obesidade e dislipidemias em adolescentes do ensino publico e privado de Campina Grande-PB, Brasil. METODOS: Estudo transversal com 180 adolescentes de 14 a 17 anos matriculados no ensino publico e privado de Campina Grande-PB. O estado nutricional foi classificado segundo os percentis do Indice de Massa Corporal para sexo e idade. Foi realizada coleta sanguinea para avaliacao do perfil lipidico (colesterol total, fracoes HDL-colesterol, LDL-colesterol e triglicerideos). Considerou-se dislipidemia a existencia de alteracao em pelo menos um dos exames. As analises estatisticas foram realizadas a partir do Epi Info 3.3 e Stata 7.0. RESULTADOS: A prevalencia de sobrepeso foi de 14,4% enquanto que 83,9% dos estudantes eram eutroficos e 1,7% apresentavam baixo peso. Nao foram encontradas diferencas estatisticamente significantes para o estado nutricional quando estratificado por sexo e tipo de escola. Todas as taxas bioquimicas investigadas mostraram algum nivel de alteracao. Chamou a atencao a prevalencia de dislipidemia, observada em 66,7% dos estudantes, e a alteracao do HDL-colesterol, verificada em 56,7% destes. Registrou-se associacao estatisticamente significante (p<0,05) do Indice de Massa Corporal, categorizado em tercis, com o colesterol total e sua fracao LDL, inclusive quando estratificados por sexo e tipo de escola. CONCLUSOES: Considerando-se a faixa etaria estudada, foram elevados os achados de sobrepeso e dislipidemia. Recomenda-se a adicao de medidas preventivas, a fim de evitar que cada vez mais criancas e adolescentes venham a se tornar adultos portadores de obesidades e outras doencas cronicas.

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.

Leptin and cardiometabolic risk factors in obese children and adolescents

To verify the relationship between leptin and cardiometabolic risk factors in obese children and adolescents.

Ensaios toxicológicos clínicos da casca do maracujá-amarelo (Passiflora edulis, f. flavicarpa), como alimento com propriedade de saúde

Ha muito tempo as propriedades sedativas do maracujazeiro ja sao conhecidas, especialmente quando utilizadas as infusoes ou tinturas das folhas. Recentemente foi descrita uma nova propriedade relacionada ao fruto: a atividade hipoglicemiante da farinha produzida a partir de sua casca, porcao rica em pectina, uma fracao de fibra soluvel que, quando hidratada, regula respostas metabolicas na reducao de absorcao de nutrientes, como glicidios e lipidios, devido a formacao de uma camada gelatinosa na mucosa intestinal, mecanismo que pode explicar sua acao hipoglicemiante. O objetivo desse estudo foi avaliar a toxicologia clinica do uso da farinha de casca de maracuja em voluntarios saudaveis. Para isso foi realizado um ensaio toxicologico clinico, em 36 voluntarios de ambos os sexos, que utilizaram 10 g do produto tres vezes ao dia, durante oito semanas. Os individuos foram incluidos no estudo apos uma avaliacao clinica, com a realizacao de exames fisicos e laboratoriais. O uso do produto foi bem tolerado pelos voluntarios, nao sendo relatadas reacoes adversas que pudessem comprometer sua utilizacao como alimento com propriedade de saude. Os exames efetuados nao evidenciaram sinais de toxicidade nos diversos orgaos e sistemas avaliados, indicando que a farinha de casca de maracuja podera ser utilizada em futuros estudos farmacologicos clinicos.

Fatores maternos associados ao peso fetal estimado pela ultra-sonografia

PURPOSE to evaluate the effect of maternal, socioeconomic and obstetric variables, as well the presence of artery incisions in the 20th and 24th weeks on the fetal weight estimated at the end of pregnancy (36th week) in pregnant women attended by Programa Saúde da Família, in an inland town of the northeast of Brazil. METHODS a longitudinal study including 137 pregnant women, who have been followed up every four weeks in order to assess clinical, socioeconomic and obstetric conditions, including their weight. The uterine arteries were evaluated by Doppler in the 20th and 24th weeks, the fetal weight and the amniotic fluid index (AFI), determined in the 36th week. The initial maternal nutritional state has been determined by the body mass index (BMI), the pregnant women being classified as low weight, eutrophic, over weight and obese. Weight gain during gestation has been evaluated, according to the initial nutritional state, being classified at the end of the second and third trimester as insufficient, adequate and excessive weight gain. Analysis of variance was performed to evaluate the association of the fetal weight in the 36th week with the predictor variables, adjusted by multiple linear regression. RESULTS an association between the fetal weight estimated in the 36th week and the mothers age (p=0.02), mothers job (p=0.02), initial nutritional state (p=0.04), weight gain in the second trimester (p=0.01), presence of incisions in the uterine arteries (p=0.02), and AFI (p=0.007) has been observed. The main factors associated to the fetal weight estimated in the 36th week, after the multiple regression analysis were: BMI at the pregnancy onset, weight gain in the second trimester, AFI and tabagism. CONCLUSIONS in the present study, the fetal weight is positively associated with the initial maternal nutritional state, the weight gain in the second trimester and the volume of amniotic fluid, and negatively, to tabagism.

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.

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.

Síndrome metabólica infanto-juvenil persistente e relação com o risco de doença cardiovascular

OBJECTIVE to verify persistence of metabolic syndrome (MetS) and components in overweight children and adolescents, as well as its relation to socioeconomic and demographic characteristics and to the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) score. METHOD a two-point longitudinal study: at enrollment and after a 24-month interval, with 133 individuals ages from two to 18 years. The demographic anthropomorphic and blood variables were evaluated. Analysis was carried out by simple and paired association tests, as well as multiple logistic regression. RESULTS persistent MetS was observed in 38.3% of the sample, associated cardiovascular risk (ACR) in 79.7%, reduction in arterial pressure and do HDL-c. After adjusting for age and sex, excess weight (ExpB: 0.182; CI: 0.059-0.561), low HDL-c (ExpB: 9.247; CI: 1.157-73.930) and high LDL-c (ExpB:1.915; CI: 0.921-3.979) were associated with persistent MetS. CONCLUSION persistent MetS was associated with obesity, HDL-c and LDL-c, but not with the PDAY score.

Adolescentes: comportamento e risco cardiovascular

Resumo 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.

Assessment of the carotid artery intima-media complex through ultrasonography and the relationship with Pathobiological Determinants of Atherosclerosis in Youth.

OBJECTIVE To evaluate the presence of carotid thickening and its relationship with the Pathobiological Determinants of Atherosclerosis in Youth score. METHODS We carried out a cross-sectional study involving 512 brazilian adolescents. Variables such as sex, body mass index, concentrations of non-high-density lipoprotein and high-density lipoprotein cholesterol, blood pressure, blood glucose and glycated haemoglobin A1c levels that make up the score, and carotid thickening through the intima-media complex measured by ultrasound were evaluated. We adopted two cut-off points to evaluate carotid thickening, being considered altered for those higher or equal to the z-score 2+ and ⩾75th percentile. The association was assessed using the χ2 test and univariate and multivariate logistic regression analyses. RESULTS High cardiovascular risk was present in 10.2% of the adolescents; carotid thickness was present in 4.3% determined by the z-score 2+ and in 25.0% determined by the 75th percentile. When measured by the z-score, carotid thickening was associated with high systolic blood pressure (p=0.024), high-non-high density lipoprotein cholesterol (p=0.039), and high cardiovascular risk assessed by the score and by the 75th percentile, with body mass index >30 (p=0.005). In the multivariate analysis, high cardiovascular risk was found to be independently associated with the presence of carotid thickness evaluated by the z-score, with risk four times greater (p=0.010) of presenting with this condition compared with individuals with low risk, and this fact was not observed when factors were analysed alone. CONCLUSION The presence of high cardiovascular risk in adolescents assessed by the Pathobiological Determinants of Atherosclerosis in Youth score was associated with marked thickening of the carotid artery in healthy adolescents.