Denise Tavares Giannini

Metabolic Syndrome in Overweight and Obese Adolescents: A Comparison of Two Different Diagnostic Criteria

Background: Due to the lack of consensus on its definition, the metabolic syndrome (MS) in children and adolescents is not formally recognized. However, several researchers have changed the adult criteria for pediatric standards in order to assess the prevalence. Objective: The aim of this study was to evaluate the frequency of MS and its components according to two of the currently used definitions in overweight and obese adolescents. Methods: A cross-sectional study with 232 adolescents with excess weight from a public school of the city of Rio de Janeiro. Anthropometric, blood pressure, and biochemical variables were assessed. MS was defined using two different diagnostic criteria: the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) and International Diabetes Federation (IDF). Results: MS was diagnosed in 40.4 and 24.6% of obese adolescents and 9.4 and 1.9% of overweight adolescents according to the NCEP-ATPIII and IDF criteria, respectively. The degree of agreement, assessed by the κ index, from the definitions adopted in this study was 0.48. Conclusion: The results show a significant difference between the two diagnostic criteria. A higher frequency was found when the NCEP-ATPIII was used, which is of concern given the association of MS with diabetes and cardiovascular disease.

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.

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

Heart Failure: Correlation between anthropometric parameters, body bomposition and cell integrity

Background: Knowledge about phase angle and its use as a prognostic determinant in patients with heart failure is still scarce. Objective: To evaluate the correlation between anthropometric indicators, cardiac function and cell integrity in patients with heart failure with reduced ejection fraction. Methods: This was a cross-sectional study that evaluated patients with heart failure with reduced ejection fraction by anthropometry and bioelectrical impedance analysis. Chi-square test and Students t test were used to analyze differences, and Pearsons linear correlation was used to evaluate associations, using p < 0.05 to indicate statistical significance. Results: We evaluated 41 subjects aged 30-74 years, of which 34 were men (82.9%). Mean phase angle was higher among women (7.1%), but significant differences between men and women were found only for body fat percentage. Phase angle correlated with body mass index (r = 0.44, p = 0.004) and there was a trend of correlation of the phase angle with waist-to-height ratio (r = 0.29, p = 0.06) and the left ventricular ejection fraction (r = 0.29, p = 0.07). Conclusions: Phase angle showed a good correlation with body mass index and showed a trend of correlation with the left ventricular ejection fraction, supporting the obesity paradox and the prognostic importance of this marker. Further studies on the applicability of the phase angle in the prognosis of these patients are still needed. (Int J Cardiovasc Sci. 2018;31(3)226-234)Mailing address: Denise Tavares Giannini Rua Gustavo Corção, 606 apto: 301. Postal Code: 22790-150, Recreio dos Bandeirantes, Rio de Janeiro, RJ – Brazil. E-mail: denisegiannini@uol.com.br Heart Failure: Correlation between Anthropometric Parameters, Body Composition and Cell Integrity Tathiana Carestiato Faria, Denise Tavares Giannini, Patrícia Vasconcelos Fontana Gasparini, Ricardo Mourilhe Rocha

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.

C-reactive protein in Brazilian adolescents: distribution and association with metabolic syndrome in ERICA survey

Background/Objectives:C-reactive protein (CRP) is a marker of inflammation that has been shown to be predictive of cardiovascular diseases in adults. To evaluate the distribution of CRP as well as its association with metabolic syndrome and its components.Subjects/Methods:This is a cross-sectional study on adolescents aged 12–17, participants in the Study of Cardiovascular Risk in Adolescents (ERICA). Anthropometric, biochemical and blood pressure data were collected from 6316 adolescents, selected from a random sample of students in the cities of Brasilia, Fortaleza, João Pessoa, Manaus, Porto Alegre and Rio de Janeiro. Metabolic syndrome was defined by the criteria proposed by International Diabetes Federation for adolescent. Poisson regression model with robust variance, taking into consideration the study’s complex sampling design, was used to determine multivariate-adjusted prevalence rate ratios expressing the relationship of metabolic syndrome with CRP.Results:In adolescents with metabolic syndrome, CRP concentrations were five times higher (1.01 mg/l; interquartile range (IQR): 0.54–3.47) compared with those without metabolic syndrome (0.19 mg/l; IQR: 0.10–0.78). In multivariate Poisson regression analysis adjusted by sex, age and skin color, the prevalence of elevated CRP (>3.0 mg/l) was almost three times higher in adolescents with metabolic syndrome than in those without this condition (prevalence ratio (PR): 2.9; 95%CI: 2.0–4.3; P<0.001). Of the metabolic syndrome components, elevated waist circumference, low high-density lipoprotein-cholesterol and high triglycerides were significantly related to CRP in a graded (dose–response) manner.Conclusions:The association of CRP with metabolic syndrome and its components suggests that inflammation may be useful in assessing cardiovascular risk in adolescents.

Metabolic syndrome in patients with chronic heart failure

Prevalence studies estimate that 23 million people worldwide have HF and two million new cases are diagnosed each year. It is a progressing epidemic problem2-4. Industrialization and urbanization have led the development of chronic non-transmissible diseases4. HF is the common final pathway of most of these diseases that affect the heart5,6. Epidemiological evidence increasingly demonstrates the association between metabolic syndrome (MS) and the presence of cardiovascular abnormalities, since, in an independent manner, risk factors related to HF are the same that make up MS6.