Eliane Said Dutra

Metabolic syndrome in central Brazil: prevalence and correlates in the adult population

BackgroundThe prevalence of metabolic syndrome (MetS) has increased in developing countries in recent decades. This syndrome, a clustering of metabolic abnormalities, has been correlated to various socioeconomic and behavioral variables. We investigated the prevalence and prevalence ratios (PR) of MetS and related factors in an adult population of the Federal District (FD) of Brazil, which is located in the central region of the country.MethodsA cross-sectional, population-based study conducted in 2007, with 2130 adults (aged 18 years or older) in the FD of Brazil. Metabolic syndrome was defined according to the recently harmonized criteria. The prevalence of MetS and PR were estimated for each sex according to the diagnostic components and the overall contribution of the selected correlates.ResultsThe overall prevalence of MetS was 32.0% (95%CI: 28.9–35.2), with no gender difference. The single component with the greatest contribution to the diagnosis of MetS was hypertension in men (PR 5.10, 95%CI: 3.17–8.22) and high waist circumference in women (PR 5.02, 95%CI: 3.77–6.69). The prevalence of MetS increased significantly and progressively with age and excess weight. In women, higher education was protective against MetS (PR 0.66, 95%CI: 0.49–0.89) compared to 8 or less years of education. There was no association between the prevalence of MetS and behavioral variables studied.ConclusionsThis study provides comprehensive and alarming data about the prevalence of MetS among the adult population of Brazil’s FD. The results suggest that reducing education inequalities may be an important public policy goal to improve health outcomes, especially among women.

Adesão a um programa de aconselhamento nutricional para adultos com excesso de peso e comorbidades

OBJETIVO: Investigar adesao a programa de aconselhamento nutricional em grupo para individuos com excesso de peso e comorbidades. METODOS: Estudo analitico de intervencao controlada e aberta. Oitenta adultos, de ambos os sexos, com indice de massa corporal entre 25 e 35kg/m², portadores de dois ou mais fatores de risco cardiovascular associados foram alocados aleatoriamente em dois grupos para acompanhamento por tres meses. O grupo de intervencao com aconselhamento nutricional em grupo recebeu atendimento individual e participou de seis reunioes grupais para discussao sobre alimentacao saudavel e atividade fisica, com dinâmicas e metodo participativo. O grupo-controle, com atendimento padrao individual, foi assistido em tres consultas ambulatoriais. Consideraram-se repercussoes dieteticas antes e apos a intervencao e assiduidade as reunioes como parâmetros de adesao ao tratamento. RESULTADOS: Trinta e tres participantes concluiram o estudo. Do total inicial, 45,8% e 40,7% do grupo de intervencao com aconselhamento nutricional em grupo e do grupo-controle com atendimento padrao individual, respectiva-mente, atingiram nivel otimo de assiduidade. Os fatores mais citados como barreiras a adesao ao tratamento foram fazer refeicoes fora de casa (46,7% - grupo-controle com atendimento padrao individual) e dificuldade em aplicar os conhecimentos na pratica, principalmente em eventos sociais (33,3% - grupo de intervencao com aconselhamento nutricional em grupo). Verificou-se aumento significativo do percentual medio do uso de temperos naturais e do numero de refeicoes ao dia nos dois grupos apos a intervencao. Porem, nao houve diminuicao significativa do consumo energetico intra ou entre os grupos. CONCLUSAO: Apesar da abrangencia do conteudo e do emprego de um metodo participativo no grupo de intervencao, a adesao foi insuficiente para alterar significativamente os principais parâmetros dieteticos estudados. O apro-fundamento da abordagem comportamental, continuada e multiprofissional deve ser objeto de mais investigacoes.

Effect of Grazing Behavior on Weight Regain Post-Bariatric Surgery: A Systematic Review

Grazing, a type of maladaptive eating behavior, has been associated with poor weight outcomes in bariatric patients. The purpose of this study was to conduct a systematic review of the association between grazing behavior and weight regain post-bariatric surgery. Literature searches, study selection, design of the method, and quality appraisal were carried out by two independent authors. The search strategy was performed until October 2017 in Medline, Embase, Cochrane, Lilacs, Scopus, Web of Science, Google Scholar, ProQuest Dissertation & Theses, and Open Grey. Of a total of 3764 articles, five papers met the inclusion criteria (four original articles and one thesis), comprising 994 subjects, mostly women. The prevalence of grazing behavior ranged from 16.6 to 46.6%, and the highest prevalence of significant weight regain was 47%. The association between grazing and weight regain was observed in four of the five evaluated studies. Our findings support an association between grazing behavior and weight regain after bariatric surgery, regardless of surgery type and contextual concept of grazing. Further studies are needed to confirm the clarity of the real prevalence and interfering factors related to grazing behavior and weight outcomes.

Reducing risk factors in overweight adult users of the family health strategy of the Distrito Federal

OBJECTIVE: To evaluate the results of a multidisciplinary program to promote healthy habits on anthropometric and biochemical parameters on participants of the Family Health Strategy of the Distrito Federal. METHODS: The sample consisted of 279 overweight and obese adults of both sexes divided into two groups: intervention (IG, n=198) and control group (CG, n=89). The IG received standard Family Health Strategy care plus a multidisciplinary health promoting program that included dietary interventions and physical activity, called Set Waist Program. The control group received only standard ESF care. Data were collected at baseline and after 4 and 8 months of follow up. Body mass index, waist circumference, fasting blood glucose and lipid profile were assessed. RESULTS: Prevalence of obesity (63.3% to 49.4%, p=0.027) and waist circumference (102.2cm to 94.8cm, p<0.0001) were significantly reduced in IG. Total cholesterol, LDL and HDL-cholesterol were reduced in both groups. CONCLUSION: Reductions in anthropometric measures were maximized through simple interventions that stimulated lifestyle changes. These results suggest that multidisciplinary initiatives such the Set Waist Program can be incorporated into other Family Health Strategy teams to optimize the control of obesity and health promotion. Participant compliance is an issue that deserves further investigation.

Prevalence of hypertension among adolescents: systematic review and meta-analysis

ABSTRACT OBJECTIVE To estimate the prevalence of hypertension among adolescent Brazilian students. METHODS A systematic review of school-based cross-sectional studies was conducted. The articles were searched in the databases MEDLINE, Embase, Scopus, LILACS, SciELO, Web of Science, CAPES thesis database and Trip Database. In addition, we examined the lists of references of relevant studies to identify potentially eligible articles. No restrictions regarding publication date, language, or status applied. The studies were selected by two independent evaluators, who also extracted the data and assessed the methodological quality following eight criteria related to sampling, measuring blood pressure, and presenting results. The meta-analysis was calculated using a random effects model and analyses were performed to investigate heterogeneity. RESULTS We retrieved 1,577 articles from the search and included 22 in the review. The included articles corresponded to 14,115 adolescents, 51.2% (n = 7,230) female. We observed a variety of techniques, equipment, and references used. The prevalence of hypertension was 8.0% (95%CI 5.0–11.0; I2 = 97.6%), 9.3% (95%CI 5.6–13.6; I2 = 96.4%) in males and 6.5% (95%CI 4.2–9.1; I2 = 94.2%) in females. The meta-regression failed to identify the causes of the heterogeneity among studies. CONCLUSIONS Despite the differences found in the methodologies of the included studies, the results of this systematic review indicate that hypertension is prevalent in the Brazilian adolescent school population. For future investigations, we suggest the standardization of techniques, equipment, and references, aiming at improving the methodological quality of the studies.

Nutritional aspects of children and adolescents with epidermolysis bullosa: literature review

Epidermolysis Bullosa is a genetic disorder that affects mainly the skin, however, all others systems are influenced. The nutritional care of children and adolescents with Epidermolysis Bullosa is a key treatment strategy, since the energy needs are increased due to the diseases metabolism, burdening the immune system and cicatrization process, symptoms caused by the disease hinder the intake and adequate absorption of nutrients, which may result in inadequate growth and development. Because this is a rare disease, there are few professionals who know the characteristics of both the clinical evolution and nutritional and dietary treatments. This literature review discusses the latest knowledge on energy and specific nutrient requirements to the dietary treatment and monitoring of children and adolescents with Epidermolysis Bullosa.

Accuracy of self-reported hypertension in Brazilian adolescents: Analysis of the Study of Cardiovascular Risk in Adolescents

Given the high prevalence of hypertension in adolescents, it is important to investigate alternatives for estimating the magnitude of the disease. Our objective was to investigate the accuracy of self‐reported hypertension. The study assessed participants of the Study of Cardiovascular Risk in Adolescents (ERICA). The following were calculated: sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The associations between inaccurate self‐reporting and socioeconomic factors were investigated. The accuracy of self‐reported hypertension had a sensitivity of 7.5% (95% CI, 6.9‐8.2), a specificity of 96.6% (95% CI, 96.5‐96.7), a PPV of 18.9% (95% CI, 17.4‐20.5), and a NPV of 90.8% (95% CI, 90.6‐91.0). The prevalence of inaccurate self‐reported hypertension was smaller among girls (PR 0.68; 95% CI, 0.55‐0.83) and younger boys (PR 0.68; 95% CI, 0.54‐0.86) who were attending private schools. The use of self‐reported hypertension was not a good strategy for investigating the hypertension in adolescents.

Workplace nutrition knowledge questionnaire: psychometric validation and application

Workplace dietary intervention studies in low- and middle-income countries using psychometrically sound measures are scarce. This study aimed to validate a nutrition knowledge questionnaire (NQ) and its utility in evaluating the changes in knowledge among participants of a Nutrition Education Program (NEP) conducted at the workplace. A NQ was tested for construct validity, internal consistency and discriminant validity. It was applied in a NEP conducted at six workplaces, in order to evaluate the effect of an interactive or a lecture-based education programme on nutrition knowledge. Four knowledge domains comprising twenty-three items were extracted in the final version of the NQ. Internal consistency of each domain was significant, with Kuder-Richardson formula values>0·60. These four domains presented a good fit in the confirmatory factor analysis. In the discriminant validity test, both the Expert and Lay groups scored>0·52, but the Expert group scores were significantly higher than those of the Lay group in all domains. When the NQ was applied in the NEP, the overall questionnaire scores increased significantly because of the NEP intervention, in both groups (P<0·001). However, the increase in NQ scores was significantly higher in the interactive group than in the lecture group, in the overall score (P=0·008) and in the healthy eating domain (P=0·009). The validated NQ is a short and useful tool to assess gain in nutrition knowledge among participants of NEP at the workplace. According to the NQ, an interactive nutrition education had a higher impact on nutrition knowledge than a lecture programme.

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.

Emotional eating behavior hinders body weight loss in women after Roux-en-Y gastric bypass surgery

OBJECTIVE Successful weight loss and maintenance after Roux-en-Y gastric bypass (RYGB) may be related to eating behavior. The aim of this study was to assess the eating behavior domains that prevail in women during the RYGB postoperative period and their associations with surgery outcome. METHODS This cross-sectional study investigated eating behavior in 95 women (47.3 ± 9.8 y old)  ≥ 2 y after Roux-en-Y gastric bypass. Patients were grouped according to surgery outcome: successful group (SG; n = 67), defined as having lost ≥ 50% of the preoperative excess weight loss (EWL), and an unsuccessful group (UG; n = 28). Mean postoperative time was 59.5 ± 21.2 mo (55.7 ± 19.9 in the SG and 68.6 ± 21.9 in the UG). The short version of the Three-Factor Eating Questionnaire was used to assess cognitive restraint, emotional eating, and uncontrolled eating behaviors. Multivariate analysis was used to investigate associations between eating behavior scores and EWL. RESULTS The highest score in both groups was for the cognitive restraint domain, followed by emotional and uncontrolled eating. Emotional eating was negatively associated with percentage of EWL (β = -0.286; P = 0.033), regardless of age, educational attainment, and postoperative time. CONCLUSION The cognitive restraint domain was the main type of eating behavior observed, and patients with higher emotional eating score were at a higher risk for having insufficient weight loss after RYGB. These results indicate the relevance of monitoring emotional components during the long-term nutritional follow-up of bariatric patients to achieve better surgery outcomes.