Felipe Silva Neves

Evaluation of the predictive capacity of vertical segmental tetrapolar bioimpedance for excess weight detection in adolescents

OBJECTIVE To analyze the predictive capacity of the vertical segmental tetrapolar bioimpedance apparatus in the detection of excess weight in adolescents, using tetrapolar bioelectrical impedance as a reference. METHODS This was a cross-sectional study conducted with 411 students aged between 10 and 14 years, of both genders, enrolled in public and private schools, selected by a simple and stratified random sampling process according to the gender, age, and proportion in each institution. The sample was evaluated by the anthropometric method and underwent a body composition analysis using vertical bipolar, horizontal tetrapolar, and vertical segmental tetrapolar assessment. The ROC curve was constructed based on calculations of sensitivity and specificity for each point of the different possible measurements of body fat. The statistical analysis used Students t-test, Pearsons correlation coefficient, and McNemars chi-squared test. Subsequently, the variables were interpreted using SPSS software, version 17.0. RESULTS Of the total sample, 53.7% were girls and 46.3%, boys. Of the total, 20% and 12.5% had overweight and obesity, respectively. The body segment measurement charts showed high values of sensitivity and specificity and high areas under the ROC curve, ranging from 0.83 to 0.95 for girls and 0.92 to 0.98 for boys, suggesting a slightly higher performance for the male gender. Body fat percentage was the most efficient criterion to detect overweight, while the trunk segmental fat was the least accurate indicator. CONCLUSION The apparatus demonstrated good performance to predict excess weight.

Association between anthropometric indicators of adiposity and hypertension in a Brazilian population: Baependi Heart Study.

Background Recently, some studies have evaluated the role of adiposity measures in the prediction of hypertension risk, but the results are conflicting. Thus, the aim of this study was to compare which of the four indicators of adiposity (waist circumference–WC, body mass index–BMI, body adiposity index–BAI, and visceral adiposity index–VAI) were better associated with hypertension in a Brazilian population. Methods and findings For this study, were selected 1627 individuals (both genders, and aged over 18 years) resident in the municipality of Baependi, a city located in the Southeast of Brazil. WC, BMI, BAI and VAI were determined according to a standard protocol. Hypertension was defined as mean systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg, and/or antihypertensive drug use. The indicators of adiposity WC, BMI, BAI, and VAI were higher in hypertensive when compared to non-hypertensive individuals. In addition, WC and BMI were most strongly associated with hypertension in men and women, respectively. The area under the curve (AUC) of WC was significantly higher than VAI in men. In women, both AUC of BMI and WC showed higher discriminatory power to predict hypertension than BAI and VAI. Conclusions The indicators of adiposity WC and BMI were better associated with hypertension than BAI and VAI, in both genders, and it could be a useful tools for the screening of hypertensive patients.

THE BABY-LED WEANING METHOD (BLW) IN THE CONTEXT OF COMPLEMENTARY FEEDING: A REVIEW

ABSTRACT Objective: To review the scientific findings on the baby-led weaning method (BLW) in the context of complementary feeding. Data sources: Two independent examiners searched the Medical Literature Analysis and Retrieval System Online (MEDLINE)/PubMed database in August 2016. No time-period was defined for the publication dates. The following descriptors were used: “baby-led weaning” OR “baby-led” OR “BLW”. Inclusion criteria were: original studies that were available in English, and which addressed the BLW method. Exclusion criteria were: references in other languages, opinion articles and literature reviews, editorials and publications that did not elaborate on the intended subject. Of the 97 references identified, 13 were included in the descriptive synthesis. Data synthesis: The BLW group of babies, when compared to the traditional eating group, were less prone to being overweight, less demanding of food, and ate the same foods as the family. The number of choking episodes did not differ between groups. Mothers who opted for the implementation of BLW had higher levels of schooling, held managerial positions at work, and were more likely to have breastfed until the sixth month of the child’s life. Concerns were raised about messes made during meals, wasting food, and choking, but most of the mothers recommended adopting the method. Health professionals were hesitant to indicate this method. Conclusions: BLW was recommended by mothers who followed the method with their own children. However, concerns have been reported, which, coupled with professionals’ fears about the inability of infants to self-feed, reflect a lack of knowledge about the method.

QUEMERINA E FATORES RELACIONADOS AO RISCO CARDIOVASCULAR EM CRIANÇAS E ADOLESCENTES: UMA REVISÃO SISTEMÁTICA

ABSTRACT Objective: To review findings on chemerin and factors related to cardiovascular risk in children and adolescents. Data source: A systematic review was performed, according to the standards proposed by the PRISMA guideline, on PubMed, Science Direct, and Lilacs databases. The descriptor “chemerin” was used in combination with “children” and “adolescent”, no time limit applied. The research encompassed only original articles written in English, conducted with human subjects - the adult and elderly populations excluded -, as well as literature reviews, brief communications, letters, and editorials. Data synthesis: After independent analyses of the studies by two reviewers, seven articles meeting the eligibility criteria, published between 2012 and 2016, remained for the review. Cross-sectional, prospective, cohort, and case-control studies were included. The importance of chemerin adipokines on the risk factors for cardiovascular disease is demonstrated by its association with obesity and diabetes mellitus, as well as clinical, anthropometric, and biochemical parameters. However, the strength of evidence from these studies is relatively low, due to their heterogeneity, with several limitations such as small samples and consequent lack of representativeness, lack of standardization in dosage methods, cross-sectional design of most studies, and impossibility of extrapolating results. Conclusions: The deregulation of chemerin caused by increased adipose tissue may contribute to the development of cardiovascular diseases, suggesting that this adipokine may play a significant role in early identification of individuals at risk.

Waist-to-height ratio is as reliable as biochemical markers to discriminate pediatric insulin resistance

OBJECTIVE Given the importance of incorporating simple and low-cost tools into the pediatric clinical setting to provide screening for insulin resistance, the present study sought to investigate whether waist-to-height ratio is comparable to biochemical markers for the discrimination of insulin resistance in children and adolescents. METHODS This cross-sectional study involved students from nine public schools. In total, 296 children and adolescents of both sexes, aged 8-14 years, composed the sample. Waist-to-height ratio, triglycerides/glucose index, and triglycerides-to-HDL-C ratio were determined according to standard protocols. Insulin resistance was defined as homeostatic model assessment for insulin resistance with cut-off point ≥3.16. RESULTS Age, body mass index, frequency of overweight, waist circumference, waist-to-height ratio, insulin, glucose, homeostatic model assessment for insulin resistance, triglycerides, triglycerides/glucose index, and triglycerides-to-HDL-C were higher among insulin-resistant boys and girls. Moderate correlation of all indicators (waist-to-height ratio, triglycerides/glucose index, and triglycerides-to-HDL-C ratio) with homeostatic model assessment for insulin resistance was observed for both sexes. The areas under the receiver operational characteristic curves were similar between waist-to-height ratio and biochemical markers. CONCLUSION The indicators provided similar discriminatory power for insulin resistance. However, taking into account the cost-benefit ratio, the authors suggest that waist-to-height ratio may be a useful tool to provide screening for insulin resistance in pediatric populations.

Reply: Vertical segmental tetrapolar bioimpedance for excess body fat assessment in adolescents,

As indagacoes apresentadas pelos professores Dr. Roberto Fernandes da Costa e Dr. Edilson Serpeloni Cyrino sao pertinentes e, por isso, gostariamos de esclarecer os comentarios submetidos ao Jornal. Valorizamos, de inicio, a discussao cientifica e as colocacoes registradas pelos estimados pesquisadores cooperaram para a compreensao de nossos achados. Em resposta ao questionamento referente a admissao do aparelho Biodynamics (modelo 450; WA, EUA) como nossa tecnica de referencia, ressaltamos que a literatura corrobora essa escolha metodologica. A titulo de exemplo, Goncalves et al. constataram que tal equipamento tinha boa capacidade preditiva na deteccao do excesso de gordura corporal em individuos adolescentes. Ate afirmaram que mesmo diante da impossibilidade de cumprimento do protocolo de medicao os resultados obtidos tambem se assemelharam aos da Absortometria Radiologica de Dupla Energia (Dexa). Nao obstante, ressaltamos que em momento algum fizemos quaisquer comentarios que caracterizassem, erroneamente, o aparelho usado em nossa pesquisa como um padrao-ouro, pois reconhecemos que ele apresenta limitacoes e nao deve ser julgado como um substituto homologo para os metodos indiretos: a Dexa, a pesagem hidrostatica, a pletismografia etc. Tambem nao mencionamos que estavamos validando a bioimpedância tetrapolar segmentada vertical Tanita (modelo BC-558; Amsterda, Paises Baixos). Propomo-nos, sim, a compara-la simplificadamente com outro aparelho, cujo uso e respaldado para a avaliacao dos publicos adulto e pediatrico, alem de mais acessivel na pratica clinica. Aproveitamos esta circunstância para assinalar uma retificacao: o teor de massa livre de gordura dos participantes submetidos aos exames foi estimado por meio das equacoes referidas por Chumlea et al. no estudo ‘‘Specific resistivity used to estimate fat-free mass from segmental body measures of bloelectric impedance’’. No entanto, nos equivocamos na secao de referencias e citamos outra

Artigo originalEvaluation of the predictive capacity of vertical segmental tetrapolar bioimpedance for excess weight detection in adolescentsAvaliação da capacidade preditiva da bioimpedância tetrapolar segmentada vertical na detecção do excesso de peso em adolescentes

Objective To analyze the predictive capacity of the vertical segmental tetrapolar bioimpedance apparatus in the detection of excess weight in adolescents, using tetrapolar bioelectrical impedance as a reference.