Felipe Vogt Cureau

Clustering of risk factors for noncommunicable diseases in Brazilian adolescents: prevalence and correlates.

BACKGROUND Few studies have investigated the prevalence and correlates of risk factors for noncommunicable diseases among Brazilian adolescents. We evaluated the clustering of risk factors and their associations with sociodemographic variables. METHODS We used a cross-sectional study carried out in 2011 comprising 1132 students aged 14-19 years from Santa Maria, Brazil. The cluster index was created as the sum of the risk factors. For the correlates analysis, a multinomial logistic regression was used. Furthermore, the observed/expected ratio was calculated. RESULTS Prevalence of individual risk factors studied was as follows: 85.8% unhealthy diets, 53.5% physical inactivity, 31.3% elevated blood pressure, 23.9% overweight, 22.3% excessive drinking alcohol, and 8.6% smoking. Only 2.8% of the adolescents did not present any risk factor, while 21.7%, 40.9%, 23.1%, and 11.5% presented 1, 2, 3, and 4 or more risk factors, respectively. The most prevalent combination was between unhealthy diets and physical inactivity (observed/expected ratio =1.32; 95% CI: 1.16-1.49). Clustering of risk factors was directly associated with age and inversely associated with socioeconomic status. CONCLUSIONS Clustering of risk factors for noncommunicable diseases is high in Brazilian adolescents. Preventive strategies are more likely to be successful if focusing on multiple risk factors, instead of a single one.

ERICA: leisure-time physical inactivity in Brazilian adolescents

ABSTRACT OBJECTIVE To evaluate the prevalence of leisure-time physical inactivity in Brazilian adolescents and their association with geographical and sociodemographic variables. METHODS The sample was composed by 74,589 adolescents participating in the Study of Cardiovascular Risks in Adolescents (ERICA). This cross-sectional study of school basis with national scope involved adolescents aged from 12 to 17 years in Brazilian cities with more than 100 thousand inhabitants. The prevalence of leisure-time physical inactivity was categorized according to the volume of weekly practice (< 300; 0 min). The prevalences were estimated for the total sample and by sex. Poisson regression models were used to assess associated factors. RESULTS The prevalence of leisure-time physical inactivity was 54.3% (95%CI 53.4-55.2), and higher for the female sex (70.7%, 95%CI 69.5-71.9) compared to the male (38.0%, 95%CI 36.7-39.4). More than a quarter of adolescents (26.5%, 95%CI 25.8-27.3) reported not practicing physical activity in the leisure time, a condition more prevalent for girls (39.8%, 95%CI 38.8-40.9) than boys (13.4%, 95%CI 12.4-14.4). For girls, the variables that were associated with physical inactivity were: reside in the Northeast (RP = 1.13, 95%CI 1.08-1.19), Southeast (RP = 1.16, 95%CI 1.11-1.22) and South (RP = 1.12, 95%CI 1.06-1.18); have 16-17 years (RP = 1.06, 95%CI 1.12-1.15); and belong to the lower economic class (RP = 1.33, 95%CI 1.20-1.48). The same factors, except reside in the Southeast and South, were also associated with not practicing physical activity in the leisure time for the same group. In males, as well as the region, being older (p < 0.001) and declaring to be indigenous (RP = 0.37, 95%CI 0.19-0.73) were also associated with not practicing physical activities in the leisure time. CONCLUSIONS The prevalence of leisure-time physical inactivity in Brazilian adolescents is high. It presents regional variations and is associated with age and low socioeconomic status. Special attention should be given to girls and to those who do not engage in any physical activity during the leisure time, so that they can adopt a more active lifestyle.

Does body mass index modify the association between physical activity and screen time with cardiometabolic risk factors in adolescents? Findings from a country-wide survey

Background:Moderate and vigorous physical activity (MVPA) and screen time (ST) have been associated with cardiometabolic health in youth. However, previous studies are conflicting whether these associations are independent of each other and it is unknown if they are modified by adiposity. We aimed to examine the independent and joint associations between MVPA and ST with cardiometabolic risk across body mass index (BMI) categories.Methods:A total of 36 956 Brazilian adolescents (12–17 years) from the Study of Cardiovascular Risks in Adolescents were included. Information on time spent in MVPA and ST were assessed by self-reports. Blood pressure, Homeostasis Model Assessment of Insulin Resistance, triglycerides, high-density lipoprotein-cholesterol and waist circumference were used to calculate a cardiometabolic risk score (sex-age-specific top-risk quintile for each biomarker). Ordered logistic regression was used to examine the associations.Results:In final adjusted models, both higher MVPA (proportional odds ratio (POR)=0.80; 95% confidence interval (CI): 0.67–0.95) and ST (POR=1.23; 95% CI: 1.10–1.37) were independently associated with cardiometabolic risk. After stratification by normal weight vs overweight/obese, the inverse independent association for MVPA remained unchanged, whereas ST was positively associated with cardiometabolic risk only in overweight/obese adolescents (POR=1.62; 95% CI: 1.18–2.22). Participants who met the recommendations for both MVPA and ST had lower odds for cardiometabolic risk, especially if they were overweight/obese (POR=0.46; 95% CI: 0.31–0.68).Conclusions:MVPA and ST are independently associated with cardiometabolic risk; the association with ST, however, appears modified by BMI. Normal-weight adolescents should be encouraged to increase MVPA, whereas a combination of increasing MVPA and decreasing ST is recommended in those who are overweight or obese.

Prevalence and correlates of screen time among Brazilian adolescents: findings from a country-wide survey.

The purpose of this study was to evaluate the distribution, prevalence, and correlates of excessive screen time (>2 h/day) among Brazilian adolescents. The Study of Cardiovascular Risks in Adolescents (ERICA) is a national, school-based, cross-sectional multicenter study. Information about time spent in front of screens was assessed by questionnaire. Poisson regression models were used to examine the associations between following correlates (region, sex, age, skin color, income, Internet access, and number of TVs at home) and excessive screen time. A total of 66 706 Brazilian adolescents (aged 12-17 years) were included. The overall mean time in front of screens was 3.25 h/day (95% confidence interval (95%CI): 3.20-3.31) and the prevalence of excessive screen time was 57.3% (95%CI: 55.9-58.6). Moreover, excessive screen time also differs across Brazilian regions, being higher in Southeast and South, respectively. In adjusted models stratified by region, the socioeconomic status was associated with excessive screen time in North, Northeast, and Midwest. In all regions, having a computer with Internet access was associated with higher prevalence of excessive screen time. In conclusion, prevalence of excessive screen time in Brazilian adolescents is high. It presents regional variations and facility for Internet access.

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.

Common mental disorders in adolescents with and without type 1 diabetes: Reported occurrence from a countrywide survey

AIMS The aim of this study was to evaluate the frequency of common mental disorders symptoms in adolescents with type 1 diabetes in comparison to a population-based sample of adolescents in Brazil. METHODS We compared characteristics of 116 youth with type 1 diabetes and 73,508 youth without type 1 diabetes from the same population-based sample of adolescents aged 12-17years, taken from the Brazilian Study of Cardiovascular Risk in Adolescents (ERICA). We evaluated the 12-item General Health Questionnaire (GHQ) score, which is a self-administered screening survey for detecting mental health symptoms. Scores ≥3 were used to determine common mental disorder. RESULTS Adolescents with and without type 1 diabetes were comparable with respect to age and race/ethnicity distributions. Youth with type 1 diabetes did not report higher scores on the weighted GHQ analyses in comparison to youth without type 1 diabetes (3.16, SE 0.76 vs. 2.10, SE 0.03, respectively; P = .167). No differences were found regarding the odds of having a GHQ score ≥3 (OR 1.48, 95% CI 0.72-3.08). However, analyses of mental health symptoms separately consistently showed that youth with type 1 diabetes more frequently endorsed mental health barriers in comparison to youth without type 1 diabetes. CONCLUSIONS Mental health symptoms seem to be more frequent than diagnosis of common mental disorders in adolescents with type 1 diabetes, which may also interfere in glycemic control. Our findings highlight the need for appropriate mental health assessment in diabetes care in order to prevent glycemic control deterioration.

Adiponectin levels in Brazilian adolescents: Distribution and associated factors in ERICA survey

BACKGROUND The aim of this study was to evaluate the distribution of adiponectin and associated factors with low adiponectin levels in a large sample of adolescents from different Brazilian regions. METHODS This is a national, school-based, cross-sectional multicenter study of cardiovascular risk factors in Brazilian adolescents aged 12 to 17 years. Serum adiponectin levels (μg/ml) were measured by enzyme-linked immunosorbent assay kit. Given the lack of reference values, sex-and age-specific median was adopted as the cutoff point, with the values below the median representing a higher-risk profile. Associated factors with low levels of adiponectin were investigated using Poisson regression. RESULTS The sample consisted of 4546 adolescents, the majority female (61.2%). The prevalence of overweight/obesity and abdominal obesity was 30% and 13.4%, respectively. The medians of adiponectin were 13.4 μg/ml (95%CI: 12.8-14.0) in males and 14.2 μg/ml (95%CI: 13.3-15.0) in females. Lower adiponectin levels were associated with both overweight (Prevalence Ratios (PR) = 1.17; 95%CI 1.01-1.36) and obesity (PR = 1.36; 95%CI 1.16-1.56) in males, while, in females, adiponectin levels were associated only with obesity (PR = 1.45; 95% CI 1.26-1.66). Increased waist circumference in both males and females was inversely associated with adiponectin level. CONCLUSIONS Adiponectin levels were lower among adolescents with weight excess and abdominal obesity. Male adolescents who live in rural areas and study at private schools also showed lower adiponectin concentrations.

Low Levels of Usual Physical Activity Are Associated with Higher 24 h Blood Pressure in Type 2 Diabetes Mellitus in a Cross-Sectional Study.

The aim of this study is to evaluate the association between usual physical activity and 24 h blood pressure (BP) profile in people with type 2 diabetes mellitus (DM). This is a cross-sectional study of 151 participants with type 2 DM. Usual physical activity was assessed by step counting and self-reported questionnaire. BP was measured in office and by 24 h ambulatory BP monitoring (ABPM; 24 h, daytime and nighttime). Mean participant age was 61.1 ± 8.4 years, 64% was women, and mean duration of diabetes was 14.3 ± 8.5 years. Ninety-two percent of participants had hypertension, and office BP was 138 ± 18/78 ± 10 mmHg. Inverse correlations were observed between step count and 24 h BP (systolic, r = −0.186; p = 0.022), daytime BP (systolic, r = −0.198; p = 0.015), and nighttime BP (pulse pressure, r = −0.190; p = 0.019). People were categorized into tertiles of daily step count, and the 1st tertile had higher 24 h systolic BP, daytime systolic BP, daytime mean BP, and daytime systolic BP load than those in the other tertiles, even after adjusting for age and HbA1c. Participants with type 2 DM and low levels of physical activity exhibit higher 24 h and daytime systolic ambulatory BP values as compared with those who performed more steps per day, even after adjustments for confounding factors.

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.

Prevalence of high HbA1c levels in Brazilian adolescents: The Study of Cardiovascular Risk in Adolescents

AIM To evaluate the prevalence of elevated glycated haemoglobin (HbA1c) levels in a population of adolescents participating in the Study of Cardiovascular Risk in Adolescents. METHODS This is a school-based cross-sectional study based on a complex sample of adolescents 12-17years old representative at the national and macro-regional levels and for each Brazilian state capital. Blood was collected in schools and then evaluated in a single laboratory. HbA1c levels were considered elevated if ⩾5.7% (39mmol/mol) and were analyzed according to sex, age, macro-region, type of school, skin color, and nutritional status. RESULTS Data from 37,804 adolescents were analyzed. The mean level of HbA1c was 5.4% (95%CI 5.4-5.4) (36mmol/mol [95%CI 36-36]), and 20.5% (95%CI 19.1-22.0) of adolescents presented values ⩾5.7% (⩾39mmol/mol). Among males, 23.6% (95%CI 21.8-25.6) showed elevated HbA1c levels compared to 17.5% (95%CI 15.9-19.2) observed in females. The prevalence of elevated levels of HbA1c was higher in adolescents with black skin color (27.6%; 95%CI 23.2-32.4) vs. white skin color (16.9%; 95%CI 15.4-18.5), and higher in those who studied in public schools (21.6%; 95%CI 20.0-23.4) vs. private schools (16.7%; 95%CI 14.7-19.0). Among obese adolescents, 29.7% (95%CI 25.4-34.3) had elevated levels of HbA1c, compared to 19.3% (95%CI 18.0-20.7) in normal weight students and 19.7% (95%CI 17.1-22.6) in overweight adolescents. CONCLUSIONS Obese male adolescents of lower socioeconomic status had a higher prevalence of elevated HbA1c levels. Our findings highlight the importance of focusing on this high risk group for interventions to prevent diabetes.