Gloria Valeria da Veiga

School randomised trial on prevention of excessive weight gain by discouraging students from drinking sodas

OBJECTIVE To determine whether an educational programme aimed at discouraging students from drinking sugar-sweetened beverages could prevent excessive weight gain. DESIGN Forty-seven classes in twenty-two schools were randomised as intervention or control. SUBJECTS Participants were 1140, 9-12-year-old fourth graders (435 in the intervention group and 608 in the control group). Sugar-sweetened beverages and juice intake were measured through one 24 h recall at baseline and another at the end of the trial. The main outcome was the change in BMI (BMI = weight (kg)/height (m2)), measured at the beginning and at the end of the school year. Intention-to-treat analysis was performed taking into account the cluster (classes) effect. RESULTS A statistically significant decrease in the daily consumption of carbonated drinks in the intervention compared to control (mean difference = -56 ml; 95 % CI -119, -7 ml) was followed by a non-significant overall reduction in BMI, P = 0.33. However, among those students overweight at baseline, the intervention group showed greater BMI reduction (-0.4 kg/m2 compared with -0.2 kg/m2 in the control group (P = 0.11)), and this difference was statistically significant among girls (P = 0.009). Fruit juice consumption was slightly increased in the intervention group (P = 0.08), but not among girls. CONCLUSION Decreasing sugar-sweetened beverages intake significantly reduced BMI among overweight children, and mainly among girls. Efforts to reduce energy intake through liquids need to emphasise overall sweetened beverages and addition of sugar on juices.

Trends in Overweight Among Adolescents Living in the Poorest and Richest Regions of Brazil

OBJECTIVES We assessed changes in body mass index (BMI) among Brazilian adolescents. METHODS In 1975, 1989, and 1997, we conducted household surveys of the weights and statures of a probabilistic sample of about 50,000 Brazilian adolescents aged 10 to 19 years. Weighted prevalences were calculated and an analysis was performed with the sample design taken into account. RESULTS Adolescents of rich (southeast) and poor (northeast) regions showed a substantial increase in BMI. In the southeast, the prevalence of overweight, defined by international age- and gender-specific BMI cutoffs, for both genders reached 17% in 1997, whereas in the northeast, the prevalence tripled, reaching 5% among boys and 12% among girls. Older girls living in urban areas in the southeast showed a decrease in prevalence from 16% to 13% in the latter 2 surveys. For all boys and for young girls, the BMI values for the 85th percentile in 1997 were much higher than the 95th percentile values in 1975. CONCLUSIONS BMI increased dramatically in Brazilian adolescents, mainly among boys; among older girls from the richest region, the prevalence of overweight is decreasing.

Associação entre fatores socioeconômicos e insegurança alimentar: estudo de base populacional na Região Metropolitana do Rio de Janeiro, Brasil

OBJECTIVE: This work aims to evaluate the prevalence of food insecurity among families from Duque de Caxias, in the Rio de Janeiro Metropolitan Area and the association between socioeconomic indicators and food insecurity. METHODS: A population-based cross-sectional study investigated a probabilistic sample composed of 1,085 households from the district of Campos Eliseos, in the municipality of Duque de Caxias, Rio de Janeiro, Brazil. Information on socioeconomic condition was obtained using a structured questionnaire. Food insecurity was assessed by the Brazilian Food Insecurity Scale, which allows classifying the families into food security, or mild, moderate or severe food insecurity. The analyses took into account the sampling design effect. The food insecurity prevalence was estimated and its association with socioeconomic variables was assessed using the chi-square test (p<0.05). RESULTS: Food insecurity prevalence was 53.8%. The following variables were inversely and significantly associated with food insecurity: family monthly per capita income, head of family educational level, socioeconomic level (classified according to the Brazilian Association of Market Research criteria), number of family members, and having a water filter in the household. CONCLUSION: Family income was the variable that discriminated both food security and insecurity.

Meal consumption patterns and anthropometric measurements in adolescents from a low socioeconomic neighborhood in the metropolitan area of Rio de Janeiro, Brazil.

We investigated the association between meal consumption and anthropometric measurements in a probabilistic sample of 528 12-18-year-old adolescents assessed in a population-based cross-sectional study developed in the Rio de Janeiro Metropolitan Area, Brazil. A score ranging from zero to nine according to the frequency of meal consumption (breakfast, lunch and dinner) assessed meal patterns which were defined as satisfactory or unsatisfactory. Nutritional status was defined by the sex- and age-specific body mass index cut-offs. Underweight was observed in 5.7% of the adolescents (8.6% boys, 2.5% girls) and overweight in 20.9%. The omission of breakfast was observed in 4.5% of the boys and 12.4% of the girls. Unsatisfactory meal consumption pattern was more frequent among girls (38.7% vs. 29.2%), and among teenagers over 15 years of age (40.0% vs. 25.4%). Boys with unsatisfactory patterns of meal consumption presented higher means of BMI and of waist and hip circumferences than the ones with satisfactory patterns. The higher values of anthropometric measurement observed among adolescents with an unsatisfactory meal pattern indicate that they may be at risk for overweight or obesity.

Eating disorder risk behavior in Brazilian adolescents from low socio-economic level

We investigated the prevalence, by gender, age and nutritional status, of eating disorder (ED) risk behavior, using a simplified self-report questionnaire in a probabilistic sample of 561, 12-19-year-old students from public schools in the metropolitan area of Rio de Janeiro, Brazil. Sex- and age-specific body mass index cut-offs were used to assess nutritional status. The prevalence of overweight/obesity was 16.2% and of being underweight was 2.5%; 37.3% of the adolescents studied presented symptoms of binge eating (BE) and 24.7% would go on a strict diet at least once a week, both cases more frequent in females (40.8% vs. 25.3%; 31.2% vs. 10.5%, respectively). Older students were shown to be more susceptible to binge eating and younger students more susceptible to strict dieting. Overweight adolescents were shown to be more susceptible to strict dieting than normal-weight adolescents, regardless of sex and age. The prevalence of binge eating and strict dieting was high in low-income Brazilian adolescents and females are at greater risk of developing eating disorders than males. The greater prevalence of strict dieting in younger students shows they are at nutritional risk.We investigated the prevalence, by gender, age and nutritional status, of eating disorder (ED) risk behavior, using a simplified self-report questionnaire in a probabilistic sample of 561, 12-19-year-old students from public schools in the metropolitan area of Rio de Janeiro, Brazil. Sex- and age-specific body mass index cut-offs were used to assess nutritional status. The prevalence of overweight/obesity was 16.2% and of being underweight was 2.5%; 37.3% of the adolescents studied presented symptoms of binge eating (BE) and 24.7% would go on a strict diet at least once a week, both cases more frequent in females (40.8% vs. 25.3%; 31.2% vs. 10.5%, respectively). Older students were shown to be more susceptible to binge eating and younger students more susceptible to strict dieting. Overweight adolescents were shown to be more susceptible to strict dieting than normal-weight adolescents, regardless of sex and age. The prevalence of binge eating and strict dieting was high in low-income Brazilian adolescents and females are at greater risk of developing eating disorders than males. The greater prevalence of strict dieting in younger students shows they are at nutritional risk.

A comparison of distribution curves of body mass index from Brazil and the United States for assessing overweight and obesity in Brazilian adolescents

OBJECTIVE To assess the validity of recommendations for use of the 85th and 95th percentiles of body mass index (BMI) of the population in the United States of America as a screening tool to assess overweight/obesity in adolescents. METHODS We investigated the relation between BMI and percent body fat in 1,540 adolescents (717 males and 823 females) aged 10 to 17.9 years old from a private high school in Niterói, a city in the state of Rio de Janeiro, Brazil. We used bioelectric impedance, with the appropriate equations for adolescents, to estimate percent body fat, which served as the gold standard (30% for girls and 25% for boys) to calculate the sensitivity and specificity of the 85th and 95th percentiles of the United States and Brazilian distribution curves of BMI. RESULTS Sensitivity and specificity were high (above 80%) for the Niterói boys, except for the 85th percentile of the Brazilian curve (specificity = 61.8%) and for the 95th percentile of the United States curve (sensitivity = 55.4%). For the Niterói girls, the 85th- and 95th-percentile BMI cutoff points, from both the United States and Brazilian curves, showed low sensitivity, and that sensitivity decreased with age. Specificity was high for the girls, and much higher than it was for the boys. CONCLUSIONS These data suggest that using BMI to screen for overweight/obesity in adolescents can generate a high percentage of false-positives for Niterói boys and an even higher percentage of false-negatives for Niterói girls. A more universal approach to using anthropometric measures to screen for overweight/obesity should be developed, preferably linked to stages of maturation.

Avaliação de programa de prevenção de obesidade em adolescentes de escolas públicas

OBJETIVO: Evaluar los efectos de un programa de prevencion de obesidad sobre practicas alimentarias de adolescentes de escuelas publicas. METODOS: Intervencion con 331 estudiantes de 11 a 17 anos de 5a y 6a anos de dos escuelas publicas estatales de Niteroi, Sureste de Brasil, en 2005. Las escuelas fueron clasificadas en escuela de intervencion (EI) y escuela de control (EC) para comparacion. Practicas alimentarias fueron abordadas en cuestionarios auto-respondidos antes y despues del periodo de intervencion: consumo de fast food, consumo de gaseosas, sustitucion de comidas por meriendas, consumo de frutas, verduras y legumbres y tipo de alimentacion consumida en los intervalos de las clases. Pruebas chi-cuadrado y McNemar se aplicaron para comparar proporciones, considerando valor de p<0,05. RESULTADOS: En la linea base participaron 185 estudiantes de la EI (82,2% de los elegibles) y 146 estudiantes de la EC (70,5% de los elegibles). En la fase de post-intervencion hubo perdida de 10,3% de los adolescentes de la EI y 27,4% de la EC. No se observo cambios significativos en las practicas alimentarias en la EC. En la EI aumento la proporcion de estudiantes que informaron no consumir meriendas vendidas por ambulantes (de 36,7% para 50,6%; p=0,02) y de los jovenes que informaron no sustituir almuerzo (de 44,5% para 65,2%; p<0,01) y cena (de 38,4% para 54,3%; p<0,01) por meriendas. El principal cambio favorable fue la reduccion en la frecuencia de consumo de meriendas fast food en la EI comparado con la EC (72,7% vs. 54,4%; p=0,001). CONCLUSIONES: Cambios favorables en las practicas alimentarias de los adolescentes fueron encontrados y estimulan la implantacion de programas de esta naturaleza, sin embargo, intervenciones de mayor duracion precisan ser implementadas y evaluadas con relacion a su efectividad.

Anemia em crianças menores de cinco anos que freqüentam creches públicas do município do Rio de Janeiro, Brasil

OBJETIVOS: estimar a prevalencia de anemia em criancas matriculadas em creches municipais do Rio de Janeiro e identificar os subgrupos de maior risco. METODOS: foram avaliadas 865 criancas. A hemoglobina (Hb) foi dosada em fotometro portatil (HemoCue) e a anemia foi definida quando Hb <11g/dL e <9,5g/dL para maiores e menores de seis meses, respectivamente. Foram obtidas informacoes biologicas e socioeconomicas atraves de questionarios aplicados as maes. RESULTADOS: A prevalencia de anemia foi de 47,3%. As criancas anemicas apresentaram medias de z escore de peso para a idade (-0,239) e a altura para a idade (-0,548) mais baixas do que as nao-anemicas. O risco de anemia foi maior para as criancas com idade abaixo de dois anos (razao de prevalencia [RP]=1,73; intervalo de confianca [IC95%: 1,52-1,97), para as que tinham pais com menos de quatro anos de estudo (RP=1,57; IC95%:1,24-1,99) e moravam em domicilios com mais de oito moradores (RP=1,45; IC95%:,1,07-1,95). . CONCLUSOES: a prevalencia de anemia foi elevada. As criancas com mais baixo peso e estatura para a idade, menores de dois anos, que moravam em residencias com numero elevado de pessoas e que tinham pais com baixa escolaridade foram as mais vulneraveis a anemia, devendo ser alvo de politicas de controle e prevencao.

Desempenho de pontos de corte do índice de massa corporal de diferentes referências na predição de gordura corporal em adolescentes

This study evaluates the accuracy of cutoff points in the body mass index (BMI) for identifying adolescents with overweight, compared to the percentage of body fat, estimated by electric bioimpediance, in a probabilistic sample of 610 adolescents from 12 to 19 years of age (222 boys and 388 girls) enrolled in public schools in Niteroi, Rio de Janeiro, Brazil. ROC was used to evaluate the sensitivity and specificity of BMI cutoffs from one Brazilian, two North American, and one international reference. The cutoff points in the study sample were lower than the other references, with 76% to 95% sensitivity and 75% to 95% specificity. The Brazilian cutoff points were also more sensitive (53% to 100%) as compared to the other references (40% to 86%). The international parameter showed better sensitivity for older adolescents, and the Northern American references for younger adolescents. BMI was a good proxy for adiposity, but cutoff points from other population references should be used with caution, since they can lead to classification errors in adolescents with overweight.

Inadequação do consumo de nutrientes entre adolescentes brasileiros

OBJETIVO: Estimar o consumo de energia e nutrientes e a prevalencia de inadequacao da ingestao de micronutrientes entre adolescentes brasileiros. METODOS: Amostra probabilistica composta por 6.797 adolescentes (49,7% do sexo feminino) entre dez e 18 anos de idade foi avaliada no Inquerito Nacional de Alimentacao, 2008-2009. Os fatores de expansao, a complexidade do desenho da amostra e a correcao da variabilidade intrapessoal do consumo foram considerados. A prevalencia de inadequacao de consumo de micronutrientes foi estimada pela proporcao de adolescentes com ingestao abaixo da necessidade media estimada. Para o sodio, estimou-se a prevalencia de consumo acima do valor de ingestao maxima toleravel. RESULTADOS: A media de consumo de energia variou de 1.869 kcal, observada nas adolescentes de 10 a 13 anos, a 2.198 kcal, estimada para os adolescentes de 14 a 18 anos. Os carboidratos forneceram 57% da energia total, os lipidios, 27% e as proteinas, 16%. As maiores prevalencias de inadequacao foram observadas para calcio (> 95%), fosforo (entre 54% e 69%) e vitaminas A (entre 66% e 85%), E (100%) e C (entre 27% e 49%). Mais de 70% dos adolescentes apresentaram consumo de sodio superior a ingestao maxima toleravel. CONCLUSOES: As medias de consumo energetico e a distribuicao de macronutrientes eram adequadas, mas foram observadas elevadas prevalencias de inadequacao no consumo de vitaminas e minerais, destacando-se consumo de sodio muito acima do recomendado, consumo de calcio reduzido e nas adolescentes de 14 a 18 anos foi observada importante inadequacao na ingestao de ferro.