Ilaine Schuch

The multidimensional evaluation and treatment of anxiety in children and adolescents: rationale, design, methods and preliminary findings

OBJECTIVE This study aims to describe the design, methods and sample characteristics of the Multidimensional Evaluation and Treatment of Anxiety in Children and Adolescents - the PROTAIA Project. METHOD Students between 10 and 17 years old from all six schools belonging to the catchment area of the Primary Care Unit of Hospital de Clínicas de Porto Alegre were included in the project. It comprises five phases: (1) a community screening phase; (2) a psychiatric diagnostic phase; (3) a multidimensional assessment phase evaluating environmental, neuropsychological, nutritional, and biological factors; (4) a treatment phase, and (5) a translational phase. RESULTS A total of 2,457 subjects from the community were screened for anxiety disorders. From those who attended the diagnostic interview, we identified 138 individuals with at least one anxiety disorder (apart from specific phobia) and 102 individuals without any anxiety disorder. Among the anxiety cases, generalized anxiety disorder (n = 95; 68.8%), social anxiety disorder (n = 57; 41.3%) and separation anxiety disorder (n = 49; 35.5%) were the most frequent disorders. CONCLUSION The PROTAIA Project is a promising research project that can contribute to the knowledge of the relationship between anxiety disorders and anxiety-related phenotypes with several genetic and environmental risk factors.

Efeito de intervenções sobre o índice de massa corporal em escolares

OBJECTIVE To evaluate the effect of intervention programs using nutritional education, physical activity or both on the reduction of body mass index in school-age students. METHODS The systematic review with meta-analysis included randomized controlled studies available from the following electronic databases for the years 1998 to 2010: PubMed, Lilacs, Embase, Scopus, Web of Science and Cochrane Library. The descriptors were: randomized controlled trial, overweight, obesity, body mass index, child, adolescent, physical activity, nutrition education and Schools. A weighted average was based on the standardized means difference and used a 95% confidence interval. The inconsistency test was utilized to evaluate the heterogeneity of studies. RESULTS Initially, 995 studies were identified, of which 23 were included, and 3 meta-analyses were performed. Isolated physical activity interventions did not present a significant reduction in BMI, with a standardized mean difference of -0.02 (95%CI: -0.08; 0.04). A similar result (n= 3,524) was observed in the isolated interventions of nutritional education, with a standardized mean difference of -0.03 (95%CI: -0.10; 0.04).When the interventions with physical activity and nutritional education were combined, the result of the meta-analysis (n= 9,997) presented a statistically significant effect in the reduction of body mass index in school-age students, with a standardized mean difference: -0.37 (95%CI: -0.63; -0.12). CONCLUSIONS The interventions that combined physical activity and nutritional education had more positive effects in the reduction of body mass index among school-age students than when they were applied individually.OBJETIVO: Avaliar o efeito dos programas de intervencoes com a atividade fisica e/ou a educacao nutricional na reducao do indice de massa corporal em escolares. METODOS: Revisao sistematica com metanalise de estudos controlados randomizados disponiveis nas seguintes bases de dados eletronicas entre o ano de 1998 a 2010: PubMed, Lilacs, Embase, Scopus, Web of Science e Cochrane Library, com os descritores: estudo controlado randomizado, sobrepeso, obesidade, indice de massa corporal, crianca, adolescente, atividade fisica, educacao nutricional e escolas. Medida de sumario baseada na diferenca das medias padronizadas foi usada com intervalo de 95% de confianca. O teste de inconsistencia foi utilizado para avaliar a heterogeneidade dos estudos. RESULTADOS: Foram identificados 995 estudos, dos quais 23 foram incluidos e realizadas tres metanalises. Intervencoes isoladas com atividade fisica nao apresentaram efeito significativo na reducao do indice de massa corporal, com diferenca das medias padronizadas: -0,02 (IC95% -0,08;0,04). Resultado semelhante (n = 3.524) foi observado nas intervencoes isoladas com educacao nutricional, com diferenca das medias padronizadas: -0,03 (IC95% -0,10;0,04). Quando combinadas as intervencoes com atividade fisica e educacao nutricional, o resultado da metanalise (n = 9.997) apresentou efeito estatisticamente significativo na reducao do indice de massa corporal em escolares, com diferenca das medias padronizadas: - 0,37 (IC95% -0,63;-0,12). CONCLUSOES: As intervencoes combinadas de atividade fisica e educacao nutricional tiveram mais efeitos positivos na reducao do indice de massa corporal em escolares do que quando aplicadas isoladamente.

Effect of interventions on the body mass index of school-age students

OBJECTIVE To evaluate the effect of intervention programs using nutritional education, physical activity or both on the reduction of body mass index in school-age students. METHODS The systematic review with meta-analysis included randomized controlled studies available from the following electronic databases for the years 1998 to 2010: PubMed, Lilacs, Embase, Scopus, Web of Science and Cochrane Library. The descriptors were: randomized controlled trial, overweight, obesity, body mass index, child, adolescent, physical activity, nutrition education and Schools. A weighted average was based on the standardized means difference and used a 95% confidence interval. The inconsistency test was utilized to evaluate the heterogeneity of studies. RESULTS Initially, 995 studies were identified, of which 23 were included, and 3 meta-analyses were performed. Isolated physical activity interventions did not present a significant reduction in BMI, with a standardized mean difference of -0.02 (95%CI: -0.08; 0.04). A similar result (n= 3,524) was observed in the isolated interventions of nutritional education, with a standardized mean difference of -0.03 (95%CI: -0.10; 0.04).When the interventions with physical activity and nutritional education were combined, the result of the meta-analysis (n= 9,997) presented a statistically significant effect in the reduction of body mass index in school-age students, with a standardized mean difference: -0.37 (95%CI: -0.63; -0.12). CONCLUSIONS The interventions that combined physical activity and nutritional education had more positive effects in the reduction of body mass index among school-age students than when they were applied individually.OBJETIVO: Avaliar o efeito dos programas de intervencoes com a atividade fisica e/ou a educacao nutricional na reducao do indice de massa corporal em escolares. METODOS: Revisao sistematica com metanalise de estudos controlados randomizados disponiveis nas seguintes bases de dados eletronicas entre o ano de 1998 a 2010: PubMed, Lilacs, Embase, Scopus, Web of Science e Cochrane Library, com os descritores: estudo controlado randomizado, sobrepeso, obesidade, indice de massa corporal, crianca, adolescente, atividade fisica, educacao nutricional e escolas. Medida de sumario baseada na diferenca das medias padronizadas foi usada com intervalo de 95% de confianca. O teste de inconsistencia foi utilizado para avaliar a heterogeneidade dos estudos. RESULTADOS: Foram identificados 995 estudos, dos quais 23 foram incluidos e realizadas tres metanalises. Intervencoes isoladas com atividade fisica nao apresentaram efeito significativo na reducao do indice de massa corporal, com diferenca das medias padronizadas: -0,02 (IC95% -0,08;0,04). Resultado semelhante (n = 3.524) foi observado nas intervencoes isoladas com educacao nutricional, com diferenca das medias padronizadas: -0,03 (IC95% -0,10;0,04). Quando combinadas as intervencoes com atividade fisica e educacao nutricional, o resultado da metanalise (n = 9.997) apresentou efeito estatisticamente significativo na reducao do indice de massa corporal em escolares, com diferenca das medias padronizadas: - 0,37 (IC95% -0,63;-0,12). CONCLUSOES: As intervencoes combinadas de atividade fisica e educacao nutricional tiveram mais efeitos positivos na reducao do indice de massa corporal em escolares do que quando aplicadas isoladamente.

Effect of intervention programs in schools to reduce screen time: a meta-analysis

OBJECTIVE to evaluate the effects of intervention program strategies on the time spent on activities such as watching television, playing videogames, and using the computer among schoolchildren. SOURCES a search for randomized controlled trials available in the literature was performed in the following electronic databases: PubMed, Lilacs, Embase, Scopus, Web of Science, and Cochrane Library using the following Keywords randomized controlled trial, intervention studies, sedentary lifestyle, screen time, and school. A summary measure based on the standardized mean difference was used with a 95% confidence interval. DATA SYNTHESIS a total of 1,552 studies were identified, of which 16 were included in the meta-analysis. The interventions in the randomized controlled trials (n=8,785) showed a significant effect in reducing screen time, with a standardized mean difference (random effect) of: -0.25 (-0.37, -0.13), p<0.01. CONCLUSION interventions have demonstrated the positive effects of the decrease of screen time among schoolchildren.

Estado nutricional dos indígenas Kaingáng matriculados em escolas indígenas do Estado do Rio Grande do Sul, Brasil

The studys objective was to characterize the nutritional status of 3,254 Kaingang Indians in indigenous schools in Rio Grande do Sul State, Brazil. This was a school-based study. Weight (W), height (H), and waist circumference (WC) were measured according to World Health Organization guidelines (1995). Childrens nutritional status classification included H/A, W/A, and W/H according to the National Center for Health Statistics (WHO, 1995) and H/A, W/A, and body mass index/age (BMI/A) according to WHO (2006). Adolescents were classified for BMI/A (WHO, 1995 and 2006) and H/A (WHO, 2006). Adults were classified for BMI (WHO, 1995) and WC (WHO, 2003). Adolescents represented 56% of the sample, children 42.5%, adults 1.4%, and elderly 0.1%. Prevalence rates for stunting were 15.1% (WHO, 1983) and 15.5% (WHO, 2006) in children and 19.9% in adolescents. Prevalence rates for overweight were 11% (WHO, 1983) and 5.7% (WHO, 2006) in children, 6.7% in adolescents, and 79.2% in adults. 45.3% of adults were at increased risk of metabolic diseases. A nutritional transition was observed in the group, characterized by significant prevalence of stunting in children and adolescents and prominent overweight in all age groups.

Ultra-processed food consumption in children from a Basic Health Unit

OBJECTIVES To evaluate the contribution of ultra-processed food (UPF) on the dietary consumption of children treated at a Basic Health Unit and the associated factors. METHODOLOGY Cross-sectional study carried out with a convenience sample of 204 children, aged 2-10 years old, in Southern Brazil. Childrens food intake was assessed using a 24-h recall questionnaire. Food items were classified as minimally processed, processed for culinary use, and ultra-processed. A semi-structured questionnaire was applied to collect socio-demographic and anthropometric variables. Overweight in children was classified using a Z score >2 for children younger than 5 and Z score >+1 for those aged between 5 and 10 years, using the body mass index for age. RESULTS Overweight frequency was 34% (95% CI: 28-41%). Mean energy consumption was 1672.3 kcal/day, with 47% (95% CI: 45-49%) coming from ultra-processed food. In the multiple linear regression model, maternal education (r=0.23; p=0.001) and child age (r=0.40; p<0.001) were factors associated with a greater percentage of UPF in the diet (r=0.42; p<0.001). Additionally, a statistically significant trend for higher UPF consumption was observed when data were stratified by child age and maternal educational level (p<0.001). CONCLUSIONS The contribution of UPF is significant in childrens diets and age appears to be an important factor for the consumption of such products.

Correlation between n-3 polyunsaturated fatty acids consumption and BDNF peripheral levels in adolescents

BackgroundAlthough several studies have reported an association between mental disorders and serum levels of brain-derived neurotrophic factor (BDNF), this association is still poorly understood. The study of factors associated with both BDNF levels and mental disorders, such as n-3 polyunsaturated fatty acids (n-3 PUFAs), may help to elucidate the mechanisms mediating the relationship between the two variables. Therefore, the present study aimed to evaluate whether the intake n-3 PUFAs correlates with serum levels of BDNF.FindingsThis study involved 137 adolescents drawn from a community sample, including a group with high levels of anxiety, assessed using the Screen for Children and Anxiety Related Emotional Disorders. Blood samples were collected and serum BDNF levels were measured. n-3 PUFAs were estimated using a food frequency questionnaire for adolescents. Correlations were performed to assess the association between n-3 PUFAs intake and BDNF levels. Effects of potential confounders (total fat consumption, age, gender and anxiety) were examined using linear regression models. There was a direct correlation between n-3 PUFAs consumption and serum BDNF levels, which remained significant even after accounting for potential confounders.ConclusionsWe were able to detect a correlation between n-3 PUFAs intake and peripheral BDNF levels. Our study was limited by its small sample size, and our external validity may be restricted by the oversampling of anxious adolescents. Our findings may help determine the nature of the association between mental disorders and serum levels of BDNF. However, more studies are needed to elucidate the possible mechanisms by which n-3 PUFAs intake affects BDNF levels, and how this may lead to an increased vulnerability to psychiatric disorders.

Excess weight in preschoolers: prevalence and associated factors

OBJECTIVE To study the prevalence and factors associated with excess weight in children enrolled in public schools in the states of Rio Grande do Sul (RS) and Santa Catarina (SC). METHODS This was a cross-sectional study, carried out with children aged 4 to 6 years. The studied outcome was excess weight, defined by z-score > two standard deviations for body mass index (BMI)/age, compared with the World Health Organization (WHO) reference population of 2006/2007. Anthropometric measurements of body mass and height were measured in duplicate using standard techniques, in accordance with the WHO. Data were double entered using EPI-INFO software, release 6.04. Absolute and relative frequencies were calculated, as well as mean values and standard deviations. Associations between excess weight and other variables were assessed by using Poisson model with robust variance. STATA software release 12.0 was used (p < 0.05). RESULTS A total of 4,914 children were evaluated (2,578 in RS and 2,336 in SC). In RS, the incidence of excess weight was 14.4% (95% CI = 13.1% to 15.8%) and in SC, 7.5% (95% CI = 6.5% to 8.7%). The variables associated with excess weight were number of household members, maternal education, marital status, number of children, mothers age at birth of first child, gestational age, and birth weight. CONCLUSION Children enrolled in public preschools in RS had a two-fold higher excess weight prevalence than that identified in SC, demonstrating a significant difference in the magnitude of childhood obesity in two Brazilian states located in the same region.

Excess weight in preschoolers: prevalence and associated factors (Excesso de peso em crianças de pré-escolas: prevalência e fatores associados)

OBJECTIVE To study the prevalence and factors associated with excess weight in children enrolled in public schools in the states of Rio Grande do Sul (RS) and Santa Catarina (SC). METHODS This was a cross-sectional study, carried out with children aged 4 to 6 years. The studied outcome was excess weight, defined by z-score > two standard deviations for body mass index (BMI)/age, compared with the World Health Organization (WHO) reference population of 2006/2007. Anthropometric measurements of body mass and height were measured in duplicate using standard techniques, in accordance with the WHO. Data were double entered using EPI-INFO software, release 6.04. Absolute and relative frequencies were calculated, as well as mean values and standard deviations. Associations between excess weight and other variables were assessed by using Poisson model with robust variance. STATA software release 12.0 was used (p < 0.05). RESULTS A total of 4,914 children were evaluated (2,578 in RS and 2,336 in SC). In RS, the incidence of excess weight was 14.4% (95% CI = 13.1% to 15.8%) and in SC, 7.5% (95% CI = 6.5% to 8.7%). The variables associated with excess weight were number of household members, maternal education, marital status, number of children, mothers age at birth of first child, gestational age, and birth weight. CONCLUSION Children enrolled in public preschools in RS had a two-fold higher excess weight prevalence than that identified in SC, demonstrating a significant difference in the magnitude of childhood obesity in two Brazilian states located in the same region.

Bioelectrical impedance values among indigenous children and adolescents in Rio Grande do Sul, Brazil

OBJECTIVE To describe the nutritional status of indigenous children and adolescents in Rio Grande do Sul, Brazil, through bioelectrical values, and to compare the nutritional classifications of the anthropometric method to those of the body composition method. METHODS A cross-sectional survey was conducted of 3 204 subjects at 35 schools in the 12 Kaingang indigenous lands of Rio Grande do Sul, Brazil. Following World Health Organization recommendations, the weight and height (H) of each subject was measured twice and the body mass index/age (BMI/A) was classified. Body composition was assessed by Bioelectrical Impedance Vector Analysis (BIVA). Resistance (R) and reactance (Xc) were estimated using a bioelectrical impedance analyzer. Divergences between these two methods were performed on RXc graph. RESULTS Of the sample, 56.8% were adolescents and 50.6% were males. The mean values of phase angle were higher in adolescents, in males, and in individuals overweight by BMI/A. Mean values of R, Xc, R/H, and Xc/H were higher among children and among those with BMI/A < +2 z scores. Divergences in overweight classification were: male children, 94.6%; male adolescents, 77.1%; female children, 85.4%; and female adolescents, 94.8%. CONCLUSIONS The mean values of bioelectrical measures observed among the Kaingang children and adolescent were similar to those found for different populations in other studies. For both gender and age groups, differences were observed between nutritional classifications by BMI/age and by BIVA. These results reinforce the importance of employing multiple techniques, such as anthropometry and BIVA, when conducting nutritional assessments of a population.