Isa de Pádua Cintra

Obesity and metabolic syndrome in infancy and adolescence

Nas ultimas decadas a prevalencia da obesidade vem apresentando um aumento em varios paises ao redor domundo. Este fato e preocupante, ja que o excesso de gordura corporal, principalmente a abdominal, estadiretamente relacionado com alteracoes do perfil lipidico, com o aumento da pressao arterial e ahiperinsulinemia, considerados fatores de risco para o desenvolvimento de doencas cronicas, como o diabetesmelito tipo 2 e as doencas cardiovasculares. Niveis elevados de leptina e de acido urico e a alteracao dosfatores fibrinoliticos tambem tem sido observados em individuos obesos. O conjunto destas alteracoes temsido descrito como “sindrome metabolica” ou “sindrome da resistencia a insulina”, ja que a hiperinsulinemiatem um papel importante no desenvolvimento dos outros componentes da sindrome metabolica. Entretanto,questiona-se se estas alteracoes ja estao presentes em criancas e adolescentes obesos. Este artigo descreve afisiopatologia dos componentes da sindrome metabolica e esclarece como este processo ocorre na faixa etariamais jovem.

Percepção e satisfação corporal em adolescentes e a relação com seu estado nutricional

Background: The self-perception of and the satisfaction with their body image are determinant factors for the self-acceptance of the adolescents, and may generate inadequate attitudes that impair their growth and development. Objective: To investigate the association between nutritional state in adolescents and the self-perception of the satisfaction with body image. Methods: We obtained body mass index (BMI) through anthropometric data in order to classify the nutritional state of the adolescents. We also used standardized silhouettes to evaluate their self-perception of their body image, and a self-completing questionnaire to determine their satisfaction with their body image. Results: Most of the population was eutrophic. The girls, however, did not regard themselves that way. Even Perception and satisfaction with body image in adolescents and correlations with nutrition status

Prevalência de sobrepeso e obesidade em escolares da cidade de Santos, SP

The aim of this population-based study was to estimate the prevalence of overweight and obesity in public and private schools of Santos city, Brazil. We evaluated a total of 10,822 children aged 7 to 10 years old. Determination of overweight and obesity was obtained by the 85th and 95th percentiles of BMI for age, respectively, as proposed by CDC in 2000. The overall prevalence rates of overweight and obesity were 15.7% (CI 95%= 15.0% to 16.4%) and 18.0% (17.3% to 18.7%), respectively. The prevalence of overweight was 13.7% (12.6% a 14.8%) in boys and 14.8% (13.7% a 15.9%) in girls of public schools. In private schools, the rates were 17.7% (15.7% to 19.7%) in boys and 22.2% (20.0% to 24.4%) in girls. Obesity was found in 16.9% (15.7% to 18.1%) of the boys and 14.3% (13.2% to 15.4%) of the girls of public schools. In the private schools, 29.8% (27.4% to 32.2%) of the boys and 20.3% (18.2% to 22.4%) of the girls were obese. We concluded that the prevalence of obesity in public and private schools in the city of Santos is higher than other studies conducted in Brazil and in other countries of Latin America. Private schools showed higher prevalence rates of obesity than public schools (p= 0.001).

Tratamento multidisciplinar reduz o tecido adiposo visceral, leptina, grelina e a prevalência de esteatose hepática não alcoólica (NAFLD) em adolescentes obesos

O objetivo do presente estudo foi avaliar as alteracoes promovidas, por intervencao multidisciplinar, nas concentracoes plasmaticas de grelina e leptina, adiposidade visceral e prevalencia de esteatose hepatica nao alcoolica (NAFLD), em adolescentes obesos. Foram avaliados 28 adolescentes obesos, 16 meninas (IMC 34,58 ± 3,86kg/m2) e 12 meninos (IMC 37,08 ± 3,17kg/m2), com idade entre 15 e 19 anos, quanto a concentracao de leptina, grelina, insulina, assim como a adiposidade visceral e o diagnostico de NAFLD pelo metodo de ultra-sonografia. Os resultados demonstraram reducao significante na concentracao circulante de grelina e leptina e na adiposidade visceral (p < 0,01). Houve ainda reducao percentual na prevalencia de NAFLD, sendo este um resultado relevante, visto que esta doenca pode progredir para cirrose, tanto em criancas quanto em adolescentes obesos. Este tipo de tratamento demonstrou ser eficiente na melhora do perfil metabolico e hormonal, contribuindo para o controle da obesidade e suas co-morbidades em adolescentes obesos.

Ingestão de cálcio e indicadores antropométricos entre adolescentes

OBJETIVO: Este estudo teve como objetivo investigar a relacao da ingestao de calcio com indicadores antropometricos de adolescentes. METODOS: Foram avaliados 507 alunos de duas escolas publicas e uma particular de Ouro Preto, Minas Gerais, por meio de questionario sobre condicoes socioeconomicas, avaliacao da maturacao sexual, antropometria, composicao corporal e consumo alimentar. RESULTADOS: A ingestao media de calcio foi 703,7 (396,0) mg/dia, sendo a maior ingestao verificada na escola de maior nivel socioeconomico. Apenas 8% dos adolescentes apresentavam ingestao superior a ingestao adequada. Houve associacao negativa do calcio, ajustado para o indice de massa corporal (r=-0,203, p=0,001), na escola de medio nivel socioeconomico e nos adolescentes com ingestao desse mineral entre 400 e 800mg/dia (r=-0,134, p=0,044). CONCLUSAO: Verificou-se ingestao insuficiente de calcio entre os adolescentes de Ouro Preto, evidenciando a necessidade de estimular o consumo de alimentos fontes desse mineral nesta populacao.

Body trunk fat and insulin resistance in post-pubertal obese adolescents

CONTEXT AND OBJECTIVEnInsulin resistance is a metabolic disorder commonly associated with excess body fat accumulation that may increase chronic disease risk. The present study was undertaken to evaluate the relationship between body composition and insulin resistance among obese adolescents.nnnDESIGN AND SETTINGnCross-sectional study, at the Adolescence Center, Pediatric Department, Universidade Federal de São Paulo.nnnMETHODSnBody composition was assessed using dual-energy X-ray absorptiometry. Dietary intake was evaluated using a three-day dietary record. The biochemical evaluation comprised glucose, insulin, serum lipid, leptin and ghrelin measurements. Insulin resistance was calculated by means of the homeostasis model assessment of insulin resistance (HOMA-IR).nnnRESULTSnForty-nine post-pubertal obese adolescents participated in the study: 12 boys and 37 girls of mean age 16.6 (1.4) years and mean body mass index (BMI) of 35.0 (3.9) kg/m(2). The mean glucose, insulin and HOMA values were 90.3 (6.4) mg/dl, 16.6 (8.1) microIU/ml and 3.7 (1.9), respectively. Hyperinsulinemia and insulin resistance were observed in 40.2% and 57.1% of the subjects, respectively. Adolescents with insulin resistance had higher BMI and body trunk fat. There was a trend towards higher leptin concentration in obese individuals with insulin resistance. Insulin resistance was positively correlated with body trunk fat, BMI, body fat mass (kg), leptin and body fat percentage. Furthermore, there was a negative correlation between HOMA-IR and lean body mass. The body composition predicted 30% of the HOMA-IR levels, according to linear regression models.nnnCONCLUSIONnBody trunk fat was significantly associated with insulin resistance, demonstrating the clinical importance of abdominal obesity during adolescence.

Notificação imprecisa da ingestão energética na dieta de adolescentes

Objectives: To examine the prevalence of under and overreporting of energy intake in adolescents and their associated factors. Methods: Cross-sectional study with 96 postpubertal adolescents (47 normal-weight and 49 obese), mean age of 16.6±1.3 years. Weight and height were measured, and body mass index was calculated. Body composition was assessed by dual energy X-ray absorptiometry. Dietary intake was evaluated by a 3-day dietary record. Biochemical assessment was performed (serum total cholesterol, LDL-cholesterol, HDL-cholesterol, plasma glucose, and insulin). Underreporters reported energy intake 2.4 x BMR. Results: Energy intake misreporting (under or overreporting) was identified in 65.6% of adolescents (64.6 and 1% of under and overreporting, respectively). Obese adolescents were 5.0 times more likely to underreport energy intake (95%CI 2.0-12.7) than normalweight participants. Underreporters showed higher rates of insufficient intake of carbohydrate (19.3 vs. 12.1%, p = 0.046) and lipids (11.3 vs. 0%, p < 0.001) than plausible reporters. Cholesterol intake was also lower in underreporters (p = 0.017). There were no significant differences in body composition and biochemical parameters in relation to misreporting. Conclusions: The results obtained demonstrated a high percentage of misreporting of energy intake among adolescents, especially among obese subjects, which suggests that energy-adjusted nutrient intake values should be employed in diet-disease risk analysis in order to contribute to a reduction in errors associated with misreporting.

Evolution of body mass index in two historical series of adolescents

OBJECTIVEnTo verify the evolution of body mass index (BMI) between two studies of adolescent populations.nnnMETHODSnData on the BMI of 8,020 adolescents aged 10 to 15 years living in the city of São Paulo, Brazil, and enrolled on the 2005 study entitled The nutritional profile of adolescents at public and private schools in São Paulo were compared with data from the 1989 National Nutrition and Health Census (PNSN - Pesquisa Nacional sobre Saúde e Nutrição). Binomial testing was used to compare proportions once both data sets had been transformed into percentiles.nnnRESULTSnComparing the two surveys, significant increases were identified in 85th and 95th percentile BMI values for male adolescents aged 10 to 15 years and for female adolescents aged 10 to 14 years. Analysis of the difference between the 5th and 95th BMI percentiles of the São Paulo and PNSN samples indicates that there was probably an increase in the number of adolescents in the higher BMI ranges in São Paulo in relation to the PNSN survey.nnnCONCLUSIONSnThese results demonstrate a tendency for the adolescents observed mean BMI values to increase during the period between the two surveys, indicating a need for increased monitoring of this measurement as a form of preventing overweight in this population.

Bone mineral density, body composition, and food intake of adolescent runway models

OBJETIVO: Avaliar a densidade mineral ossea (DMO) e relaciona-la com a ingestao alimentar e composicao corporal de adolescentes modelos de passarela. METODOS: Estudo transversal avaliando 33 modelos e 33 nao modelos de 15 a 18 anos pareadas por idade e indice de massa corporal (IMC). A densidade mineral ossea da coluna (L1-L4) foi avaliada por meio da tecnica da absorciometria de feixe duplo de energia (Lunar® DPX Alpha), e a composicao corporal, pela tecnica de pletismografia. A ingestao alimentar foi avaliada por meio do registro alimentar de 3 dias. RESULTADOS: A media de idade das adolescentes foi de 16,75±1,04 anos, sendo que 24% apresentaram IMC abaixo dos valores ideais para a idade. Nao houve diferenca de DMO entre modelos (1,108±0,080 g/cm2) e nao modelos (1,096±0,102 g/cm2) (p > 0,05), sendo identificada uma porcentagem de 6% de baixa DMO para a idade. Observou-se que a media de ingestao de energia foi menor entre as modelos em comparacao as adolescentes nao modelos (1.480,93±582,95 versus 1.973,00±557,63 kcal) (p > 0,05) e que a maioria das adolescentes de ambos os grupos apresentou consumo inadequado de micronutrientes, ressaltando-se a baixa ingestao de calcio. Verificou-se correlacao significativa da DMO apenas com a massa magra (kg) (modelos r = 0,362 e nao modelos r = 0,618; p < 0,05). CONCLUSAO: Apesar de nao ter sido encontrada associacao entre a DMO, o IMC e a ingestao de nutrientes importantes no processo de mineralizacao ossea, as inadequacoes na ingestao alimentar podem influenciar negativamente a aquisicao de massa ossea, que se encontra potencializada neste estagio de vida.

Evolução em duas séries históricas do índice de massa corporal em adolescentes

OBJECTIVE: To verify the evolution of body mass index (BMI) between two studies of adolescent populations. METHODS: Data on the BMI of 8,020 adolescents aged 10 to 15 years living in the city of Sao Paulo, Brazil, and enrolled on the 2005 study entitled The nutritional profile of adolescents at public and private schools in Sao Paulo were compared with data from the 1989 National Nutrition and Health Census (PNSN - Pesquisa Nacional sobre Saude e Nutricao). Binomial testing was used to compare proportions once both data sets had been transformed into percentiles. RESULTS: Comparing the two surveys, significant increases were identified in 85th and 95th percentile BMI values for male adolescents aged 10 to 15 years and for female adolescents aged 10 to 14 years. Analysis of the difference between the 5th and 95th BMI percentiles of the Sao Paulo and PNSN samples indicates that there was probably an increase in the number of adolescents in the higher BMI ranges in Sao Paulo in relation to the PNSN survey. CONCLUSIONS: These results demonstrate a tendency for the adolescents observed mean BMI values to increase during the period between the two surveys, indicating a need for increased monitoring of this measurement as a form of preventing overweight in this population.