Mauro Fisberg

Obesidade na infância e adolescência: uma verdadeira epidemia

Universidade Federal de Sao Paulo (UNIFESP) Departamento de Pediatria Centro de Atendimento e Apoio ao Adolescente

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.

Prevalence of Vitamin D Insufficiency in Brazilian Adolescents

Background/Aims: Cutaneous sun exposure and dietary vitamin D intake are important determinants of vitamin D status. The objective of the present study was to evaluate the vitamin D status of a group of healthy adolescent students living in Brazil. Methods: One hundred and thirty-six adolescents, 64 boys and 72 girls, aged 16–20 years old, living in a rural town in the state of São Paulo, Brazil, participated in this study. Results: The mean dietary vitamin D intake was 140 (120–156) IU/day [3.5 (3.0–3.9) μg/day]. Only 14.9% of the students met the daily adequate intake recommendation of vitamin D. Only 27.9% practice physical activity outdoors and 17.6% of the adolescents apply sunscreen daily. The mean 25(OH)D concentration was 73.0 (22.0) nmol/l [29.2 (8.8) ng/ml]. Vitamin D insufficiency was observed in 60% of adolescents. Conclusions: The present study suggests that even in a sunny climate like Brazil the prevalence of vitamin D insufficiency in adolescents is high. Most likely this is due to low intakes of vitamin D in this group. Due to the limited extent of natural dietary sources of vitamin D, a policy of vitamin D food fortification should be considered in the future, and in the meantime greater use of vitamin D supplements in this population group should be encouraged to provide the increased amounts of this essential nutrient for optimal health.

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).

Metabolic syndrome, dyslipidemia, hypertension and type 2 diabetes in youth: from diagnosis to treatment

Overweight and obesity in youth is a worldwide public health problem. Overweight and obesity in childhood and adolescents have a substantial effect upon many systems, resulting in clinical conditions such as metabolic syndrome, early atherosclerosis, dyslipidemia, hypertension and type 2 diabetes (T2D). Obesity and the type of body fat distribution are still the core aspects of insulin resistance and seem to be the physiopathologic links common to metabolic syndrome, cardiovascular disease and T2D. The earlier the appearance of the clustering of risk factors and the higher the time of exposure, the greater will be the chance of developing coronary disease with a more severe endpoint. The age when the event may occur seems to be related to the presence and aggregation of risk factors throughout life.The treatment in this age-group is non pharmacological and aims at promoting changes in lifestyle. However, pharmacological treatments are indicated in special situations.The major goals in dietary treatments are not only limited to weight loss, but also to an improvement in the quality of life. Modification of risk factors associated to comorbidities, personal satisfaction of the child or adolescent and trying to establish healthy life habits from an early age are also important. There is a continuous debate on the best possible exercise to do, for children or adolescents, in order to lose weight. The prescription of physical activity to children and adolescents requires extensive integrated work among multidisciplinary teams, patients and their families, in order to reach therapeutic success.The most important conclusion drawn from this symposium was that if the growing prevalence of overweight and obesity continues at this pace, the result will be a population of children and adolescents with metabolic syndrome. This would lead to high mortality rates in young adults, changing the current increasing trend of worldwide longevity. Government actions and a better understanding of the causes of this problem must be implemented worldwide, by aiming at the prevention of obesity in children and adolescents.

Comportamento alimentar de adolescentes em relação ao consumo de frutas e verduras

Observou-se baixa prevalencia de desvios nutricionais entre os 234 participantes: 3,8% foram classificadoscomo baixo peso e 12,4% apresentavam excesso de peso. Apenas 12,4% e 10,3% consumiam frutas everduras, respectivamente, conforme o recomendado pela Pirâmide Alimentar. Cerca de um terco da amostrafoi classificada tanto em pre-contemplacao como em manutencao. Observou-se uma discrepância entre oconsumo referido e a percepcao alimentar, tendo em vista que 79,7% e 83,7% dos adolescentes acreditavam,erroneamente, que seu consumo de frutas e verduras, respectivamente, era saudavel.

Zinc nutritional status and its relationships with hyperinsulinemia in obese children and adolescents

A perturbation of zinc metabolism has been noted in subjects with obesity. The present work intends to investigate whether the zinc nutritional status is associated with hyperinsulinemia in obesity. A study was carried out in a group of obese children and adolescents (n=23) and compared to a control group (n=21), both between 7 and 14 yr of age. Software analyzed diet information from 3-d food records. Body composition was evaluated by body mass index (BMI), bioelectrical impedance, and skinfold measurements. Zinc nutritional status was evaluated by Zn determination in plasma, erythrocyte, and 24-h urine, by atomic absorption spectrophotometry (λ=213.9 nm). Insulin was measured by radioimmunoassay (Linco Res). Diets consumed by both groups had marginal concentrations of zinc. Zinc concentrations in plasma and erythrocytes were significantly lower in the obese group. Urinary zinc excretion and serum insulin were significantly higher in the same group, although the insulinemia and the parameters of zinc nutritional status were not significantly correlated. As a result, considering that zinc is part of the synthesis and secretion of this hormone, an assessment is necessary of the possible participation of the oligoelement in the mechanisms of insulin resistance, commonly present in obese patients.

Anemia in children under 3 years of age in public day care centers

OBJECTIVE: To study the prevalence of anemia in children aged less than 36 months in public day care centers in the city of Cuiabá, state of Mato Grosso, Brazil. METHODS: Cross-sectional study with all children (n=271) less than 36 months of age who attended public day care centers in mid-1997. Children were evaluated as to their hemoglobin levels (venous blood, analyzed at the Central State Laboratory) and anthropometric indicators (weight/age, height/age, weight/height). RESULTS: A high prevalence (63%) of anemia associated with age, weight and height deficit, and time of admittance at kindergarten was observed. The prevalence of malnutrition was 0.8% according to the weight/height ratio, 5.0% according to weight/age deficit, and showed an inadequacy of 10.3% as to the height/age ratio. Thus, the percentage of anemic children was six times higher than the height deficit and twelve times higher than the weight deficit. Malnutrition was not in fact associated with anemia, but at extreme anthropometric cut-off points of height and weight for age (< -2 z score), there is an association between these conditions. CONCLUSION: The high prevalence of anemia is regarded as a severe public health problem among preschool children in the city of Cuiabá.

Zinc nutritional status in obese children and adolescents.

Studies in animals and humans have corroborated that zinc (Zn) metabolism is altered in obesity. The present work intends to evaluate the Zn nutritional status in obese children and adolescents by the determination of some biochemical parameters and analyses of the diets. The investigation was carried out in a group of obese children and adolescents (n=23) and compared to a control group (n=21), both between 7 and 14 yr of age. A software analyzed diet information from 3-d food records. Body composition was evaluated by body mass index, bioelectrical impedance, and skinfold measurements. Zinc nutritional status was evaluated by Zn determination in plasma, erythrocyte, and 24-h urine, by atomic absorption spectrophotometry (γ=213.9 nm). Diets consumed by both groups had marginal concentrations of zinc. Zinc concentrations in plasma and erythrocytes were significantly lower in the obese group. Urinary zinc excretion was significantly higher in the same group. The results allowed one to conclude that zinc nutritional status in obese individuals is altered.

Excesso de peso de escolares em região do Nordeste Brasileiro: contraste entre as redes de ensino pública e privada

OBJECTIVES: to determine the prevalence of excess weight in schoolchildren from the city of Natal. METHODS: transversal study with 1927 children aged 6-11 from public and private schools in different zones in the city of Natal, in the State of Rio Grande do Norte, Brazil, and analyze related variables, such as gender, age-group, type of school and city zones. All scholars with a body mass index equal to or greater than the 85th percentile were considered as having excess weight. RESULTS: the prevalence of excess weight among the studied scholars was 33.6%. There were no significant differences between genders and age-groups. In the private schools, the prevalence of excess weight was 54.5%, while in the public schools, 15.6% (p<0.01; OR=6.49). The prevalence of excess weight was greater in schools located in the zones with the best quality of life, east-south zone (41.3%), if compared with schools in the north-west zone (28.4%) (p<0.01). CONCLUSIONS: the prevalence of excess weight in scholars was found high, demonstrating the importance of programs of treatment and prevention. The biggest prevalence in children studying in private schools and in children studying in schools located in the best zone of the city reflects the importance of association between the best socioeconomic levels and these entities in regions of developing countries.