Vanessa Sá Leal

Excesso de peso em crianças e adolescentes no Estado de Pernambuco, Brasil: prevalência e determinantes

This study aimed to determine the prevalence of overweight and associated risk factors in children and adolescents in Pernambuco State, Brazil, in 2006. The cross-sectional, population-based study included 1,435 individuals from 5 to 19 years of age. Poisson regression was used to evaluate the association between selected variables and overweight. Prevalence was 13.3% for overweight (95%CI: 11.6-15.1) and 3.8% for obesity. Adjusted prevalence ratios showed that higher family income, maternal schooling, possession of household consumer goods, living in urban areas, and maternal overweight were associated with overweight in children and adolescents. The high prevalence of overweight in Pernambuco emphasizes the need for public health measures targeting all families regardless of socioeconomic status.

Estado nutricional de crianças e adolescentes de um município do semiárido do Nordeste brasileiro

Objective: To evaluate the nutritional status of schoolchildren, resident in a semiarid region in the Northeastern Brazil. Methods: This is a cross-sectional study, involving 860 children and adolescents aged from 5-19 years-old, enrolled in three public schools in the county. The selection of schools was non-probabilistic type and unintentional. The initial population, which integrated the database, was composed by 1,035 children and teenagers, and 175 students (16.9%) were excluded because of inconsistency in the anthropometric data, resulting in a sample of 860 students. The following outcomes were considered: stunting (malnutrition), overweight and obesity (overweight), being the height/age and body mass index/age (BMI/Age), indices respectively used. Children and adolescents with height <-2 standard deviations and overweight and obese weight z score ≥1 were considered stunted. The statistical analysis was descriptive. Results: The prevalence of stunting and overweight/obesity was 9.1% and 24.0%, respectively. Overweight and stunting were higher in adolescents aged 15 and over, compared to other age groups analyzed. In relation to gender, malnutrition presented itself in a similar way, but overweight was more frequent among females. Conclusions: The results revealed that excess weight, here represented by the sum of overweight and obesity, was more prevalent than stunting (malnutrition), highlighting the urgent need for attention to this problem in order to design interventions capable of contributing to the improvement of schoolchildren nutritional status.Objective:To evaluate the nutritional status of schoolchildren, resident in a semiarid region in the Northeastern Brazil.Methods:This is a cross-sectional study, involving 860 children and adolescents aged from 5-19 years-old, enrolled in three public schools in the county. The selection of schools was non-probabilistic type and unintentional. The initial population, which integrated the database, was composed by 1,035 children and teenagers, and 175 students (16.9%) were excluded because of inconsistency in the anthropometric data, resulting in a sample of 860 students. The following outcomes were considered: stunting (malnutrition), overweight and obesity (overweight), being the height/age and body mass index/age (BMI/Age), indices respectively used. Children and adolescents with height <-2 standard deviations and overweight and obese weight z score ≥1 were considered stunted. The statistical analysis was descriptive.Results:The prevalence of stunting and overweight/obesity was 9.1% and 24.0%, respectively. Overweight and stunting were higher in adolescents aged 15 and over, compared to other age groups analyzed. In relation to gender, malnutrition presented itself in a similar way, but overweight was more frequent among females.Conclusions:The results revealed that excess weight, here represented by the sum of overweight and obesity, was more prevalent than stunting (malnutrition), highlighting the urgent need for attention to this problem in order to design interventions capable of contributing to the improvement of schoolchildren nutritional status.

ERICA: use of screens and consumption of meals and snacks by Brazilian adolescents

ABSTRACT OBJECTIVE To describe the length of exposure to screens and the prevalence of consumption of meals and snacks by Brazilian adolescents in front of screens. METHODS We evaluated 74,589 12 to 17-year old adolescents from 1,247 schools in 124 Brazilian municipalities. A self-administered questionnaire was used. Its segment regarding nutrition contained questions about using TV, computers, and video game systems, having meals while watching TV, and consuming snacks in front of screens. Consumption of meals and snacks in front of screens was analyzed according to the following variables: geographical region, gender, age range, type of school (public or private), and school shift. The prevalences and their respective 95% confidence intervals were estimated under a complex sampling design. RESULTS A great deal of the adolescents (73.5%, 95%CI 72.3-74.7) reported spending two or more hours a day in front of screens. That habit was more frequent among male adolescents, private school students, morning shift students, and students from Brazil’s South region. More than half of the adolescents (56.6%, 95%CI 55.4-57.8) reported almost always or always having meals in front of TV, and 39.6% (95%CI 38.8-40.5) of them said they consumed snacks in front of screens exactly as often. Both situations were the most prevalent ones among the girls, who attended public schools and were from Brazil’s Midwest region. CONCLUSIONS Length of exposure to screens and consumption of meals and snacks almost always or always in front of screens are high among Brazilian adolescents. It is necessary to develop strategies aiming to reduce the length of screen use, considering the media reality that children and adolescents have been experiencing from earlier and earlier ages. That context must therefore be analyzed in an indissociable way.

Identification of cutoff points for Homeostatic Model Assessment for Insulin Resistance index in adolescents: systematic review

Abstract Objective: To identify cutoff points of the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index established for adolescents and discuss their applicability for the diagnosis of insulin resistance in Brazilian adolescents. Data source: A systematic review was performed in the PubMed, Lilacs and SciELO databases, using the following descriptors: adolescents, insulin resistance and Receiver Operating Characteristics Curve. Original articles carried out with adolescents published between 2005 and 2015 in Portuguese, English or Spanish languages, which included the statistical analysis using Receiver Operating Characteristics Curve to determine the index cutoff (HOMA-IR) were included. Data synthesis: A total of 184 articles were identified and after the study phases were applied, seven articles were selected for the review. All selected studies established their cutoffs using a Receiver Operating Characteristics Curve, with the lowest observed cutoff of 1.65 for girls and 1.95 for boys and the highest of 3.82 for girls and 5.22 for boys. Of the studies analyzed, one proposed external validity, recommending the use of the HOMA-IR cutoff>2.5 for both genders. Conclusions: The HOMA-IR index constitutes a reliable method for the detection of insulin resistance in adolescents, as long as it uses cutoffs that are more adequate for the reality of the study population, allowing early diagnosis of insulin resistance and enabling multidisciplinary interventions aiming at health promotion of this population.

Health promotion initiatives at school related to overweight, insulin resistance, hypertension and dyslipidemia in adolescents: a cross-sectional study in Recife, Brazil

BackgroundThe emergence of diseases such as dyslipidemia, systemic arterial hypertension, insulin resistance and metabolic syndrome in children and adolescents has brought about a change in the epidemiologic profile of the pediatric population. As action to promote health in the school environment is a useful tool for changing the pattern of health/disease in the young population, the present study aimed to identify schools that promote healthy eating and physical activity and to study the relationship between these practices and the prevalence of overweight, hypertension, insulin resistance and hypercholesterolemia in adolescents.MethodsA cross-sectional population-based study was conducted with 2400 adolescents aged from 12 to 17xa0years old and participating in the “Study of Cardiovascular Risk in Adolescents” (ERICA – Estudo de Riscos Cardiovasculares em Adolescente). The association between dependent (overweight, insulin resistance, hypertension and dyslipidemia) and independent variables (implementation of health promoting initiative in schools) was investigated using the chi-square test and prevalence ratio (PR) with a confidence index (CI) of 95%.ResultsThe unsatisfactory implementation of a “health promoting environment” (PRu2009=u20091.02; CI 95%: 1.0; 1.04) and “partnerships with the health sector” (PRu2009=u20091.03; CI 95%: 1.01; 1.05) were linked to a high prevalence of overweight in adolescents. Hypercholesterolemia was found to be higher in the schools with unsatisfactory implementation of “healthy eating and health on the scholar curriculum” (PRu2009=u20091.71; CI 95%: 1.22; 2.44) and those lacking a “healthy-eating promoting environment” (PRu2009=u20091.29; CI 95%: 1.10; 1.54). Schools with unsatisfactory implementation of a “health-eating promoting environment” (PRu2009=u20091.36; CI 95%: 1.04; 1.79) and those lacking “partnership with the health sector” (PRu2009=u20092.12; CI 95%: 1.38; 3.24) had more adolescents with insulin resistance. There was no association between hypertension and any other component studied.ConclusionSchools which have implemented adequate health promotion in their curriculums showed a lower prevalence of overweight, insulin resistance and hypercholesterolemia in adolescents.

ERICA: intake of macro and micronutrients of Brazilian adolescents

ABSTRACT OBJECTIVE To describe food and macronutrient intake profile and estimate the prevalence of inadequate micronutrient intake of Brazilian adolescents. METHODS Data from 71,791 adolescents aged from 12 to 17 years were evaluated in the 2013-2014 Brazilian Study of Cardiovascular Risks in Adolescents (ERICA). Food intake was estimated using 24-hour dietary recall (24-HDR). A second 24-HDR was collected in a subsample of the adolescents to estimate within-person variability and calculate the usual individual intake. The prevalence of food/food group intake reported by the adolescents was also estimated. For sodium, the prevalence of inadequate intake was estimated based on the Tolerable Upper Intake Level (UL). The Estimated Average Requirement (EAR) method used as cutoff was applied to estimate the prevalence of inadequate nutrient intake. All the analyses were stratified according to sex, age group and Brazilian macro-regions. All statistical analyses accounted for the sample weight and the complex sampling design. RESULTS Rice, beans and other legume, juice and fruit drinks, breads and meat were the most consumed foods among the adolescents. The average energy intake ranged from 2,036 kcal (girls aged from 12 to 13 years) to 2,582 kcal (boy aged from14 to 17 years). Saturated fat and free sugar intake were above the maximum limit recommended (< 10.0%). Vitamins A and E, and calcium were the micronutrients with the highest prevalence of inadequate intake (> 50.0%). Sodium intake was above the UL for more than 80.0% of the adolescents. CONCLUSIONS The diets of Brazilian adolescents were characterized by the intake of traditional Brazilian food, such as rice and beans, as well as by high intake of sugar through sweetened beverages and processed foods. This food pattern was associated with an excessive intake of sodium, saturated fatty acids and free sugar.

Health and nutrition in public and private schools in the city of Recife

Objetivos: avaliar a implementacao de iniciativas e ambientes promotores da alimen-tacao saudavel e da pratica de atividade fisica em escolas publicas e privadas de Recife. Metodos: as escolas selecionadas em Recife (n=39) fazem parte da amostra do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA). O grau de implementacao foi estimado por meio de entrevistas com o gestor escolar enfatizando os seguintes componentes: participacao da comunidade, ambientes saudaveis, parceria com o setor de saude, monitoramento do estado nutricional e politicas de nutricao. As variaveis selecionadas foram atribuidos pontos cujo somatorio as classificou como implementacao satisfatoria, implementacao insatisfatoria e implementacao critica. Resultados: a promocao da alimentacao saudavel e da pratica de atividade fisica foi implementada de forma satisfatoria em 13,8% das escolas publicas. No entanto, nenhuma das escolas privadas obteve tal classificacao. As escolas publicas, quando comparadas as escolas privadas, apresentaram - se mais estruturadas quanto as politicas e ambientes promotores da alimentacao saudavel e a participacao da comunidade escolar, mas apresentaram maior fragilidade em relacao a promocao da pratica de atividade fisica e monitoramento do estado nutricional. Poucas escolas apresentaram implementacao satisfatoria na parceria com setor saude. Conclusoes: escolas publicas e privadas apresentaram barreiras que comprometem a implementacao plena de iniciativas e ambientes promotores da alimentacao saudavel e da pratica de atividade fisica.

ERICA: ingestão de macro e micronutrientes em adolescentes brasileiros

I Instituto de Estudos em Saúde Coletiva. Universidade Federal do Rio de Janeiro. Rio de Janeiro, RJ, Brasil II Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde. Secretaria de Vigilância em Saúde. Ministério da Saúde. Brasília, DF, Brasil III Programa de Pós-Graduação em Saúde Coletiva. Instituto de Medicina Social. Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil IV Divisão de Nutrição. Hospital Universitário Pedro Ernesto. Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil V Departamento de Nutrição. Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil VI Departamento de Nutrição. Núcleo de Estudos em Saúde Pública. Universidade Federal do Piauí. Teresina, PI, Brasil VII Núcleo de Nutrição. Centro Acadêmico de Vitória. Universidade Federal de Pernambuco. Vitória de Santo Antão, PE, Brasil VIII Departamento de Nutrição. Centro de Ciências da Saúde. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil

Prevalência do excesso de peso e fatores associados em mulheres em idade reprodutiva no Nordeste do Brasil

Objetivo: Determinar a prevalencia do excesso de peso e fatores associados em mulheres em idade reprodutiva no municipio de Vitoria de Santo Antao, Pernambuco. Metodos: Estudo transversal com 322 mulheres, conduzido entre os meses de janeiro e abril de 2013 atraves de busca ativa nos domicilios. O estado nutricional foi classificado pelo indice de massa corporal para as maiores de 18 anos e pelo indice de massa corporal/idade para as adolescentes. A variavel dependente foi o excesso de peso (sobrepeso/obesidade) e os fatores associados (variaveis independentes) foram: as condicoes socioeconomicas e demograficas (idade, escolaridade, alfabetizacao, trabalho remunerado, classe economica, condicao de seguranca alimentar e nutricional, numero de pessoas no domicilio, condicoes de saneamento basico, piso, teto, numero de comodos e de dormitorios), comportamental (pratica de atividade fisica) e historia reprodutiva (menarca, numero de gestacoes e metodo contraceptivo). A regressao de Poisson foi utilizada para a analise dos fatores associados ao excesso de peso. Resultados: A prevalencia de excesso de peso nas mulheres foi de 60,9%. O modelo regressao mostrou que a idade (20-39 anos: razoes de prevalencias 1,84 intervalo de confianca 95% 1,04-3,24; ≥40 anos: razoes de prevalencias 2,20; intervalo de confianca 95% 1,18-4,08) e a idade da menarca (≤13anos: razoes de prevalencias 1,37; intervalo de confianca 95% 1,03-1,82) se associaram ao excesso de peso. Conclusao: A prevalencia de excesso de peso representou quase dois tercos da populacao estudada e esteve associada com a maior idade cronologica e a menor idade da menarca, o que corrobora outros resultados da literatura cientifica.

Anemia e fatores associados em mulheres de idade reprodutiva de um município do Nordeste brasileiro

OBJECTIVEnTo identify the prevalence of iron-deficiency anemia and associated factors in women at reproductive age in the city of Vitoria de Santo Antão, Pernambuco.nnnMETHODSnCross-sectional study with a representative sample of 322 women aged between 15 and 49 years. Anemia was diagnosed by measuring hemoglobin below 12 g/dL. The independent variables were: demographic and socioeconomic conditions (age, race/color, education, literacy, presence of children aged < 5 years in the household, regime of residence occupation, ownership of assets, and per capita income), housing conditions (number of people in the household, number of bedrooms, and basic sanitation), food and nutrition security and womens health conditions (menarche, number of pregnancies, history of miscarriages, body mass index, and ferritin). Poisson regression was used to analyze the factors associated with anemia.nnnRESULTSnThe mean age of women surveyed was 31.1 ± 6.61 years old (standard deviation - SD) and the prevalence of anemia was 18.6% (95%CI 14.7 - 23.3). After multivariate analysis, anemia was significantly associated with age ≤ 19 years and low ferritin.nnnCONCLUSIONnThe prevalence of anemia is characterized as a mild public health problem and follows the world trend in developing countries.RESUMO: Objetivo: Determinar a prevalencia de anemia e seus fatores associados em mulheres em idade reprodutiva do municipio de Vitoria de Santo Antao, Pernambuco. Metodos: Estudo transversal com amostra representativa de 322 mulheres, com idade entre 15 e 49 anos. A anemia foi diagnosticada pela dosagem de hemoglobina abaixo de 12 g/dL. As variaveis independentes foram: condicoes demograficas e socioeconomicas (idade, raca/cor, escolaridade, alfabetizacao, presenca de criancas com idade < 5 anos no domicilio, regime de ocupacao de residencia, posse de bens e renda familiar per capita), condicoes de moradia (numero de pessoas no domicilio, numero de dormitorios e condicoes de saneamento basico), seguranca alimentar e nutricional e condicoes de saude das mulheres (menarca, numero de gestacoes, passado de abortos, indice de massa corporal e ferritina). A regressao de Poisson foi utilizada para a analise dos fatores associados a anemia. Resultados: A media de idade das mulheres investigadas foi de 31,1 ± 6,61 anos (desvio padrao - DP) e a prevalencia de anemia, de 18,6% (IC95% 14,7 - 23,3). Apos analise multivariavel, a anemia apresentou associacao significativa com idade ≤ 19 anos e com baixo indice de ferritina. Conclusao: A prevalencia de anemia encontrada se caracteriza como um problema de saude publica de grau leve e segue a tendencia mundial de paises em desenvolvimento.