Efficacy of anthropometric measures for identifying cardiovascular disease risk in adolescents: review and meta-analysis.

INTRODUCTION: To compare the ability of Body Mass Index (BMI), waist circumference (WC) and waist to height ratio (WHtR) to estimate cardiovascular disease (CVD) risk levels in adolescents. EVIDENCE ACQUISITION: A systematic review and meta-analysis was performed after a database search for relevant literature (Cochrane, Centre for Review and Dissemination, PubMed, British Nursing Index, CINAHL, BIOSIS citation index, ChildData, metaRegister). EVIDENCE SYNTHESIS: The study included 117 records representing 96 studies with 994,595 participants were included in the systematic review, 14 of which (13 studies, N.=14,610) were eligible for the meta-analysis. The results of the meta-analysis showed that BMI was a strong indicator of systolic blood pressure, diastolic blood pressure, triglycerides, high-density lipoprotein cholesterol and insulin; but not total cholesterol, low-density lipoprotein or glucose. Few studies were eligible for inclusion in the meta-analysis considering WC or WHtR (N.≤2). The narrative synthesis found measures of central adiposity to be consistently valid indicators of the same risk factors as BMI. CONCLUSIONS: BMI was an indicator of CVD risk. WC and WHtR were efficacious for indicating the same risk factors BMI performed strongly for, though there was insufficient evidence to judge the relative strength of each measure possibly due to heterogeneity in the methods for measuring and classifying WC.

Associations between low consumption of fruits and vegetables and nutritional deficiencies in Brazilian schoolchildren.

OBJECTIVE: We examined associations between the frequency of fruit and vegetable (F&V) consumption and nutritional deficiencies among Brazilian schoolchildren. DESIGN: A cross-sectional, population-based study was performed. A short FFQ was used to assess consumption of fruits and vegetables (F&V) over the past month. The prevalence ratios (PR) and 95 % confidence intervals for stunting, obesity, anaemia, vitamin A and folate deficiencies, vitamin E and vitamin D insufficiencies were estimated for low F&V consumption frequency (vegetables ≤ 3 times/month and fruits ≤ 3 times/week) and compared with children with usual F&V consumption frequency (vegetables ≥ 1 time/week and fruits ≥ 4 times/week). SETTING: Acrelândia, Western Brazilian Amazon. SUBJECTS: A total of 702 children aged 4-10 years. RESULTS: Only 5 % of children consumed F&V ≥ 5 times/d. Prevalence of deficiency was 31 %, 15 %, 9 % and 2 % for vitamins D, A, E and folate, respectively. Overall, 6.3% of children were anaemic, 3.3% were stunted, 2.7% were obese and 33 % had multiple nutritional deficiencies. Low frequency of F&V consumption was associated with lower plasma concentrations of carotenoids and vitamin E. Nutritional deficiencies were higher among non-consumers of F&V when compared with usual consumers: anaemia (PR=1.9; 95 % CI 1.0, 3.7), vitamin E insufficiency (PR=2.5; 95% CI 1.5, 4.2), vitamin D insufficiency (PR=1.5; 95% CI 1.1, 1.9) and stunting (PR=2.6; 95% CI 1.1, 6.1). CONCLUSIONS: In our study, the occurrence of nutritional deficiencies in children with low F&V consumption was twice as high as in children with usual F&V consumption, reinforcing the importance of effective actions to promote the consumption of F&V.

Genetic and environmental factors associated with vitamin B12 status in Amazonian children.

OBJECTIVE: To evaluate the prevalence of vitamin B12 deficiency and factors associated with vitamin B12 status in Amazonian children. DESIGN: Genetic risk score (GRS), socio-economic and nutritional status, and morbidity data were the independent variables used in multiple linear regression models to evaluate factors associated with vitamin B12 status in a population-based cross-sectional study. GRS was created by summing a number of known risk alleles for low serum vitamin B12. SETTING: Acrelândia, western Brazilian Amazon. SUBJECTS: Children (n 988) aged <10 years. RESULTS: Overall prevalence of vitamin B12 deficiency (<150 pmol/l) was 4·2 (95 % CI 3·0, 5·6) % and was highest in children aged <24 months: 13·6 (95 % CI % 8·8, 19·7) %. For children <24 months, wealth index (ß=0·017, P=0·030) and animal protein intake (ß=0·219, P=0·003) were positively associated with vitamin B12 status. GRS (ß=-0·114, P<0·001) and serum homocysteine (ß=-0·049, P<0·001) were negatively associated. Among children aged ≥24 months, vitamin B12 status was positively associated with wealth index (ß=0·012, P<0·001), height-for-age Z-score (ß=0·024, P=0·033) and serum vitamin A (ß=0·089, P<0·001). Age≥60 months (ß=-0·118, P<0·001), GRS (ß=-0·048, P<0·001), maternal schooling <5 years (ß=-0·083, P<0·001), low intake of animal-derived foods (ß=-0·050, P=0·030), serum homocysteine (ß=-0·053, P<0·001), serum folate ≥23·6 nmol/l (ß=-0·055, P=0·012) and geohelminth infection (ß=-0·141, P=0·017) were negatively associated with vitamin B12 status. CONCLUSIONS: GRS, poverty, low intake of animal-derived foods, geohelminth infection, vitamin A and folate status were important factors associated with vitamin B12 status of children in our study.

25-Hydroxyvitamin D3 Levels, BsmI Polymorphism and Insulin Resistance in Brazilian Amazonian Children.

Vitamin D is associated with a wide range of other functions beyond bone development. We evaluated the factors associated with 25-hydroxyvitamin D levels in 974 children aged ≤ 10 years and the impact of BsmI polymorphism of the vitamin D receptor (VDR) gene (rs1544410) on metabolic parameters in a subsample (n: 430) with a follow-up 2 years later from the initial population-based cross-sectional study. Multiple linear regression models were used in the analyses. The prevalence (95% CI) of vitamin D deficiency, insufficiency and sufficiency of children was 11.1% (9.2-13.2), 21.8% (19.2-24.5) and 67.2% (64.1-70.1), respectively. Overall, 23% of the variation in serum 25-hydroxyvitamin D concentrations was accounted for by BsmI polymorphism ß = -0.053 (95% CI) (-0.100, -0.006), maternal schooling (≥ 9 years) ß = 0.100 (0.039, 0.161), serum vitamin E ß = 0.478 (0.381, 0.574), total cholesterol concentration ß = 0.232 (0.072, 0.393) and serum folate ß = 0.064 (0.013, 0.115). BsmI polymorphism was positively associated with HOMA-IR ß = 0.122 (0.002, 0.243) and fasting glucose concentration ß = 1.696 (0.259, 3.133). In conclusion, variables related to socioeconomic level, the presence of the allele risk for BsmI and other nutrient concentrations were associated with serum 25-hydroxyvitamin D concentrations. Our results suggest that BsmI polymorphism is correlated with metabolic outcomes.

Factors associated with stunting and overweight in Amazonian children: a population-based, cross-sectional study.

OBJECTIVE: To examine the prevalence of stunting and overweight in children and identify demographic, socio-economic and maternal characteristics, as well as biochemical indicators, associated with these outcomes. DESIGN: A population-based, cross-sectional study was performed. Data from structured questionnaires, anthropometric measurements, and blood and stool samples were used in Poisson regression models to estimate prevalence ratios (PR) according to a hierarchical conceptual framework. SETTING: Acrelândia, western Brazilian Amazon. SUBJECTS: Children (n 1139) aged <10 years. RESULTS: Prevalence of stunting was 7·1 % (95 % CI 5·1, 9·6 %) and 3·7 % (95 % CI 2·4, 5·7 %) among children aged <5 years and ≥5 years, respectively; overweight was detected in 20·6 % (95 % CI 17·4, 24·2 %) and 9·4 % (95 % CI 7·2, 12·1 %) of children aged <5 years and ≥5 years, respectively. Among children <5 years of age, stunting was positively associated with the lowest maternal height tertile (PR = 3·09, 95 % CI 1·26, 7·63), low birth weight (PR = 2·70, 95 % CI 1·41, 5·19), diarrhoea for ≥3d (PR = 2·21, 95 % CI 1·03, 4·77) and geohelminth infections (PR = 2·53, 95 % CI 1·02, 6·13). Overweight in children <5 years of age was positively associated with caesarean delivery (PR = 1·45, 95 % CI 1·02, 2·06), birth weight ≥3500 g (PR = 1·82, 95 % CI 1·30, 2·55) and Fe deficiency (PR = 1·64, 95 % CI 1·07, 2·53). Among children aged ≥5 years, land or livestock ownership (PR = 1·85, 95 % CI 1·07, 3·22), maternal overweight (PR = 2·06, 95 % CI 1·23, 3·47), high C-reactive protein concentration (PR = 2·43, 95 % CI 1·26, 4·70), vitamin A deficiency (PR = 1·97, 95 % CI 1·13, 3·41) and high serum TAG concentration (PR = 2·16, 95 % CI 1·27, 3·68) were associated with overweight. CONCLUSIONS: Overweight was more prevalent than stunting, being associated with higher household wealth, maternal overweight, caesarean delivery, high birth weight, micronutrient deficiencies and high TAG concentration. Improvements in maternal and child health care with sustainable access to healthy food are necessary to reduce short- and long-term health complications related to overweight in this population.

Health outcomes of the Bolsa Família program among Brazilian Amazonian children.

OBJECTIVE: One of the primary objectives of Brazil's conditional cash transfer program, Bolsa Família, is to break the intergenerational transmission of poverty by improving human capital via conditionalities. In this study, we hypothesized that health indicators of Bolsa Família participants would be comparable to those of other local children who were nonparticipants after two years of follow-up in the city of Acrelândia, Acre state, Western Brazilian Amazon. METHODS: Data from a population-based longitudinal study were analyzed to examine school enrollment, vaccination coverage, height and body mass index for age z-scores, and biomarkers of micronutrient deficiencies (iron and vitamin A) between Bolsa Família participants (n = 325) and nonparticipants (n = 738). RESULTS: Out of 1063 children 10 years and younger included in the 2007 baseline survey, 805 had anthropometric measurements and 402 had biochemical indicators in the 2009 follow-up survey. Prevalence rate ratio (PRR) for non-enrollment in school at 4 years of age was 0.58 (95%CI: 0.34-1.02) when comparing Bolsa Família participants with nonparticipants. No difference was found for vaccination coverage, which was insufficient for most vaccine-preventable diseases. Bolsa Família participants were less likely to show a positive change in body mass index for age z-scores compared with nonparticipants (PRR = 0.81, 95%CI: 0.70-0.95), while a positive change in height for age z-scores was similar in the groups. No differences in micronutrient deficiencies were found between groups after 2 years. CONCLUSIONS: Early school enrollment and consistent nutritional indicators between Bolsa Família participants and nonparticipants suggest Bolsa Família was facilitating similarities between groups over time.

[Bone mineral density in overweight and obese adolescents]. / Densidade mineral óssea de adolescentes com sobrepeso e obesidade.

OBJECTIVE: To study bone density as a concomitant factor for obesity in post-pubertal adolescents, controlling for other variables that may interfere in such a relation. METHODS: Study comprising 83 overweight and obese adolescents (BMI > or = P85) and 89 non obese ones (P5 < or = BMI < or = P85). Cases and controls were selected out of 1,420 students (aged 14-19) from a public school in the city of São Paulo. The bone mineral density of the lumbar spine (L2-L4 in g/cm2) was assessed by dual-energy x-ray absorptiometry (LUNARtrade mark DPX-L). The variable bone density was dichotomized using 1.194 g/cm2 as cutoff point. Bivariate analyses were conducted considering the prevalence of overweight and obesity followed by multivariate analysis (logistic regression) according to a hierarchical conceptual model. RESULTS: The prevalence of bone density above the median was twice more frequent among cases (69.3%) than among controls (32.1%). In the bivariate analysis such prevalence resulted in an odds ratio (OR) of 4.78. The logistic regression model showed that the association between obesity and mineral density is yet more intense with an OR of 6.65 after the control of variables related to sedentary lifestyle and intake of milk and dairy products. CONCLUSION: Obese and overweight adolescents in the final stages of sexual maturity presented higher bone mineral density in relation to their normal-weight counterparts; however, cohort studies will be necessary to evaluate the influence of such characteristic on bone resistance in adulthood and, consequently, on the incidence of osteopenia and osteoporosis at older ages.

Health outcomes of the bolsa família program among Brazilian Amazonian children

ABSTRACT OBJECTIVE One of the primary objectives of Brazil's conditional cash transfer program, Bolsa Família, is to break the intergenerational transmission of poverty by improving human capital via conditionalities. In this study, we hypothesized that health indicators of Bolsa Família participants would be comparable to those of other local children who were nonparticipants after two years of follow-up in the city of Acrelândia, Acre state, Western Brazilian Amazon. METHODS Data from a population-based longitudinal study were analyzed to examine school enrollment, vaccination coverage, height and body mass index for age z-scores, and biomarkers of micronutrient deficiencies (iron and vitamin A) between Bolsa Família participants (n = 325) and nonparticipants (n = 738). RESULTS Out of 1063 children 10 years and younger included in the 2007 baseline survey, 805 had anthropometric measurements and 402 had biochemical indicators in the 2009 follow-up survey. Prevalence rate ratio (PRR) for non-enrollment in school at 4 years of age was 0.58 (95%CI: 0.34-1.02) when comparing Bolsa Família participants with nonparticipants. No difference was found for vaccination coverage, which was insufficient for most vaccine-preventable diseases. Bolsa Família participants were less likely to show a positive change in body mass index for age z-scores compared with nonparticipants (PRR = 0.81, 95%CI: 0.70-0.95), while a positive change in height for age z-scores was similar in the groups. No differences in micronutrient deficiencies were found between groups after 2 years. CONCLUSIONS Early school enrollment and consistent nutritional indicators between Bolsa Família participants and nonparticipants suggest Bolsa Família was facilitating similarities between groups over time.

Vitamin A status and associated factors in infants attending at Primary Health Care in Goiânia, Goiás, Brazil.

OBJECTIVE: This study aimed to assess the nutritional status of vitamin A and associated factors in children assisted in Primary Care Health in Goiânia, Goiás, Brazil. METHODS: This is a cross-sectional study with a sample of 228 children 12 to 16 months of age. The nutritional status of vitamin A was assessed by serum retinol concentration, determined by high performance liquid chromatography. Multiple linear regression models with hierarchical selection of independent variables were used to evaluate the correlation with serum retinol as the dependent variable. RESULTS: The vitamin A deficiency (retinol < 0,7 µmol/L) was observed in 14,0% of the children. Maternal schooling and hemoglobin concentration were positively correlated with serum retinol concentration, while C-reactive protein showed a negative correlation (R2 = 0,1648). CONCLUSION: The vitamin A deficiency in one-year-old children attended in Basic Health Units in Goiânia configures itself as a moderate public health problem. Actions to promote maternal education, morbidity control and prevention of other micronutrient deficiencies are important for prevention and control of the vitamin A deficiency in this population.

Obesity and cardiovascular risk factors in adolescents attending public schools.

BACKGROUND: Overweight in adolescence is a risk factor for the development of cardiovascular diseases in adulthood. OBJECTIVE: To study the association of cardiovascular risk factors (CRF) in overweight and normal-weight adolescents of both genders aged from 14 to 19 years, attending public schools. METHODS: Case-control study including 163 overweight and 151 normal-weight adolescents. Multiple logistic regression analysis was used to evaluate the associations between overweight and CRF (lipid profile, blood pressure and baseline insulin level). A set of CRF was defined for each individual, ranging from 0 (no risk factors) to 6 (all risk factors present). RESULTS: Overweight adolescents (body mass index > 85th percentile) presented a higher frequency of CRF in comparison to the normal- weight group. The CRF associated with overweight were HDLc < 35 mg/dl (OR = 3.41; CI: 1.24-9.38), triglycerides > 150 mg/dl (OR = 3.04; CI: 1.01-9.13), abnormal baseline insulin levels > 15 µU/ml (OR = 8.65; CI: 4.03-18.56) and abnormal blood pressure (OR = 3.69; CI: 1.76-7.72). Among overweight adolescents, 22.09% had more than three risk factors, whereas this percentage dropped to 6.12% among normal-weight adolescents. CONCLUSION: Overweight adolescents presented risk factors for cardiovascular diseases. The need for programs and policies targeted at the diagnosis and treatment of this condition is pointed out in order to reduce the risks of morbidity and mortality in adulthood.

Vitamin A status and associated factors in infants attending at Primary Health Care in Goiânia, Goiás, Brazil / Estado nutricional de vitamina A e fatores associados em lactentes atendidos em Unidades Básicas de Saúde de Goiânia, Goiás, Brasil

This study aimed to assess the nutritional status of vitamin A and associated factors in children assisted in Primary Care Health in Goiânia, Goiás, Brazil.

Este estudo teve por objetivo avaliar o estado nutricional de vitamina A e fatores associados em crianças atendidas em Unidades Básicas de Saúde de Goiânia, Goiás.

Obesidade infantil na percepção dos pais / Perception of childhood obesity by parents

OBJETIVO:Revisar as pesquisas atuais sobre a capacidade dos pais para perceber o peso corporal dos filhos, as crenças relacionadas ao peso, os fatores que influenciam essa percepção, assim como as possíveis ações capazes de ampliar a consciência dos pais sobre o excesso de peso de seus filhos e suas consequências. FONTES DE DADOS: As bases de dados utilizadas na pesquisa foram: Medline - Pubmed, SciELO e Scopus. Foram incluídos os artigos publicados nos últimos dez anos (2000 a 2010) relacionados ao tema e que abordavam a faixa pediátrica e os fatores condicionantes da percepção dos pais a respeito do peso dos filhos. SÍNTESE DOS DADOS: A percepção dos pais quanto ao peso dos filhos foi sempre baixa, apesar da diversidade das amostras estudadas, regiões diferentes, nível socioeconômico e escolaridade variada. Muitos pais de filhos com excesso de peso não reconhecem ou não consideram que este seja um problema de saúde. Com relação aos fatores que influenciam a percepção, destacam-se a idade das crianças (quanto menor, menos se percebe o excesso de peso); o sexo (o peso das meninas é percebido corretamente); a baixa escolaridade e o não entendimento das curvas de crescimento. CONCLUSÕES: A falta de percepção e consciência dos pais quanto ao estado nutricional dos filhos é um dos fatores que dificulta o sucesso da prevenção, tratamento e consequente diminuição da prevalência da obesidade.

OBJECTIVE:To review the current literature about parent´s ability to perceive the body weight of their children, the beliefs related to weight, the factors that influence their perception, as well as the possible actions to enhance the awareness of parents about their children's excess of weight and it's consequences. DATA SOURCES: The databases used in the research were: Medline, SciELO and Scopus. Studies from 2000-2010 addressing the parental perception of children's body weight were included. DATA SYNTHESIS: The parents perception of their children's body weight was generally poor, despite the diversity of the samples studied across different regions, socio-economic status and educational levels. Many parents of overweight children do not recognize or do not consider overweight/obesity of their children as a health problem. The wrong perceptions were frequently associated with factors like children's age (harder to perceive the excess of weight in younger children), gender (girl's excess of weight is more frequently noticed), poor education and misunderstanding of the growth curves. CONCLUSIONS: The lack of perception and awareness of parents about the nutritional status of children is one of the factors that act against the success of the prevention and the treatment of obesity.

Obesidade e fatores de risco cardiovascular em adolescentes de escolas públicas / Obesity and cardiovascular risk factors in adolescents attending public schools

FUNDAMENTO: O excesso de peso na adolescência é fator de risco para o desenvolvimento de doenças cardiovasculares na vida adulta. OBJETIVO: Estudar a associação dos fatores de risco cardiovascular (FRC) em adolescentes com excesso de peso e eutróficos, de ambos os sexos, de 14 a 19 anos em escolas públicas. MÉTODOS: Estudo caso-controle com 163 adolescentes com excesso de peso e 151 eutróficos. Análise de regressão logística múltipla foi utilizada para avaliar as associações entre excesso de peso e os FRC (perfil lipídico, pressão arterial e insulina basal). Um conjunto de FRC foi definido para cada indivíduo, variando de 0 (nenhuma das condições) até 6 (presença de todas essas condições). RESULTADOS: Adolescentes com excesso de peso (índice de massa corporal > percentil 85) apresentaram maiores frequências dos FRC quando comparados ao grupo de eutróficos. Os FRC associados ao excesso de peso foram HDLc < 35 mg/dl (OR = 3,41; IC: 1,24-9,38), triglicérides > 150 mg/dl (OR = 3,04; IC: 1,01-9,13), insulina basal alterada > 15 µU/ml (OR = 8,65; IC: 4,03-18,56) e pressão arterial alterada (OR = 3,69; IC: 1,76-7,72). Entre os adolescentes com excesso de peso, 22,09 por cento tinham mais do que três fatores de risco, enquanto que entre os eutróficos, este percentual foi de 6,12 por cento. CONCLUSÃO: Adolescentes com excesso de peso apresentaram fatores de risco para doenças cardiovasculares. Ressalta-se a necessidade de programas e políticas de diagnóstico e de tratamento, a fim de reduzir os riscos de morbimortalidade na idade adulta.

BACKGROUND: Overweight in adolescence is a risk factor for the development of cardiovascular diseases in adulthood. OBJECTIVE: To study the association of cardiovascular risk factors (CRF) in overweight and normal-weight adolescents of both genders aged from 14 to 19 years, attending public schools. METHODS: Case-control study including 163 overweight and 151 normal-weight adolescents. Multiple logistic regression analysis was used to evaluate the associations between overweight and CRF (lipid profile, blood pressure and baseline insulin level). A set of CRF was defined for each individual, ranging from 0 (no risk factors) to 6 (all risk factors present). RESULTS: Overweight adolescents (body mass index > 85th percentile) presented a higher frequency of CRF in comparison to the normal- weight group. The CRF associated with overweight were HDLc < 35 mg/dl (OR = 3.41; CI: 1.24-9.38), triglycerides > 150 mg/dl (OR = 3.04; CI: 1.01-9.13), abnormal baseline insulin levels > 15 µU/ml (OR = 8.65; CI: 4.03-18.56) and abnormal blood pressure (OR = 3.69; CI: 1.76-7.72). Among overweight adolescents, 22.09 percent had more than three risk factors, whereas this percentage dropped to 6.12 percent among normal-weight adolescents. CONCLUSION: Overweight adolescents presented risk factors for cardiovascular diseases. The need for programs and policies targeted at the diagnosis and treatment of this condition is pointed out in order to reduce the risks of morbidity and mortality in adulthood.

Densidade mineral óssea de adolescentes com sobrepeso e obesidade / Bone mineral density in overweight and obese adolescents

OBJETIVO: Estudar a densidade óssea como fator concomitante da obesidade em adolescentes pós-púberes, controlando outras variáveis que possam interferir nessa relacão. MÉTODOS: Estudo com 83 sobrepesos e obesos (IMC > P85) e 89 não obesos (P5 < IMC < P85). Casos e controles foram selecionados entre 1420 estudantes (14-19 anos) de escola pública na cidade de São Paulo. A densidade mineral óssea de coluna (L2-L4 em g/cmy) foi avaliada por meio de densitometria de duplo feixe de raios X (LUNAR® DPX-L). A variável densidade óssea foi categorizada utilizando a mediana 1,194 g/cmy como ponto de corte. Foram realizadas análises bivariadas, observando-se a prevalência de sobrepeso e obesidade. Em seguida, procedeu-se à análise multivariada (regressão logística), de acordo com um modelo conceitual hierárquico. RESULTADOS: A prevalência de densidade óssea acima da mediana foi duas vezes mais freqüente entre os casos (69,3 por cento) do que entre os controles (32,1 por cento). Na análise bivariada, tais prevalências resultaram em odds ratio (OR) de 4,78. O modelo de regressão logística mostrou que a associacão entre obesidade e densidade mineral é ainda mais intensa com OR de 6,65, após o controle das variáveis relacionadas ao sedentarismo e ao consumo de leite e derivados. CONCLUSAO: Observou-se, neste estudo, que adolescentes com sobrepeso e obesidade nos estadios finais da maturacão sexual apresentaram maior densidade mineral óssea com relacão aos seus pares eutróficos. No entanto, estudos de coorte serão necessários para avaliar a influência dessa característica sobre a resistência óssea na vida adulta e, conseqüentemente, sobre a incidência de osteopenia e osteoporose em faixas etárias mais avancadas.