Low intake of dietary fibre among Brazilian adolescents and association with nutritional status: cross-sectional analysis of Study of Cardiovascular Risks in Adolescents data.

OBJECTIVE: To evaluate dietary fibre intake in Brazilian adolescents and its association with nutritional status. DESIGN: This was a cross-sectional study including data from the Brazilian multicentre Study of Cardiovascular Risks in Adolescents (ERICA). Data analysed were geographic region, sex, age, nutritional status, sexual maturation stage, socioeconomic status, school type and level of physical activity. For nutritional status classification, BMI/age was used by sex. Dietary intake was assessed by 24-h recall. Dietary fibre intake was expressed in g/d, and adequacy was determined using dietary reference intake (DRI) values. Complex sample design was considered in statistical analysis, and logistic regression was used to estimate OR for fibre intake and nutritional status. SETTING: Brazilian municipalities with more than 100 000 inhabitants. PARTICIPANTS: A total of 71 740 adolescents aged 12-17 years were included. RESULTS: The average total dietary fibre intake was 19·1 g/d (95 % CI 18·5, 19·7), and only 13·1 % (95 % CI 11·6, 14·7) of Brazilian adolescents reached the recommendations. The results of logistic regression analysis adjusted for geographic region, sex and type of school showed that overweight and obese adolescents were 1·6 and 1·8 times more likely, respectively, to have inadequate dietary fibre intake (P < 0·0001). CONCLUSIONS: Brazilian adolescents had a significantly inadequate dietary fibre intake. This was particularly notable in adolescents with excess weight. Education policies on nutrition must be implemented, as dietary fibre plays an important role in the prevention and treatment of obesity and other chronic diseases.

Waist-to-Height Ratio as a Predictor of C-Reactive Protein Levels.

BACKGROUND: C-reactive protein is an acute-phase protein that has been found in association with adiposity and cardiovascular disease risk. In this paper, the objective was to assess the relationship of C-reactive protein to four anthropometric measurements: body mass index, waist-to-height ratio, C index, and waist circumference. METHODS: A cross-sectional random sample of the Study of Cardiovascular Risk in Adolescents (Portuguese acronym "ERICA") was included in the study. The analysis was adjusted for the complex sampling design. Poisson regression models with robust variance were used to estimate a multivariate-adjusted prevalence rate ratio expressing the relationship of each anthropometric measure to C-reactive protein. We evaluated adolescents aged 12 to 17 years participating in the capital of Porto Alegre, Brazil. RESULTS: In all, 778 adolescents were included (60% female, 58% aged 15-17 years). Waist-to-height ratio was found to be the strongest adiposity marker associated with C-reactive protein even after adjusting for age, sex, smoking, physical activity, and insulin resistance (prevalence rate ratio = 7.09; 95% confidence interval, 5.01-9.18; p < 0.001). CONCLUSIONS: Waist-to-height ratio is a strong predictor of C-reactive protein in adolescents in Porto Alegre, Brazil.

The Study of Cardiovascular Risk in Adolescents--ERICA: rationale, design and sample characteristics of a national survey examining cardiovascular risk factor profile in Brazilian adolescents.

BACKGROUND: The Study of Cardiovascular Risk in Adolescents (Portuguese acronym, "ERICA") is a multicenter, school-based country-wide cross-sectional study funded by the Brazilian Ministry of Health, which aims at estimating the prevalence of cardiovascular risk factors, including those included in the definition of the metabolic syndrome, in a random sample of adolescents aged 12 to 17 years in Brazilian cities with more than 100,000 inhabitants. Approximately 85,000 students were assessed in public and private schools. Brazil is a continental country with a heterogeneous population of 190 million living in its five main geographic regions (North, Northeast, Midwest, South and Southeast). ERICA is a pioneering study that will assess the prevalence rates of cardiovascular risk factors in Brazilian adolescents using a sample with national and regional representativeness. This paper describes the rationale, design and procedures of ERICA. METHODS/DESIGN: Participants answered a self-administered questionnaire using an electronic device, in order to obtain information on demographic and lifestyle characteristics, including physical activity, smoking, alcohol intake, sleeping hours, common mental disorders and reproductive and oral health. Dietary intake was assessed using a 24-hour dietary recall. Anthropometric measures (weight, height and waist circumference) and blood pressure were also be measured. Blood was collected from a subsample of approximately 44,000 adolescents for measurements of fasting glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, glycated hemoglobin and fasting insulin. DISCUSSION: The study findings will be instrumental to the development of public policies aiming at the prevention of obesity, atherosclerotic diseases and diabetes in an adolescent population.

Caffeine consumption and association with sleep duration and screen time in Brazilian adolescents (ERICA Study).

OBJECTIVES: Some studies have demonstrated that caffeine consumption is a risk factor for insufficient sleep or poor sleep quality in adolescents. The aim of this study was to estimate the average daily caffeine consumption and to investigate the association between caffeine, sleep duration, and screen time in a large sample of Brazilian adolescents. METHODS: We evaluated data from 71 533 adolescents aged 12 to 17 y, who participated in the ERICA study (Study of Cardiovascular Risk in Adolescents). Caffeine intake was extracted from 24-h dietary recalls of caffeine-containing products. The mean daily intake of caffeine/mg and caffeine/mg/kg, the prevalence of caffeine intake, and their respective 95% confidence intervals (CIs) were estimated according to the general characteristics. Associations between caffeine consumption, sleep duration, and screen time were analyzed by a multinomial logistic regression model, considering P < 0.05. RESULTS: The overall average daily caffeine intake was 99.45 mg (95% CI, 91.43-107.47) and 1.88 mg/kg (95% CI, 1.71-2.04). Daily caffeine intake >3 mg/kg was significantly associated with screen time ≤2 h/d (odds ratio [OR], 1.16; 95% CI, 1.06-1.26) and sleep duration ≥8 h (OR, 1.31; 95% CI, 1.17-1.46), which remained significant after adjustment. The time of day of the highest caffeine consumption was in the morning (05:00-12:59). The most consumed caffeine-containing product was coffee (35%), followed by soda (27%). CONCLUSIONS: This study demonstrated that caffeine consumption does not interfere with sleep duration or screen time. Moreover, the study provided important information about the source of caffeine most consumed by Brazilian adolescents, which could help professionals plan appropriate caffeine consumption.

Association between polyunsaturated fatty acids intake and insulin resistance in Brazilian adolescents (ERICA Study).

OBJECTIVE: Some studies have proposed a beneficial effect of polyunsaturated fatty acid (PUFA) intake with regard to insulin sensitivity. The aim of this study was to estimate the energy percentage and the daily PUFA intake to investigate the association between PUFAs and insulin resistance in a large sample of Brazilian adolescents. METHODS: We evaluated 37 023 adolescents ages 12 to 17 y, who were participants in ERICA (Study of Cardiovascular Risk in Adolescents). Energy percentage and PUFA daily intake were extracted from a 24-h dietary recall. The mean daily intake of total fat, median, and the respective 95% confidence intervals (95% CI) of daily intake of linoleic acid (LA), α-linolenic acid (ALA) and the ratio of LA to ALA were estimated according to sociodemographic variables. Associations of PUFA and markers of glucose homeostasis were analyzed by Poisson regression model. RESULTS: Mean total fat intake was 30.1% of energy (95% CI, 29.9-30.4). Most participants met the current recommended values of PUFA and LA/ALA ratio ranging from 5:1 to 10:1 (80.9%, 95% CI, 79.8-81.8). ALA intake was inversely associated with higher waist circumference (prevalence ratio [PR], 0.996; 95% CI, 0.994-0.998). LA/ALA ratio ≥9:1 was significantly associated with higher levels of homeostasis model assessment of insulin resistance (HOMA-IR; PR, 1.01; 95% CI, 1.006-1.02), and ratio >10:1 also showed significant association with higher levels of HOMA-IR (PR, 1.02; 95% CI, 1.01-1.03) and glycated hemoglobin (PR, 1.14; 95% CI, 1.04-1.26). These associations remained significant after adjustment. CONCLUSION: Promotion of ALA intake and balanced LA/ALA ratio should be considered as a possible health strategy aimed at contributing to better control of glucose homeostasis and insulin resistance in adolescents.

ERICA: prevalence of fish consumption and its association with cardiovascular risk factors and healthy behavior in Brazilian adolescents.

OBJECTIVE: To describe the prevalence of fish consumption and its association with cardiovascular risk factors and healthy behavior in Brazilian adolescents. METHOD: The authors investigated data from 71,533 participants of the Study of Cardiovascular Risk in Adolescents (Estudo de Riscos Cardiovasculares em Adolescentes - ERICA), a nationwide, cross-sectional, school-based study. Of these, 37,815 adolescents were included for blood analyses. All prevalence estimates were presented proportionally with their 95% confidence intervals. Bivariate relationships were evaluated with Pearson's Chi-square test, and a multinomial logistic regression model was applied, considering p < 0.05. RESULTS: Prevalence of fish consumption in the 7 days prior to the interview was 28.6% (95%CI 26.9-30.3), significantly higher among male adolescents (p = 0.0049), Asian descendants (p = 0.0270), private and rural school students (p < 0.001), and who resided in the Northern region (p < 0.001). A positive association between fish consumption and healthy behavior (breakfast consumption: OR=1.16; 95%CI 1.10-1.22; meals with family members: lunch: OR = 1.07; 95%CI 1.01-1.13; dinner: OR = 1.13; 95%CI 1.04-1.23; physical activity: OR = 1.14; 95%CI 1.02-1.28) and an inverse association with hypertriglyceridemia (OR = 0.84; 95%CI 0.73-0.98) remained significant even after adjustment for possible confounding factors. CONCLUSION: This study demonstrated that fish consumption was associated with lower cardiovascular risk and may represent a marker of a healthy lifestyle in Brazilian adolescents.

Adolescents Emotional State and Behavioral and Dietary Habit Changes during Isolation Due to the COVID-19 Pandemic.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) was recognized as a pandemic by the World Health Organization on March 11, 2020. As an infectious disease with no specific treatment, several measures have been established to minimize the outbreak of this disease, including social isolation. OBJECTIVE: To evaluate the behavior of adolescents during the isolation period. METHODS: This is a cross-sectional descriptive study conducted at the Adolescent Health Studies Center. Data were obtained from a questionnaire prepared on Google Forms, sent by a multiplatform instant messaging application, and analyzed using the Stata 14 software. RESULTS: A total of 208 adolescents with a mean age of 15.3 years (SD ± 1.8) answered the questionnaire, 57.7% were female. About 93.3% of adolescents said they were in isolation with a changed routine, 67.3% increased their food consumption, 86.5% were inactive, and 58.7% reported screen time over 8 h/d. There was an association between anxiety and increased food consumption (odds ratio: 3.9; CI 95% 2-7.5; p = 0.00), sleeping difficulty (odds ratio: 3.6; CI 95% 1.9-6.8; p = 0.00), and conflicting family relationship (odds ratio: 5.7; CI 95% 1.6-7.8; p = 0.01). CONCLUSION: The study revealed that social isolation due to an infectious disease was associated with several effects on the behavior and eating behavior of adolescents, which need to be acknowledged to encourage them to lead a healthy lifestyle after the COVID-19 confinement.

RELATIONSHIP BETWEEN FIBER INTAKE AND CARDIOVASCULAR RISK FACTORS IN ADOLESCENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS.

OBJECTIVE: To evaluate the fiber intake and the relationship with cardiovascular risk factors in adolescents with juvenile systemic lupus erythematosus. METHODS: This is a cross-sectional in which adolescents with juvenile systemic lupus erythematosus were evaluated. The dietary consumption was assessed by the 24-hour recall; nutritional status was classified according to the Body Mass index/Age by Sex; abdominal obesity was assessed through waist circumference, waist-to-height ratio and glucose and lipid metabolism. The data were analyzed using Statistical Software for Professionals 14 and all statistical analyses used an alpha error of 5%. RESULTS: 52 patients were evaluated, with a mean age of 16.7±1.5 years. Inadequate fiber consumption occurred in 61.5% (n=32) of them. Average of waist circumference measures (81.4 vs. 75.5 cm; p=0.02), waist-to-height ratio (0.51 vs. 0.47; p=0.02) and systolic blood pressure (122.1 vs. 114.8 mmHg; p=0.03) were higher in those who had inadequate fiber intake. Among the cardiovascular risk factors evaluated, the waist/height ratio showed a significant negative correlation with fiber consumption (r=-0.3; p=0.04), that is, the higher the fiber consumption, the lower the value of the waist ratio /stature. CONCLUSIONS: Low dietary fiber intake in adolescents with systemic lupus erythematosus juvenile is related to higher abdominal adiposity and consequently with increased cardiovascular risk.

Cutoff values for HOMA-IR associated with metabolic syndrome in the Study of Cardiovascular Risk in Adolescents (ERICA Study).

OBJECTIVE: The aim of this study was to determine the distribution of homeostatic model assessment of insulin resistance (HOMA-IR) values and define its cutoff associated with metabolic syndrome (MetS) in the participants of the Study of Cardiovascular Risk in Adolescents (Estudo de Risco Cardiovascular em Adolescentes). METHODS: MetS was defined according to the International Diabetes Federation criteria. HOMA-IR values were calculated and tabulated by corresponding percentiles for age and sex. Receiver operating characteristic curves were constructed to identify the optimal cutoff values of HOMA-IR associated with MetS in the total population and by sex. RESULTS: We evaluated 37 815 adolescents ages 12 to 17 y. The highest HOMA-IR medians were found among girls and boys ages 12 and 14 y, respectively. Thereafter, values tended to decrease with age. The optimal cutoff values of the HOMA-IR associated with MetS in the total population, in female adolescents, and in male adolescents were 2.80, 2.32, and 2.87, respectively. Insulin resistance was prevalent in 19.1% (95% confidence interval, 17.7-20.7) of the total population, and the prevalence was higher among girls and overweight Brazilian adolescents. CONCLUSIONS: These findings may serve as new reference points for detecting insulin resistance in Brazilian adolescents.

Prevalence and factors associated with hypovitaminosis D in adolescents from a sunny country: Findings from the ERICA survey.

Vitamin D plays a role in bone and metabolic health in life long, however hypovitaminosis D is common in different settings. The aim of this study was to describe vitamin D status among adolescents from a large sunny country and analyze associated factors. This was a multicenter, cross-sectional, school-based study. A total of 1152 adolescents age 12-17 from four Brazilian cities, Rio de Janeiro, Fortaleza, Brasília, and Porto Alegre, were included. Anthropometric variables, diet, type of school, race and season of data collection were evaluated. Serum concentrations of 25-hydroxyvitamin D [25(OH)D] were measured and categorized into three levels: ≤ 20 ng/mL, 21-29 ng/mL and ≥ 30 ng/mL. Ordered logistic regression models were used to explore the factors associated with hypovitaminosis D. The prevalence of vitamin D levels below 20 ng/mL, between 21 and 29 ng/mL and above 30 ng/mL was 21 % (95 %CI: 19 %-24 %), 42 % (95 %CI: 39 %-46 %) and 37 % (95 %CI: 33 %-40 %), respectively. In the final adjusted model, hypovitaminosis D was positively associated with gender, center (latitudes), data collected in winter or spring, non-whites, and private school students. A higher proportional odds ratio (POR) for hypovitaminosis D was found among obese boys (POR = 2.2, 95 %CI: 1.1-4.5), but not girls. Adequate dietary intake of vitamin D was a protective factor (POR = 0.4, 95 %CI: 0.2-0.6) against hypovitaminosis D. In conclusion, there is a high prevalence of Brazilian adolescents at risk of hypovitaminosis D, independent of region. Due to their potential benefits, lifestyle changes should be stimulated, including healthier food choices and spending more time outdoors (with sun protection).

Correlation between vitamin D and blood pressure in adolescents.

Introduction Low serum levels of vitamin D have been associated with hypertension worldwide. Hypovitaminosis D has been observed even in countries with high incidence of sunlight all year round. Several studies demonstrated a high prevalence of deficiency/insufficiency of vitamin D in adolescents. Objective To investigate the association between the nutritional status of vitamin D with anthropometric measures and blood pressure in overweight adolescents. Methods This a descriptive and cross-sectional study with overweight adolescents of both sexes aged 12-19 years. The anthropometric data, biochemical profile, blood pressure and serum vitamin D dosage were analyzed. The chi-squared test for verification of association and Student's t-test to compare medians between variables were used. Results There were high frequencies of hypovitaminosis D (34%) and hypertension (43.3%) in overweight adolescents. We observed an inverse correlation between serum vitamin D levels and BP (r = -0.28, p = 0.005). Patients with desirable serum vitamin D had lower body mass index values (31.3 kg/m2 vs. 33.9 kg/m2; p < 0.02), waist circumference (95.2 cm vs. 101.1 cm; p < 0.03), waist-to-height ratio (0.58 vs. 0.61; p < 0.03) and systolic blood pressure (120 mm Hg vs. 127.6 mm Hg; p = 0.007). Conclusions High frequency of vitamin D deficiency is associated with increased BP and adiposity in overweight adolescents.

Dyslipidemia in Adolescents Seen in a University Hospital in the city of Rio de Janeiro/Brazil: Prevalence and Association.

BACKGROUND: Early exposure to obesity favors greater risks of cardiovascular factors such as dyslipidemia. OBJECTIVES: To establish the prevalence of dyslipidemia, and to evaluate its association with nutritional status of the adolescents attended at the ambulatory of the Adolescent Health Studies Center of the University Hospital Pedro Ernesto. METHODS: This is a cross-sectional, observational study, the sample of which was of convenience, consisting of adolescents from 12 to 18 years old of both genders. The lipid profile was evaluated, along with its association with the anthropometric indicators: body mass index and waist circumference. For statistical analysis, a significance level of 5% was used. RESULTS: A total of 239 adolescents, 104 boys (43.5%) and 135 girls (56.5%) were evaluated and, of these, 52 (21.8%) were eutrophic, 60 (25.1%) overweight, and 127 (53.1%) obese. Obeseadolescents had significantly lower mean values of HDL-cholesterol (44.7 mg/dl vs 53.9 mg/dl; p < 0.001) and higher triglycerides (109.6 mg/dl vs 87.3 mg/dl; p = 0.01). The changes with higher prevalence were low HDL-cholesterol (50.6%), hypercholesterolemia (35.1%), and hypertriglyceridemia (18.4%). A negative association of HDL-cholesterol with body mass index and a positive association of triglycerides with body mass index could be observed, even after adjustment for gender and skin color. CONCLUSION: This study demonstrated high prevalence of dyslipidemia among adolescents. In view of the significant association between lower levels of HDL-cholesterol and increased triglycerides with overweight, the control of these factors should receive attention, with the precocious diagnosis of the dyslipidemia being important, mainly if it is associated with another cardiovascular risk, to develop effective intervention strategies.

Physical activity but not sedentary time is associated with vitamin D status in adolescents: study of cardiovascular risk in adolescents (ERICA).

BACKGROUND/OBJECTIVES: The association between active lifestyle components and vitamin D status in adolescents remains relatively unexplored. We aimed to investigate independent and joint associations of moderate-to-vigorous physical activity (MVPA) and screen time with serum 25-hydroxyvitamin D [25(OH)D] concentrations in adolescents. METHODS: This multicenter cross-sectional study involved 1152 Brazilian adolescents (age 12-17 years). Serum 25(OH)D was measured in a single laboratory and categorized as ≤20, 21-29, or ≥30 ng/mL. Demographic and lifestyle characteristics were assessed by self-reports. Ordered logistic regression was used to investigate potential associations of being physically active (MVPA ≥ 300 min/week) and excessive screen time (>2 h/day) with serum 25(OH)D concentrations. RESULTS: The prevalence of higher serum 25(OH)D concentrations (≥30 ng/mL) was 36.4%. In adjusted models, being physically active was associated with higher serum 25(OH)D concentrations only in boys [proportional odds ratio (POR) = 2.04, 95% CI 1.42-2.93], while excessive screen time was not associated with serum 25(OH)D. Adolescents who were physically active and limited their screen time had higher odds of a higher serum 25(OH)D concentration, but the association was significant only for boys (POR = 2.11, 95% CI 1.19-3.74). CONCLUSIONS: MVPA may play an important role in increasing serum 25(OH)D concentrations in adolescence, especially for boys, regardless of screen time.

ERICA: prevalence of fish consumption and its association with cardiovascular risk factors and healthy behavior in Brazilian adolescents

Abstract Objective: To describe the prevalence of fish consumption and its association with cardiovascular risk factors and healthy behavior in Brazilian adolescents. Method: The authors investigated data from 71,533 participants of the Study of Cardiovascular Risk in Adolescents (Estudo de Riscos Cardiovasculares em Adolescentes - ERICA), a nationwide, cross-sectional, school-based study. Of these, 37,815 adolescents were included for blood analyses. All prevalence estimates were presented proportionally with their 95% confidence intervals. Bivariate relationships were evaluated with Pearson's Chi-square test, and a multinomial logistic regression model was applied, considering p < 0.05. Results: Prevalence of fish consumption in the 7 days prior to the interview was 28.6% (95%CI 26.9-30.3), significantly higher among male adolescents (p = 0.0049), Asian descendants (p = 0.0270), private and rural school students (p < 0.001), and who resided in the Northern region (p < 0.001). A positive association between fish consumption and healthy behavior (breakfast consumption: OR=1.16; 95%CI 1.10-1.22; meals with family members: lunch: OR=1.07; 95%CI 1.01-1.13; dinner: OR=1.13; 95%CI 1.04-1.23; physical activity: OR=1.14; 95%CI 1.02-1.28) and an inverse association with hypertriglyceridemia (OR = 0.84; 95%CI 0.73-0.98) remained significant even after adjustment for possible confounding factors. Conclusion: This study demonstrated that fish consumption was associated with lower cardiovascular risk and may represent a marker of a healthy lifestyle in Brazilian adolescents.

Challenges for conducting blood collection and biochemical analysis in a large multicenter school-based study with adolescents: lessons from ERICA in Brazil.

The Study of Cardiovascular Risk in Adolescents (ERICA) is a pioneering study that aimed to assess the prevalence of cardiovascular risk factors, including metabolic syndrome components in Brazilian adolescents. This study aims to describe the methodological aspects related to blood collection as well as to report pertaining results of the preparation, transport, storage, and exams in ERICA. Exams in ERICA were performed in a single laboratory and blood samples were collected in schools in a standardized manner. Logistics involved air transportation of samples to the reference laboratory with controlled temperature since sample collection. The serum was stored in local biorepositories in four centers to be used in future analyses. During the study, 284,247 exams were performed and rate of participation in exams was 56.2%, thus involving 40,732 adolescents. From the total, 92.6% of the samples reached the reference laboratory maintaining the temperature between 0-10°C. No clinical significant changes in results due to temperature changes were identified. External quality control recorded satisfactory results in 98.7% of the evaluations. Four biorepositories with samples of 7,785 adolescents were created. Thus, we can consider that the logistics adopted in ERICA was fairly successful and description of this as well as the difficulties experienced in Brazil can inform and facilitate the planning of future studies, especially in developing countries.

Relationship between fiber intake and cardiovascular risk factors in adolescents with systemic lupus erythematosus / Relação entre consumo de fibra e fatores de risco cardiovascular em adolescentes portadores de lúpus eritematoso sistêmico

ABSTRACT Objective: To evaluate the fiber intake and the relationship with cardiovascular risk factors in adolescents with juvenile systemic lupus erythematosus. Methods: This is a cross-sectional in which adolescents with juvenile systemic lupus erythematosus were evaluated. The dietary consumption was assessed by the 24-hour recall; nutritional status was classified according to the Body Mass index/Age by Sex; abdominal obesity was assessed through waist circumference, waist-to-height ratio and glucose and lipid metabolism. The data were analyzed using Statistical Software for Professionals 14 and all statistical analyses used an alpha error of 5%. Results: 52 patients were evaluated, with a mean age of 16.7±1.5 years. Inadequate fiber consumption occurred in 61.5% (n=32) of them. Average of waist circumference measures (81.4 vs. 75.5 cm; p=0.02), waist-to-height ratio (0.51 vs. 0.47; p=0.02) and systolic blood pressure (122.1 vs. 114.8 mmHg; p=0.03) were higher in those who had inadequate fiber intake. Among the cardiovascular risk factors evaluated, the waist/height ratio showed a significant negative correlation with fiber consumption (r=-0.3; p=0.04), that is, the higher the fiber consumption, the lower the value of the waist ratio /stature. Conclusions: Low dietary fiber intake in adolescents with systemic lupus erythematosus juvenile is related to higher abdominal adiposity and consequently with increased cardiovascular risk.

RESUMO Objetivo: Avaliar o consumo de fibras e analisar a sua relação com os fatores de risco cardiovascular em adolescentes portadores de lúpus eritematoso sistêmico juvenil. Métodos: Trata-se de um estudo transversal em que foram avaliados adolescentes com lúpus eritematoso sistêmico juvenil. O consumo alimentar foi avaliado pelo recordatório de 24 horas; o estado nutricional, classificado de acordo com o índice de massa corporal/idade, segundo o sexo; e a obesidade abdominal, analisada por meio da circunferência da cintura e razão cintura/estatura e do metabolismo glicídico e lipídico. Os dados foram analisados no Statistical Software for Professionals 14, e todas as análises estatísticas usaram erro alfa de 5%. Resultados: Foram avaliados 52 pacientes, com média de idade de 16,7±1,5 anos. O consumo inadequado de fibras ocorreu em 61,5% (n=32) dos adolescentes e evidenciou que a média das medidas da circunferência da cintura (81,4 vs. 75,5 cm; p=0,02), a relação cintura/estatura (0,51 vs. 0,47; p=0,02) e a pressão arterial sistólica (122,1 vs. 114,8 mmHg; p=0,03) foram maiores naqueles que tiveram consumo inadequado de fibras. Entre os fatores de risco cardiovascular avaliados, a relação cintura/estatura apresentou correlação negativa significante com consumo de fibras (r=-0,3; p=0,04). Ou seja, quanto maior o consumo de fibras, menor o valor da relação cintura/estatura. Conclusões: A baixa ingestão de fibras da dieta nos adolescentes com lúpus eritematoso sistêmico juvenil está relacionada com maior adiposidade abdominal e, consequentemente, com maior risco cardiovascular.

ERICA: intake of macro and micronutrients of Brazilian adolescents.

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.

ERICA: prevalences of hypertension and obesity in Brazilian adolescents.

OBJECTIVE To estimate the prevalence of arterial hypertension and obesity and the population attributable fraction of hypertension that is due to obesity in Brazilian adolescents. METHODS Data from participants in the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA), which was the first national school-based, cross-section study performed in Brazil were evaluated. The sample was divided into 32 geographical strata and clusters from 32 schools and classes, with regional and national representation. Obesity was classified using the body mass index according to age and sex. Arterial hypertension was defined when the average systolic or diastolic blood pressure was greater than or equal to the 95th percentile of the reference curve. Prevalences and 95% confidence intervals (95%CI) of arterial hypertension and obesity, both on a national basis and in the macro-regions of Brazil, were estimated by sex and age group, as were the fractions of hypertension attributable to obesity in the population. RESULTS We evaluated 73,399 students, 55.4% female, with an average age of 14.7 years (SD = 1.6). The prevalence of hypertension was 9.6% (95%CI 9.0-10.3); with the lowest being in the North, 8.4% (95%CI 7.7-9.2) and Northeast regions, 8.4% (95%CI 7.6-9.2), and the highest being in the South, 12.5% (95%CI 11.0-14.2). The prevalence of obesity was 8.4% (95%CI 7.9-8.9), which was lower in the North region and higher in the South region. The prevalences of arterial hypertension and obesity were higher in males. Obese adolescents presented a higher prevalence of hypertension, 28.4% (95%CI 25.5-31.2), than overweight adolescents, 15.4% (95%CI 17.0-13.8), or eutrophic adolescents, 6.3% (95%CI 5.6-7.0). The fraction of hypertension attributable to obesity was 17.8%. CONCLUSIONS ERICA was the first nationally representative Brazilian study providing prevalence estimates of hypertension in adolescents. Regional and sex differences were observed. The study indicates that the control of obesity would lower the prevalence of hypertension among Brazilian adolescents by 1/5.

ERICA: prevalence of metabolic syndrome in Brazilian adolescents.

OBJECTIVE To determine the prevalence of metabolic syndrome and its components in Brazilian adolescents. METHODS We evaluated 37,504 adolescents who were participants in the Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional, school-based, national study. The adolescents, aged from 12 to 17 years, lived in cities with populations greater than 100,000 inhabitants. The sample was stratified and clustered into schools and classes. The criteria set out by the International Diabetes Federation were used to define metabolic syndrome. Prevalences of metabolic syndrome were estimated according to sex, age group, school type and nutritional status. RESULTS Of the 37,504 adolescents who were evaluated: 50.2% were female; 54.3% were aged from 15 to 17 years, and 73.3% were from public schools. The prevalence of metabolic syndrome was 2.6% (95%CI 2.3-2.9), slightly higher in males and in those aged from 15 to 17 years in most macro-regions. The prevalence was the highest in residents from the South macro-region, in the younger female adolescents and in the older male adolescents. The prevalence was higher in public schools (2.8% [95%CI 2.4-3.2]), when compared with private schools (1.9% [95%CI 1.4-2.4]) and higher in obese adolescents when compared with nonobese ones. The most common combinations of components, referring to 3/4 of combinations, were: enlarged waist circumference (WC), low HDL-cholesterol (HDL-c) and high blood pressure; followed by enlarged WC, low HDL-c and high triglycerides; and enlarged WC, low HDL-c, high triglycerides and blood pressure. Low HDL was the second most frequent component, but the highest prevalence of metabolic syndrome (26.8%) was observed in the presence of high triglycerides. CONCLUSIONS ERICA is the first Brazilian nation-wide study to present the prevalence of metabolic syndrome and describe the role of its components. Despite the prevalence of Metabolic Syndrome being low, the high prevalences of some components and participation of others in the syndrome composition shows the importance of early diagnosis of this changes, even if not grouped within the metabolic syndrome.