Anthropometric and body composition parameters in adolescents with the metabolically obese normal-weight phenotype.

We aimed to investigate the anthropometric and body composition parameters associated with the metabolically obese normal-weight (MONW) phenotype. This cross-sectional study was conducted with 506 adolescents in Brazil (aged 10-19 y). The MONW phenotype was defined as normal-weight, according to BMI/age, and at least one metabolic alteration. Anthropometric measurements were obtained and the DEXA was used for body composition analysis. Crude and adjusted Poisson regression models with robust variance were used to estimate the associations. The phenotype was positively associated with waist circumference (male: prevalence ratio (PR) = 1·05; 95% CI 1·01, 1·09; female: PR = 1·06; 95% CI 1·02, 1·09), waist:height ratio (male: PR = 1·26; 95% CI 1·07, 1·49; female: PR = 1·29; 95% CI 1·07, 1·56) and android:gynoid fat ratio (male: PR = 1·25; 95% CI 1·03, 1·51; female: PR = 1·39; 95% CI 1·20, 1·62), in both sexes. Furthermore, there was a positive association of phenotype with waist:hip ratio (PR = 1·32; 95% CI 1·06, 1·65) and trunk:arm fat ratio (PR = 1·13; 95% CI 1·02, 1·24) only in males and with trunk:leg fat ratio (PR = 2·84; 95% CI 1·46, 5·53), BAIp (PR = 1·06; 95% CI 1·01, 1·12), fat mass index (PR = 1·24; 95% CI 1·10, 1·41) and regional indices of metabolic load and capacity (PR = 1·29; 95% CI 1·09, 1·53), in females. Anthropometric and body composition parameters indicative of central and total fat are associated with the MONW phenotype.

Factors associated with normal-weight obesity in adolescents.

A new phenotype of obesity has been studied: normal-weight obesity (NWO), which describes individuals with normal-weight by BMI and excess body fat. Despite normal-weight, individuals with NWO have a higher cardiometabolic risk. There is still a gap in the literature on the subject, especially in adolescents, as studies with this population are scarce. This study aims to investigate the sociodemographic factors, family history of chronic non-communicable diseases, body perception, lifestyle and food consumption associated with NWO in adolescents. This is a cross-sectional study, with 506 normal-weight adolescents aged 10­19 years, of both sexes. Weight and height were obtained, and BMI/age was calculated. Body fat analysis was performed using dual-energy X-ray absorptiometry. Sociodemographic data, level of physical activity, food consumption, body self-perception and lifestyle habits were also obtained. Logistic regression with hierarchical approach was used to analyse the associations. The odds of NWO are greater with age (OR = 1·14; 95 % CI = 1·04, 1·26), lower in male adolescents (OR = 0·21; 95 % CI = 0·11, 0·41) and higher in those with a history of familial dyslipidemia (OR = 1·81; 95 % CI = 1·01, 3·28). Adolescents satisfied with their body (OR = 0·30; 95 % CI 0·16, 0·56) and physically active (OR = 0·44; 95 % CI = 0·24, 0·81) have a lower odds of NWO, compared with the others. In addition, it was observed that the odds of NWO is greater among adolescents who use sweeteners (sugar substitutes) (OR = 3·84; 95 % CI = 1·70, 8·65). The factors associated with NWO were female sex, older age, positive family history of dyslipidemia, lower body satisfaction, lower level of physical activity and greater use of sweeteners.

Eating contexts and their associations with socio-demographic factors in Brazilian adolescents (EVA-JF Study).

OBJECTIVE: To describe the eating contexts and estimate their associations with socio-demographic factors in a sample of Brazilian adolescents. DESIGN: Cross-sectional study. We used an exploratory questionnaire about eating contexts (encompassing regularity of meals, places where they occur and if they take place with attention and in company), which was submitted to cluster analysis. Subsequently, three clusters were identified: cluster 1, 'appropriate eating contexts at breakfast, lunch and dinner'; cluster 2, 'inappropriate eating context at breakfast' and cluster 3, 'inappropriate eating context at dinner'. Multinomial logistic regression models were performed, without and with adjustments, using cluster 1 as reference. SETTING: Twenty-nine public schools of Juiz de Fora, MG, Southeast Brazil. PARTICIPANTS: Adolescents, 14-19-year-olds (n 835). RESULTS: We observed relevant prevalence of adolescents omitting breakfast (52·9 %) and dinner (39·3 %), and who had the habit of eating sitting/lying on the couch/bed or standing/walking, and in front of screens. Breakfast usually occurred unaccompanied (70·8 %); around half (47·5 %) and little over a third (36·1 %) of the sample also would usually have lunch and dinner unaccompanied, respectively. Furthermore, through multivariate analysis, we found associations of eating contexts clusters with female sex (more likely in clusters 2 and 3), age range 14-15-year-olds (less likely in cluster 2) and higher mother's schooling (more likely in cluster 3). CONCLUSIONS: We verified an alarming prevalence of adolescents with eating contexts unaligned with healthy eating recommendations. Additionally, inappropriate eating contexts at breakfast and/or at dinner were associated with socio-demographic factors (sex, age range and mother's schooling).

Eating contexts at breakfast, lunch, and dinner: Associations with ultra-processed foods consumption and overweight in Brazilian adolescents (EVA-JF Study).

This cross-sectional study estimated associations of eating contexts (including regularity of meals, places where they occur, and if they take place with attention and in company) with food consumption by degree of industrial processing and overweight indicators in a sample of Brazilian adolescents (14-19 years old) enrolled in 29 public schools in Juiz de Fora, MG (n = 805). We used an exploratory questionnaire, which was submitted to cluster analysis. Three clusters were identified: cluster 1 (n = 572), "appropriate eating contexts at breakfast, lunch, and dinner"; cluster 2 (n = 139), "inappropriate eating context at breakfast"; and cluster 3 (n = 94) "inappropriate eating context at dinner". The evaluation of food consumption involved two 24-h dietary recalls, whose items were analyzed according to the NOVA classification system. Linear regression models were performed, using cluster 1 as reference. Clusters 2 and 3 were associated with an increase in the energy fraction from ultra-processed foods [respectively, ß = 2.55% (IC 95%: 0.50; 5.05) and ß = 4.18% (IC 95%: 1.21; 7.14)]; and cluster 2 was associated with a reduction in the energy fraction from unprocessed or minimally processed foods and processed culinary ingredients [ß = -3.61% (IC 95%: -6.40; -0.82)]. Additionally, clusters 2 and 3 were associated with an increase of body mass index for age [respectively, ß = 0.23 z-score (IC 95%: 0.01; 0.46) and ß = 0.27 z-score (IC 95%: 0.02; 0.54)]; and cluster 2 was associated with an increase of body fat [ß = 1.21% (IC 95%: 0.23; 2.64)]. In conclusion, inappropriate eating contexts at breakfast and dinner were associated with higher ultra-processed food intake, higher body mass index and higher body fat percentage.

Ponderal index classifies obesity in children and adolescents more accurately than body mass index z-scores.

BACKGROUND: We aimed to compare the accuracy of the ponderal index (PI) vs. BMI-for-age z-scores transformed (BMIz) in estimating body fat levels and classifying obesity in children and adolescents from a Brazilian urban population. METHODS: This is a cross-sectional study with 1149 participants (53.2% male), aged 6 to 18 years. Body fat percent (BFP) was obtained by multi-frequency bioelectrical impedance. Non-linear regression analysis provided the accuracy of both BMIz and PI in estimating BFP. False positive rate was obtained from the proportion of individuals placed at or above the 95th percentile for BMIz or PI, whereas their BFP was discordantly below the 95th percentile. RESULTS: PI and BMIz appeared with similar stability from childhood to adolescence for both boys and girls. The portion of the variability in BFP explained by BMIz (R2 = 0.74 and R2 = 0.75) was close to the variability in BFP explained by PI (R2 = 0.73 and R2 = 0.75) for boys and girls, respectively. False positive rate was higher for BMIz compared with PI among boys (21.8% vs. 3.9%) and girls (28.5% vs. 17.5%). CONCLUSIONS: PI is a promising index for replacing BMIz in children and adolescents due to its potential to reduce false diagnosis of obesity.

Agreement of body adiposity index (BAI) and paediatric body adiposity index (BAIp) in determining body fat in Brazilian children and adolescents.

OBJECTIVE: To evaluate agreement of the body adiposity index (BAI) and paediatric body adiposity index (BAIp) in estimating body fat compared with dual-energy X-ray absorptiometry (DXA) and to propose cut-off points for these indices to classify excess adiposity in Brazilian children and adolescents. DESIGN: Cross-sectional study. Measures of weight, height, hip circumference, BMI and body fat percentage (%BF) assessed by DXA were taken, and BAI and BAIp were calculated. The Bland-Altman plot was used to estimate agreement between the methods, and the receiver-operating characteristic curve to determine the cut-off points for BAI and BAIp per age and sex in comparison with DXA. SETTING: Viçosa, Minas Gerais, Brazil. SUBJECTS: Children and adolescents aged 8-19 years (n 1049). RESULTS: Of the children and adolescents, 52·4 % were girls. BAI and BAIp had satisfactory performance by the receiver-operating characteristic curve, except for the 18-19 years age group, whose BAIp had better predictive capacity than BAI. The agreement analysis showed that BAI overestimated %BF by 2·64 %, on average, using DXA; while BAIp underestimated %BF by 3·37 %. CONCLUSIONS: BAI and BAIp showed low agreement with the body fat obtained by DXA, requiring caution when interpreting body composition data in children and adolescents.

Evaluation of lifestyle of female adolescents through latent class analysis approach.

BACKGROUND: Lack of regular physical activity, high sedentary behavior and presence of unbalanced alimentary practices are attitudes associated with an inadequate lifestyle among female adolescents. OBJECTIVE: to assess the lifestyle of female adolescents based on measurements of behavioral variables. METHODS: Cross-sectional study with 405 female adolescents between 14 and 19 years old, resident and attending public schools in Viçosa (state of Minas Gerais). Their lifestyle was analyzed by the Physical Activity Recall, number of steps, screen time (ST), cellphone time (CT), sitting time, food frequency questionnaire (FFQ), and alcohol and tobacco consumption. With multiple correspondence analysis it was possible to observe dispersion and approximation of the variables' categories. Latent class analysis (LCA) was used for modeling the "lifestyle" variable, having been conducted in the poLCA (Polychromous Variable Latent Class Analysis) package of the R statistical software. RESULTS: The mean age was 15.92 ± 1.27 years. Most of the adolescents were considered physically inactive (78%) and with low number of steps (82.57%); 41.45% reported not performing Moderate to Vigorous Physical Activities (MVPA) adequately. Sedentary behavior was found high when assessing ST (72.90%) and CT (65.31%). It was found the best fitted latent class model for the lifestyle (p-G2 = 0.055, p-χ2 = 0.066) featured three latent classes and one covariate (alcohol): Class 1, 'Inactive and Sedentary' (γ = 77.5%); Class 2, 'Inactive and Non-sedentary lifestyle (γ=16.31%); and Class 3, 'Active and sedentary' (γ=6.19%). Female adolescents that had 'never consumed alcohol' were 2.26 times as likely (log OR = 0.8174; p = 0.033) to belong to class 3 (Active & Sedentary lifestyle) than to class 1 (Inactive & Sedentary lifestyle). CONCLUSION: Latent class analysis model with five manifest variable (MVPA, number of steps, ST, sitting time and number of meals) and alcohol consumption like covariate showed itself to be an accurate and objective method in the assessment of female adolescents' lifestyle. Female adolescents that had 'never consumed alcohol' were more as likely to belong to class 'Active & Sedentary lifestyle' than to class Inactive & Sedentary lifestyle. An inactive and sedentary lifestyle is coupled to other unhealthy behaviors during adolescence, possibly carrying over into adult life.

Abundance of Gut Microbiota, Concentration of Short-Chain Fatty Acids, and Inflammatory Markers Associated with Elevated Body Fat, Overweight, and Obesity in Female Adolescents.

BACKGROUND AND AIMS: Overweight is ever more prevalent in the pediatric population, and this cardiometabolic factor can be associated with inflammatory markers, gut microbiota composition, and short-chain fatty acid (SCFA) concentrations. The aim of this study is to evaluate to what extent the abundance of gut microbiota phyla, SCFA concentrations, and inflammatory markers are associated with elevated body fat percentage (BF%), overweight, and obesity in female adolescents. METHODS: An experimental and comparative study was conducted with 96 girls 14 to 19 years old. They were divided into 3 groups: G1-eutrophic (EUT) and adequate BF%; G2-EUT and high BF%; and G3-overweight (OW) or obese (OB) and high BF%. Waist circumference (WC), waist to height ratio (WtHR), and neck circumference (NC) were analyzed as indicators of central visceral adiposity. The BF% was evaluated by DEXA equipment. A food frequency questionnaire was used to evaluate the main types of food consumed in a week. The abundance of the Firmicutes, Bacteroidetes, and Proteobacteria phyla was measured by real-time polymerase chain reaction (RT-qPCR), and the SFCA concentrations (acetic, butyric, and propionic) were determined by high-performance liquid chromatography (HPLC). The inflammatory markers leptin, tumor necrosis factor-alpha, interleukin-6, and high-sensitivity C-reactive protein (hs-CRP) were assessed. RESULTS: Female adolescents in groups G2 and G3 had greater central visceral adiposity and leptin concentration than those in group G1. No association was found between gut microbiota phyla abundance and SFCA concentrations in any of the groups. WC and frequency of consumption of oily and fatty foods were associated with Firmicutes abundance and SFCA concentrations. Girls with high WC also had the greatest leptin (p < 0.001) and hs-CRP (p = 0.035) concentrations. CONCLUSIONS: Inflammatory markers showed association with increased BMI and high BF% in female adolescents. The abundance of Firmicutes was associated with WC and NC, but not with BMI classification or BF%. Specifically, WC and the consumption of oils and fats showed correlation with SCFA concentrations. Different anthropometric indicators, such as NC and WC, should be incorporated into the clinical evaluation of the nutritional status of individuals in the adolescent population.

Frequency of breakfast consumption and its associations with food consumption by degree of industrial processing and with indicators of overweight in Brazilian adolescents (EVA-JF Study).

OBJECTIVE: The aim of this study was to investigate the frequency of breakfast consumption and estimate its associations with the consumption of food at different degrees of industrial processing and with overweight indicators in Brazilian adolescents. METHODS: This cross-sectional study involved a probabilistic sample of 14- to 19-y-old adolescents enrolled in 29 public schools in the municipality of Juiz de Fora, MG, Southeast Brazil (n = 805). The frequency of breakfast consumption was evaluated via a questionnaire (classified into "do not consume", "sometimes consume", and "regularly consume"). The evaluation of food consumption involved two 24-h dietary recalls, the items of which were analyzed according to the NOVA classification system. Overweight indicators (waist circumference, body mass index for age (BMI-for-age), and body fat percentage) were evaluated according to a standard protocol. Linear regression models were performed, first without and then with adjustments for sociodemographic characteristics. RESULTS: We found that 20% of adolescents skipped breakfast, and ∼46% of the caloric intake came from ultra-processed foods. Breakfast omission was associated with a mean increase of 3.02% (95% confidence interval [CI], 0.52-5.53) in energy intake from ultra-processed foods, in addition to a mean increase of 0.28 z-score (95% CI, 0.05- 0.52) of BMI-for-age and of 1.64% (95% CI, 0.21-3.08) in body fat. CONCLUSIONS: We verified that the omission of breakfast was associated with higher consumption of ultra-processed foods, as well as a higher BMI-for-age and higher percentage of body fat, reinforcing the importance of actions to encourage the consumption of this meal and the adoption of healthy eating practices in adolescents.

Involvement of Brazilian adolescents in home cooking: An exploratory analysis (EVA-JF Study).

OBJECTIVE: The aim of this study was to investigate the involvement of Brazilian adolescents in home cooking, estimating its associations with sex and socioeconomic status. METHODS: This cross-sectional study involved a probabilistic sample of 14- to 19-y-olds enrolled in 29 public schools in the municipality of Juiz de Fora, MG, Southeast Brazil (n = 835). To assess involvement in home cooking, a 12-question questionnaire was used. The content was based on the Brazilian Food Guide, which encourages the acquisition, development, and sharing of culinary skills. Pearson's χ test and Poisson regression models were carried out, without and with adjustments. RESULTS: Most of the adolescents did not usually participate in meal planning (61%), and in the choice/purchase of food and culinary ingredients (67%). Boys were less likely to know how to cook "from scratch", positively self-evaluate their culinary skills, enjoy cooking, wish to learn more about cooking and meal preparation, and to participate frequently in the planning and preparation of meals. Belonging to a lower socioeconomic status represented a greater probability of preparing meals alone for the family. CONCLUSIONS: We verified an alarming prevalence of adolescents with behaviors unaligned with Brazilian Food Guide recommendations; that is, most of them, especially boys, were not involved in home cooking. Adolescence may present a window of opportunity for the development of culinary skills, resulting in long-term benefits for the population's diet quality. Furthermore, to change a historical pattern that overloads women's daily lives, it is necessary to encourage, from an early age, the presence of boys in the kitchen.

Cardiometabolic risk in adolescents with normal weight obesity.

BACKGROUND: Normal weight obesity (NWO), which is defined by the excess of body fat in normal weight individuals, has been neglected among adolescents, due to their normal weight and young age. Few studies were carried out on the topic with adolescents. OBJECTIVE: To analyze whether the NWO is associated with cardiometabolic risk factors in adolescents. SUBJECTS/METHODS: Cross-sectional study, with 506 normal weight adolescents aged 10-19 years, selected in schools in Brazil. Weight, height, waist circumference (WC) and neck circumference were obtained and the body mass index (BMI) and waist/height ratio (WHR) were calculated. Body composition analysis was performed using dual-energy X-ray absorptiometry. The clinical evaluation included lipid and glycid profile, platelets, leukocytes, lymphocytes, monocytes, uric acid and blood pressure, as well as the presence of metabolic syndrome (MS) and its components. NWO was defined by the presence of normal weight, according to BMI for age, and excess body fat (≥25% and ≥30% in males and females, respectively). Logistic regression models were used to analyze associations between normal weight adolescents with and without the NWO phenotype. RESULTS: NWO associated positively with abdominal obesity, analyzed through WC (OR = 1.36;95%CI = 1.27-1.47), WHR (OR = 25.89;95%CI = 10.43-64.26) and android fat (OR = 1.49;95%CI = 1.36-1.63); insulin resistance (OR = 4.09;95%CI = 1.72-9.70), hyperinsulinemia (OR = 3.83;95%CI = 1.50-9.76) and the highest values of the triglycerides-glycemia index (OR = 4.28;95%CI = 1.21-15.08); uric acid (OR = 1.81;95%CI = 1.29-2.55), as well as the changes in LDL (OR = 3.39;95%CI = 1.47-7.81), total cholesterol (OR = 2.77;95%CI = 1.22-6.29), and in at least one (OR = 1.87;95%CI = 1.04-3.37) or two (OR = 6.61;95%CI = 1.45-30.19) components of MS. CONCLUSION: NWO is associated with the presence of cardiometabolic risk factors in adolescents.

TRI-PONDERAL MASS INDEX IS USEFUL FOR SCREENING CHILDREN AND ADOLESCENTS WITH INSULIN RESISTANCE.

OBJECTIVE: To investigate whether tri-ponderal mass index and body mass index Z scores are equivalent for screening children and adolescents with insulin resistance. METHODS: Cross-sectional study with 296 children and adolescents enrolled at public schools of Vitória, Espírito Santo, Brazil, aged eight to 14 years. The tri-ponderal mass index was calculated as the ratio between weight and height cubed. The body mass index was calculated as the ratio between weight and height squared. Insulin resistance was defined with the homeostatic model assessment (HOMA-IR). RESULTS: The HOMA-IR was higher in the 4th quartile of body mass index Z scores and tri-ponderal mass index compared to 1st and 2nd quartiles for both girls and boys. The areas under the age-adjusted receiver operating characteristic curves were similar between the indices for girls (body mass index Z scores=0.756; tri-ponderal mass index=0.763) and boys (body mass index Z scores=0.831; tri-ponderal mass index=0.843). In addition, according to the simple linear regression analyses estimations, both body mass index Z scores and tri-ponderal mass index explained a significant fraction of the homeostatic model assessment variability for girls (body mass index Z scores: R2=0.269; tri-ponderal mass index: R2=0.289; p<0.001) and boys (body mass index Z scores: R2=0.175; tri-ponderal mass index: R2=0.210; p<0.001). CONCLUSIONS: The tri-ponderal mass index and body mass index Z scores were similar to discriminate children and adolescents with insulin resistance. It is noteworthy that the use of tri-ponderal mass index is clearly advantageous, because it can be calculated with no concerns on adjustments for the age, a fact that makes it very applicable in the clinical practice.

Waist-to-height ratio is as reliable as biochemical markers to discriminate pediatric insulin resistance.

OBJECTIVE: Given the importance of incorporating simple and low-cost tools into the pediatric clinical setting to provide screening for insulin resistance, the present study sought to investigate whether waist-to-height ratio is comparable to biochemical markers for the discrimination of insulin resistance in children and adolescents. METHODS: This cross-sectional study involved students from nine public schools. In total, 296 children and adolescents of both sexes, aged 8-14 years, composed the sample. Waist-to-height ratio, triglycerides/glucose index, and triglycerides-to-HDL-C ratio were determined according to standard protocols. Insulin resistance was defined as homeostatic model assessment for insulin resistance with cut-off point ≥ 3.16. RESULTS: Age, body mass index, frequency of overweight, waist circumference, waist-to-height ratio, insulin, glucose, homeostatic model assessment for insulin resistance, triglycerides, triglycerides/glucose index, and triglycerides-to-HDL-C were higher among insulin resistant boys and girls. Moderate correlation of all indicators (waist-to-height ratio, triglycerides/glucose index, and triglycerides-to-HDL-C ratio) with homeostatic model assessment for insulin resistance was observed for both sexes. The areas under the receiver operational characteristic curves ware similar between waist-to-height ratio and biochemical markers. CONCLUSION: The indicators provided similar discriminatory power for insulin resistance. However, taking into account the cost-benefit ratio, we suggest that waist-to-height ratio may be a useful tool to provide screening for insulin resistance in pediatric populations.

Static cut-points of hypertension and increased arterial stiffness in children and adolescents: The International Childhood Vascular Function Evaluation Consortium.

Pediatric elevated blood pressure (BP) and hypertension are usually defined using traditional BP tables at the 90th and 95th percentiles, respectively, based on sex, age, and height, which are cumbersome to use in clinical practice. The authors aimed to assess the performance of the static cut-points (120/80 mm Hg and 130/80 mm Hg for defining elevated BP and hypertension for adolescents, respectively; and 110/70 mm Hg and 120/80 mm Hg for children, respectively) in predicting increased arterial stiffness. Using data from five population-based cross-sectional studies conducted in Brazil, China, Korea, and New Zealand, a total of 2546 children and adolescents aged 6-17 years were included. Increased arterial stiffness was defined as pulse wave velocity ≥sex-specific, age-specific, and study population-specific 90th percentile. Compared to youth with normal BP, those with hypertension defined using the 2017 American Academy of Pediatrics guideline (hereafter referred to as "percentile-based cut-points") and the static cut-points were at similar risk of increased arterial stiffness, with odds ratios and 95% confidence intervals of 2.35 (1.74-3.17) and 3.07 (2.20-4.28), respectively. Area under the receiver operating characteristic curve and net reclassification improvement methods confirmed the similar performance of static cut-points and percentile-based cut-points (P for difference > .05). In conclusion, the static cut-points performed similarly well when compared with the percentile-based cut-points in predicting childhood increased arterial stiffness. Use of static cut-points to define hypertension in childhood might simplify identification of children with abnormal BP in clinical practice.

BODY DISSATISFACTION, PHYSICAL ACTIVITY, AND SEDENTARY BEHAVIOR IN FEMALE ADOLESCENTS. / INSATISFAÇÃO CORPORAL, NÍVEL DE ATIVIDADE FÍSICA E COMPORTAMENTO SEDENTÁRIO EM ADOLESCENTES DO SEXO FEMININO.

OBJECTIVE: To evaluate the association of body image with physical activity level, body composition, and sedentary behavior (SB) of female adolescents. METHODS: Exploratory cross-sectional study conducted with 120 female adolescents aged between 14-19 years, from the city of Viçosa, Minas Gerais, Southeast Brazil. Body image was evaluated with a Body Silhouette Scale (BSS) and a Body Shape Questionnaire (BSQ). Weight, height, and waist circumference values were analyzed, as well as the waist-to-height ratio and body fat percentage. The physical activity level (PAL) was assessed by 24-hour Physical Activity Recall and SB by screen time, that is, time spent in front of a TV, playing video game, on the computer and using tablets, and, separately, the cell phone time. RESULTS: Mean age was 16.5±1.5 years, and most adolescents were eutrophic (77.6%), sedentary/low PAL (84.2%), with high screen time (85.2%) and cell phone time (58.7%). Body dissatisfaction was stated in 40.6% of BSQ and 45.8% of BSS evaluations. Body distortion was identified in 52.9% of participants. All body composition measures, along with cell phone time and PAL, were associated with body dissatisfaction, the more active adolescents presenting higher levels of dissatisfaction. CONCLUSIONS: This study concluded that female adolescents with higher cell phone time also present higher body dissatisfaction, as well as the most physically active ones. All body composition measurements were associated with body dissatisfaction, mainly body mass index, waist circumference, and waist-to-height ratio.

OBJETIVO: Avaliar a associação da imagem corporal com o nível de atividade física, composição corporal e o comportamento sedentário de adolescentes do sexo feminino. MÉTODOS: Estudo transversal e exploratório com 120 adolescentes do sexo feminino, de 14 a 19 anos, de Viçosa, MG. A imagem corporal foi avaliada por uma Escala de Silhuetas e pelo Body Shape Questionnaire (BSQ). O peso, a estatura e o perímetro da cintura foram aferidos, avaliando-se a relação cintura estatura e o percentual de gordura corporal. O nível de atividade física (NAF) foi avaliado pelo Recordatório de Atividade Física de 24h (R24h) e o comportamento sedentário, pelo tempo em frente à tela de uma TV, jogando videogame, ao computador e usando tablets e, separadamente, o tempo de tela ao celular. RESULTADOS: A média de idade foi 16,5±1,5 anos, sendo a maioria das participantes eutróficas (77,6%), sedentárias/baixo NAF (84,2%), com tempo de tela (85,2%) e tempo de celular (58,7%) elevados. A insatisfação corporal manifestou-se em 40,6% pelo BSQ e em 45,8% pela Escala de Silhuetas. A distorção corporal manifestou-se em 52,9% das participantes. As medidas de composição corporal, juntamente com o tempo ao celular e o NAF, mostraram associação com a insatisfação corporal, sendo as adolescentes mais ativas as mais insatisfeitas. CONCLUSÕES: O estudo mostrou que as adolescentes com maior tempo ao celular tinham maior insatisfação corporal, assim como as fisicamente mais ativas. Todas as medidas de avaliação da composição corporal mostraram-se associadas ao nível de insatisfação, principalmente o índice de massa corporal, perímetro da cintura e relação cintura-estatura.

Dificuldades financeiras, aspectos alimentares e de saúde em estudantes universitários, durante a pandemia de Covid-19 / Financial difficulties, dietary and health aspects in university students during the Covid-19 pandemic

Introdução: As dificuldades financeiras advindas da pandemia, em virtude de mudanças econômicas do país, além de refletirem no estado de segurança alimentar e nutricional e no estado de saúde dos indivíduos, acarretaram o aumento da evasão dos cursos superiores. Objetivo: Verificar a associação entre as dificuldades financeiras, durante a pandemia de Covid-19, com os aspectos alimentares e de saúde dos graduandos da Universidade Federal de Juiz de Fora (UFJF). Método: Estudo transversal com graduandos da UFJF. Os dados foram coletados entre setembro de 2020 e março de 2021, através de questionário on-line. Utilizou-se Teste Qui-quadrado (p<0,05) para avaliar os fatores associados às dificuldades financeiras durante a pandemia. Verificou-se a razão de chances (Odds Ratio - OR) das associações encontradas. Resultados: Avaliaram-se 584 graduandos, dentre os quais se constatou que 31,7% passaram por dificuldades financeiras durante a pandemia. Notou-se que a presença de dificuldades financeiras no período pandêmico se associou positivamente à presença de Insegurança Alimentar e Nutricional (INSAN), à autopercepção negativa de saúde, à má qualidade do sono e às alterações de depressão, ansiedade e estresse. Além disso, os indivíduos caracterizados com dificuldades financeiras tinham maiores chances de apresentarem INSAN, percepção negativa de saúde, má qualidade do sono, bem como alterações nos níveis de depressão, ansiedade e estresse, quando comparados à sua contraparte. Conclusão: Conclui-se que as dificuldades financeiras durante o período pandêmico são associadas à presença de INSAN e aspectos de saúde alterados. Assim, ressalta-se a necessidade de criação de estratégias que visem à assistência financeira e psicológica dos graduandos.

Introduction: The financial difficulties caused by the pandemic due to economic changes in the country, in addition to affecting food and nutrition security and the state of health of individuals, resulted in greater evasion from higher education courses. Objective: To check the association between financial difficulties during the COVID-19 pandemic with the dietary and health aspects of undergraduate students from Universidade Federal de Juiz de Fora (Federal University of Juiz de Fora ­ UFJF). Methods: Transversal study with UFJF undergraduate students. The data were collected between September 2020 and March 2021, via an online survey. The chi-square test (p<0.05) was used to evaluate the factors associated with financial difficulties during the pandemic. We also checked the odds ratio (OR) for the associations found. Results: We assessed 584 undergraduate students, 31.7% of which were found to have gone through financial difficulties during the pandemic. We observed that the presence of financial difficulties in that period was positively associated with Food and Nutrition Insecurity (INSAN, Portuguese acronym), negative self-perception of health, bad sleep quality, and changes in depression, anxiety, and stress levels. Moreover, individuals characterized as having financial difficulties had a higher chance of having INSAN, negative perception of health, bad sleep quality, as well as changes in the levels of depression, anxiety, and stress, when compared to their counterparts. Conclusion: We concluded that financial difficulties during the pandemic period are associated with INSAN and affected health aspects. Therefore, we highlight that there is a need for the development of strategies which aim to provide financial and psychological assistance to undergraduate students.

Tradução e adaptação transcultural do Questionário de Escolhas Alimentares para Adolescentes Brasileiros (FCQ-A-BR) / Translation and cross-cultural adaptation of the Food Choice Questionnaire for Brazilian Adolescents (FCQ-A-BR)

Resumo Introdução Instrumentos que busquem conhecer os motivos que propiciam as escolhas alimentares em adolescentes são inexistentes no Brasil até o momento. O Food Choice Questionnaire (FCQ) para adolescentes é um questionário de fácil aplicação e que pode ser utilizado não somente em pesquisas, mas também nos serviços de atenção à saúde. Objetivo Descrever as etapas iniciais - validade de face e de conteúdo - do processo de tradução e adaptação transcultural do FCQ para adolescentes da versão em espanhol para o português do Brasil. Método Trata-se de um estudo metodológico de tradução e adaptação transcultural, em conformidade com as normas internacionais para tradução de instrumentos para validação. Foram seguidas quatro etapas: tradução, retradução, avaliação por comitê de especialistas e dois pré-testes, que foram realizados com adolescentes com idades entre 14 e 19 anos. Resultados Os itens e o título do instrumento foram traduzidos para o português. Alguns itens necessitaram de ajustes para melhor compreensão do público-alvo. O tempo médio de aplicação foi de sete minutos. Um item foi eliminado do questionário e modificou-se a escala de resposta para melhor adequação do instrumento. Conclusão O processo inicial de tradução e adaptação transcultural do Questionário de Escolhas Alimentares para Adolescentes Brasileiros (FCQ-A-BR) atestou as validades de face e conteúdo. No entanto, faz-se necessária a complementação das análises psicométricas, para utilização do instrumento, caso elas se mostrem satisfatórias.

Abstract Background Instruments that seek to find out the reasons that lead to food choices among adolescents are not yet available in Brazil so far. The Food Choice Questionnaire (FCQ) for adolescents is a simple questionnaire that can be used not only in research, but also in healthcare. Objective To describe the initial steps - face and content validity - of the process of translation and cross-cultural adaptation of the FCQ for adolescents from the Spanish version into Brazilian Portuguese. Method This is a methodological study of translation and cross-cultural adaptation, in accordance with international standards for translation of instruments for validation. Four steps were followed: translation, back-translation, evaluation by an expert committee and two pre-tests, which were carried out with adolescents aged between 14 and 19 years. Results The items and the instrument title were translated to Portuguese. Some items needed adjustments to better understand the target audience. The average application time was seven minutes. One item was eliminated from the questionnaire and the response scale was modified to better suit the instrument. Conclusion The initial process of translation and cross-cultural adaptation of the Food Choice Questionnaire for Brazilian Adolescents (FCQ-A-BR) attested to the face and content validity. However, it is necessary to complement the psychometric analyses, to use the instrument, if they are satisfactory.

Factors associated with non-frequent breakfast consumption in adolescents (EVA-JF Study) / Fatores associados ao consumo não frequente de café da manhã em adolescentes (Estudo EVA-JF)

ABSTRACT Objective To estimate the association of infrequent breakfast consumption with socioeconomic, behavioral, and individual factors in a sample of Brazilian adolescents from public schools. Methods Cross-sectional study with adolescents aged from 14 to 19 from public schools in Juiz de Fora, state of Minas Gerais. The frequency of consumption of breakfast, snacks, soft drinks, industrialized drinks, the usual food consumption, body mass index, body fat percentage, and waist circumference were evaluated. Other socioeconomic, behavioral, and individual data were obtained through questionnaires. Logistic regression analysis and hierarchical selection of variables were used to verify the associated factors. Results The sample consisted of 805 adolescents; 53.4% reported infrequent breakfast consumption. Through hierarchical logistic regression analysis, it was evidenced that the house occupancy status (OR: 0.618; 95%CI: 0.4410.865; p=0.005) was the distal factor associated with infrequent breakfast consumption; the intermediate factors were the consumption of industrialized beverages (OR: 0.658; 95%CI: 0.486-0.890; p=0.007) and percentage of energy from processed foods (OR: 0.935; 95%CI: 0.907-0.964; p<0.001); and the proximal factors were the male gender (OR: 0.696; 95%CI: 0.520-0.932; p=0.0015) and being nonwhite (OR: 1.529; 95%CI: 1.131-2.069; p=0.006). Conclusion Male adolescents who lived in owned houses, with occasional consumption of industrialized beverages and a higher percentage of energy derived from processed foods, had lower chances of infrequent breakfast consumption, while non-white adolescents had higher chances.

RESUMO Objetivo Estimar as associações do consumo não frequente de café da manhã com fatores socioeconômicos, comportamentais e individuais em uma amostra de adolescentes de escolas públicas. Métodos Estudo transversal realizado com adolescentes de 14 a 19 anos matriculados em escolas públicas de Juiz de Fora (MG). Foram avaliadas a frequência de consumo de café da manhã, lanches, refrigerantes e bebidas industrializadas, consumo alimentar usual, IMC, percentual de gordura corporal e perímetro da cintura. Demais dados socioeconômicos, comportamentais e individuais foram obtidos através de questionários. A análise de regressão logística e seleção hierárquica das variáveis foram usadas para verificar fatores associados. Resultados A amostra foi composta por 805 adolescentes e 53,4% deles relataram consumo não frequente de café da manhã. Através da análise de regressão logística hierarquizada, evidenciou-se que a ocupação em domicílio próprio (OR: 0,618; IC95%: 0,441-0,865; p=0,005) foi o fator distal associado ao consumo não frequente de café da manhã, além dos fatores intermediários "consumo não frequente de bebidas industrializadas" (OR: 0,658; IC95%: 0,486-0,890; p=0,007) e "percentual de energia proveniente de alimentos processados" (OR: 0,935; IC95%: 0,907-0,964; p<0,001) e dos fatores proximais "sexo masculino" (OR: 0,696; IC95%: 0,520-0,932; p=0,0015) e "cor da pele não branca" (OR: 1,529; IC95%: 1,131-2,069; p=0,006). Conclusão Adolescentes que residiam em domicílios próprios, com consumo não frequente de bebidas industrializadas, com maior percentual de energia proveniente de alimentos processados e do sexo masculino apresentaram menores chances de consumo não frequente de café da manhã, enquanto, adolescentes com cor da pele não branca apresentaram maiores chances.

[Leukocytes as risk markers for cardiovascular disease in adolescents: association with birth characteristics, nutritional status and biochemical tests]. / Leucócitos como marcadores de risco para doenças cardiovasculares na adolescência: associação com características de nascimento, situação nutricional e exames bioquímicos.

OBJECTIVE: To evaluate the correlation between the number of leukocytes and cardiovascular risks associated with birth characteristics, nutritional status and biochemical tests. METHODS: Cross-sectional study developed with 475 adolescents, born between 1992 and 2001, in the municipality of Viçosa (MG). Maternal medical records were analyzed in the hospital units, and the following was recorded: birth weight and length, head circumference, chest circumference, Apgar score, gestational age. In adolescents, body mass index, skinfold thickness, body composition, blood count, biochemical tests and clinical variables were also assessed. The statistical analyses was carried out using Statistical Package for Social Sciences (SPSS) version 20.0 and Data Analysis and Statistical Software (STATA) with Kruskal-Wallis, Mann-Whitney, chi-square or Fisher's exact tests and Linear Regression. Significance level was set at α<0.05. The study was approved by the Research Ethics Committee of UFV for studies with human subjects. RESULTS: Weight and birth length, head and chest circumference were higher among boys. In adolescents, the number of leukocytes was higher in individuals with excess weight and body fat and high adiposity index, waist-to-height ratio and waist circumference. Only altered triglycerides showed differences between leukocyte medians. Regardless of the anthropometric variable of the final regression model, the stage of adolescence, number of platelets, eosinophils, monocytes and lymphocytes were associated with the increase in leukocytes. CONCLUSIONS: The birth variables were not associated with changes in leukocyte numbers, whereas the anthropometric variables were good indicators for a higher leukocyte count, regardless of the stage of adolescence and gender.

CARDIOVASCULAR RISK AND ASSOCIATED FACTORS IN ADOLESCENTS.

BACKGROUND: changes in lifestyle are related to early exposure of adolescents to comorbidities associated with cardiovascular disease. These conditions may have consequences in adulthood. OBJECTIVE: to determine the prevalence of cardiovascular risk and its associated factors in the three phases of adolescence. METHODS: a cross-sectional study involving adolescents 10-19 years old in the city of Viçosa distributed in three stages. We evaluated laboratory tests, body mass index classified into Z-score according to gender and age, and the percentage of body fat classified by gender. We used the chi-square test, chi-square partition with Bonferroni correction and Poisson regression. The significance level was α < 0.05. The project was approved by the UFV Committee of Ethics and Research with Humans. RESULTS: overweight, excess body fat, lipid profile, sedentary behavior, and history of CVD in family were the most prevalent cardiovascular risk factors among adolescents. The adolescents had higher rates of overweight and excess fat. As for the stages, the first one showed a higher percentage of individuals with sedentary behavior, overweight, total cholesterol and LDL in comparison with other stages. Individuals with changes in nutritional status were more likely to develop hypertension, changes in total cholesterol, LDL, triglycerides, insulin, HOMA and low HDL when compared to healthy individuals. CONCLUSIONS: the cardiovascular risk factors have been observed in younger and younger individuals and are important factors to identify a population at risk.

Introducción: los cambios en el estilo de vida están relacionados con la exposición temprana de los adolescentes a las comorbilidades asociadas a la enfermedad cardiovascular. Estas condiciones pueden tener consecuencias en la edad adulta. Objetivo: determinar la prevalencia de riesgo cardiovascular y factores asociados en las tres fases de la adolescencia. Métodos: estudio transversal que incluye a adolescentes de 10-19 años en la ciudad de Viçosa, distribuidos en tres fases. Se evaluaron las pruebas de laboratorio, el índice de masa corporal clasificadas en Z-score, según el sexo y la edad, y el porcentaje de grasa corporal, clasificados por sexo. Se utilizó la prueba de chi-cuadrado, la partición de chi-cuadrado con corrección de Bonferroni y la regresión de Poisson. El nivel de significación fue < 0,05. El proyecto fue aprobado por el Comité de Ética en Investigación de la UFV en humanos. Resultados: el sobrepeso, la grasa corporal, el perfil lipídico, el comportamiento sedentario y la historia de enfermedades cardiovasculares en la familia fueron los factores de riesgo cardiovascular más prevalentes entre los adolescentes. Los adolescentes tenían tasas más altas de sobrepeso y grasa. En cuanto a las etapas, la inicial mostró un mayor porcentaje de individuos con comportamiento sedentario, sobrepeso y colesterol total y LDL en comparación con otras fases. Los individuos con cambios en el estado nutricional eran más propensos a desarrollar hipertensión, cambios en el colesterol total, LDL, triglicéridos, insulina, HOMA y HDL bajo, en comparación con los individuos sanos. Conclusiones: los factores de riesgo cardiovascular se han observado en personas cada vez más jóvenes y son factores importantes para identificar una población en riesgo.