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.

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.

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.

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.

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.

[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.

[Anthropometric indices to identify metabolic syndrome and hypertriglyceridemic waist phenotype: a comparison between the three stages of adolescence]. / Indicadores antropométricos para identificar síndrome metabólica e fenótipo cintura hipertrigliceridêmica: uma comparação entre as três fases da adolescência.

OBJECTIVE: To determine the prevalence of metabolic syndrome (MS) and the hypertriglyceridemic waist phenotype (HW) in a representative adolescent sample; as well as to establish which anthropometric indicator better identifies MS and HW, according to gender and adolescent age. METHODS: This cross sectional study had the participation of 800 adolescents (414 girls) from 10-19 years old. Anthropometric indicators (body mass index, waist perimeter, waist/stature ratio, waist/hip ratio, and central/peripheral skinfolds) were determined by standard protocols. For diagnosis of MS, the criteria proposed by de Ferranti et al. (2004) were used. HW was defined by the simultaneous presence of increased waist perimeter (>75th percentile for age and sex) and high triglycerides (>100mg/dL). The ability of anthropometric indicators was evaluated by Receiver Operating Characteristic curve. RESULTS: The prevalence of MS was identical to HW (6.4%), without differences between genders and the adolescence phases. The waist perimeter showed higher area under the curve for the diagnosis of MS, except for boys with 17-19 years old, for whom the waist/stature ratio exhibited better performance. For diagnosing HW, waist perimeter also showed higher area under the curve, except for boys in initial and final phases, in which the waist/stature ratio obtained larger area under the curve. The central/peripheral skinfolds had the lowest area under the curve for the presence of both MS and HW phenotype. CONCLUSIONS: The waist perimeter and the waist/stature showed a better performance to identify MS and HW in both genders and in all three phases of adolescence.

Tri-ponderal mass index is useful for screening children and adolescents with insulin resistance / O índice de massa tri-ponderal é útil na triagem de crianças e adolescentes com resistência à insulina

ABSTRACT 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.

RESUMO Objetivo: Investigar se o índice de massa tri-ponderal e os escores-z do índice de massa corporal são equivalentes na triagem de crianças e adolescentes com resistência à insulina. Métodos: Estudo transversal com 296 crianças e adolescentes matriculados em escolas públicas de Vitória, Espírito Santo, Brasil, com idades entre oito e 14 anos. O índice de massa tri-ponderal foi calculado como a razão entre o peso e a altura ao cubo. O índice de massa corporal foi calculado como a razão entre o peso e a altura ao quadrado. A resistência à insulina foi definida pelo modelo de avaliação da homeostase para resistência à insulina (HOMA-IR). Resultados: O HOMA-IR foi maior no 4º quartil dos escores-z do índice de massa corporal e do índice de massa tri-ponderal, em relação ao 1º e 2º quartis em ambos os sexos. As áreas sob as curvas receiver operating characteristic ajustadas por idade foram semelhantes em meninas (escores-z do índice de massa corporal=0,756; índice de massa tri-ponderal=0,763) e meninos (escores-z do índice de massa corporal=0,831; índice de massa tri-ponderal=0,843). Além disso, de acordo com as estimativas das análises de regressão linear simples, os escores-z do índice de massa corporal e o índice de massa tri-ponderal explicaram uma fração significativa da variabilidade do modelo de avaliação da homeostase para meninas (escores-z do índice de massa corporal: R2=0,269; índice de massa tri-ponderal: R2=0,289; p<0,001) e meninos (escores-z do índice de massa corporal: R2=0,175; índice de massa tri-ponderal: R2=0,210; p<0,001). Conclusões: O índice de massa tri-ponderal e os escores-z do índice de massa corporal foram semelhantes na triagem de crianças e adolescentes com resistência à insulina. É importante ressaltar que o uso do índice de massa tri-ponderal é claramente vantajoso, pois pode ser calculado sem ajustes por idade, fato que o torna muito aplicável à prática clínica.

Waist-to-height ratio is as reliable as biochemical markers to discriminate pediatric insulin resistance / A razão cintura/estatura é tão confiável quanto marcadores bioquímicos para discriminar resistência à insulina

Abstract 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.

Resumo Objetivo: Considerando a importância de incorporar ferramentas simples e de baixo custo no cenário clínico-pediátrico para a triagem de resistência à insulina, o presente estudo buscou investigar se a razão cintura/estatura é comparável a marcadores bioquímicos na discriminação de resistência à insulina em crianças e adolescentes. Métodos: Este estudo transversal envolveu estudantes de nove escolas públicas. No total, 296 crianças e adolescentes, de ambos os sexos, com idades entre 8 e 14 anos, compuseram a amostra. A razão cintura/estatura, o índice triglicerídeos/glicose e a razão triglicerídeos/HDL-C foram determinados de acordo com protocolos padrão. A resistência à insulina foi definida por meio do modelo de avaliação homeostática para resistência insulínica, com ponto de corte ≥ 3.16. Resultados: Idade, índice de massa corporal, frequência de excesso de peso, circunferência da cintura, razão cintura/estatura, insulina, glicemia, modelo de avaliação homeostática para resistência insulínica, triglicerídeos, índice triglicerídeos/glicose e razão triglicerídeos/HDL-C foram maiores entre meninos e meninas com resistência à insulina. Também foram observadas, em ambos os sexos, correlações moderadas de todos os indicadores (razão cintura/estatura, índice triglicerídeos/glicose e razão triglicerídeos/HDL-C) com o modelo de avaliação homeostática para resistência à insulina. As áreas sob as curvas ROC foram semelhantes entre a razão cintura/estatura e os marcadores bioquímicos. Conclusão: Os indicadores forneceram poder discriminatório similar para a resistência à insulina. No entanto, levando em conta o custo-benefício, sugerimos que a razão cintura/estatura pode ser uma ferramenta útil para a triagem de resistência à insulina em populações pediátricas.

[Insulin resistance and components of metabolic syndrome, analysis by gender and stage of adolescence]. / Resistência à insulina e componentes da síndrome metabólica, análise por sexo e por fase da adolescência.

OBJECTIVE: To analyze the influence of metabolic syndrome components in insulin resistance, by gender and adolescence phase. SUBJECTS AND METHODS: We evaluated biochemical, clinical, lifestyle and body composition data of 800 adolescents from 10 to 19 years old, from both genders, from Viçosa, MG/Brasil, and there was the division by stage: early (10 to 13 years), intermediate (14 to 16 years) and late (17 to 19 years). RESULTS: 10.3 and 3.4% had, respectively, insulin resistance and metabolic syndrome. In the initial phase there was a higher prevalence of dyslipidemia and intermediate hyperuricemia and excess body fat. Females had a higher prevalence of dyslipidemia, excess body fat and insulin resistance and higher male prevalence of low HDL, hyperuricemia and blood pressure changes. Those from the initial phase had higher levels of total cholesterol, LDL, HDL, triglycerides, fasting glucose and waist/hip ratio, stayed less time sitting and had more meals (p < 0.05) in relation to other phases. The final model, adjusted for gender, was different for each phase of adolescence. CONCLUSIONS: Insulin resistance is associated with inadequate body composition, in biochemical levels and lifestyle, being the factors associated different in each phase of adolescence.

Methodological and ethical aspects of the sexual maturation assessment in adolescents.

OBJECTIVE To analyze methodological and ethical aspects in the sexual maturation assessment of adolescents. DATA SOURCES Books and theses, articles and legislations on the Medline, SciELO, Science Direct databases, besides institutional documents of the World Health Organization and the Pediatric Societies of Brazil and São Paulo, considering the period from 1962 to 2012. The following keywords were used in Portuguese and English: "sexual maturation", "self-assessment", "ethics", "OBJECTIVE assessment of sexual maturation", "puberty", "adolescent", and "adolescentdevelopment". DATA SYNTHESIS The sexual maturation assessment is used in populatinal studies and in clinical daily care. The direct evaluation is performed by a specialized physician, whereas the self-assessment is carried out by the adolescent. This evaluation should be carefully performed in the appropriate place, taking into account the ethical aspects. The patient should not be constrained and the physician must respect the privacy and the confidentiality. Before this evaluation and independently of the used method, the adolescent should receive information and explanation about the procedure and the tools that will be applied. Furthermore, the patient has the right to want or not an adult close to him. CONCLUSIONS Validation studies showed that self-assessment is inferior to clinical assessment and should, therefore, be performed only when the direct examination by physicians is not possible.

Predictive capacity of different bioelectrical impedance analysis devices, with and without protocol, in the evaluation of adolescents.

OBJECTIVE: this study was performed to determine the predictive capacity of four different bioelectrical impedance analysis (BIA) devices in the assessment of adolescents, with and without a protocol. METHODS: a cross-sectional study was performed with 215 adolescents aged 10 to 14 years, of both genders, evaluated through anthropometry and body composition by dual energy X-ray absorptiometry (DXA) and by four different BIA devices, with and without a protocol. The following tests were used: Kolmogorov-Smirnov's, chi-squared, Student's t or Mann-Whitney's, Kruskal-Wallis's, Wilcoxon's, and kappa index. The ROC curves were constructed and the sensitivity, specificity, and positive and negative predictive values were calculated. RESULTS: of the 215 adolescents, 44.2% had excessive body fat. The tetrapolar BIA device equipped with eight tactile electrodes showed more sensitivity and results that were closer to those obtained by DXA (area under the ROC curve [AUC] = 0.964 with protocol and AUC = 0.973 without protocol, p < 0.001), as well as greater agreement (k = 0.67 with protocol and k = 0.63 without protocol, p < 0.001). The evaluation without protocol was similar to that by DXA in most investigated situations (p > 0.05). CONCLUSION: BIA is capable of predicting alterations in adolescents' body composition. When it is impossible to perform the assessment with a protocol, its results may be useful in population studies.

Polycystic ovary syndrome and intervening factors in adolescents from 15 to 18 years old.

OBJECTIVE: To assess the factors related to the presence of polycystic ovary syndrome (PCOS) in adolescents. METHODS: This was a cross-sectional study, with female adolescents from 15 to 18 years old, divided into: group 1 (with a medical diagnosis of PCOS) and group 2 (not diagnosed with PCOS). The height-for-age index and the body mass index were used for classifying the nutritional status, and a semi-structured questionnaire was applied. The Mann-Whitney test, Fisher's exact test, Spearman correlation coefficients, and logistic regression were used. RESULTS: This study evaluated 485 adolescents with an average age of 16.3 ± 0.9 years old. The prevalence of PCOS was 6.2%. No difference was found between the groups regarding anthropometric parameters and period of contraceptive use; however, there were differences regarding the age at menarche (p < 0.004). Older age at menarche was a protection factor against the syndrome. CONCLUSION: An association was found between younger age at menarche and the development of the PCOS in adolescents.

Insatisfação corporal, nível de atividade física e comportamento sedentário em adolescentes do sexo feminino / Body dissatisfaction, physical activity, and sedentary behavior in female adolescents

RESUMO 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.

ABSTRACT 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.

Variáveis antropométricas e de composição corporal como preditores de risco cardiovascular e da síndrome metabólica em adolescentes / Anthropometric and body composition variables as predictors of cardiovascular risk and metabolic syndrome in adolescents

Introdução: Na triagem de indivíduos em risco de desenvolvimento de fatores de risco cardiovasculares e da síndrome metabólica, a antropometria surge como uma alternativa ao Índice de Massa Corporal (IMC), que pode ser utilizada para avaliar a composição corporal e perímetros. Assim, objetivou-se verificar a capacidade das medidas antropométricas, principalmente o perímetro do pescoço (PP) em predizer fatores de risco cardiovascular e síndrome metabólica em adolescentes. Método: Coletaram-se dados referentes à glicemia, colesterol total e frações, triglicerídeos e pressão arterial em 85 adolescentes de 11 a 15 anos, de escolas públicas de Alegre (ES). O percentual de gordura corporal (%GC) foi avaliado pela bioimpedância vertical bipolar. Resultados: Com base na curva ROC, as variáveis antropométricas perímetro do pescoço (PP), PC, IMC e %GC demonstraram ser eficazes no diagnóstico da síndrome metabólica, principalmente o PP. Quanto ao estado nutricional, 76%, 21% e 30%, respectivamente, apresentaram eutrofia, excesso de peso e alto %GC. O %GC, o perímetro da cintura (PC) e relação cintura-estatura (RCE) apresentaram valores mais elevados no sexo feminino em relação ao masculino. O colesterol total foi o que apresentou maior percentual de inadequação (37%), seguido dos triglicerídeos (18%). A prevalência geral da síndrome metabólica foi de 2,35%, sendo observada somente no sexo masculino (6,25%). Conclusão: O PP, o IMC, o %GC, o PC e a RCE são bons preditores de alterações metabólicas em adolescentes. Assim, essas medidas devem ser usadas em conjunto na avaliação nutricional deste grupo.(AU)

Introduction: In the screening of individuals at risk of developing cardiovascular risk factors and metabolic syndrome, anthropometry emerges as an alternative to the Body Mass Index (BMI), which can be used to evaluate body composition and perimeters, the ability of anthropometric measures, especially the neck circumference (PP) to predict cardiovascular risk factors and metabolic syndrome in adolescents, was verified. Methods: Data on glycemia, total cholesterol and fractions, triglycerides and blood pressure were collected from 85 adolescents aged 11 to 15 from public schools in Alegre (ES). The percentage of body fat (%GC) was evaluated by bipolar vertical bioimpedance. Results: Based on the ROC curve the anthropometric variables perimeter of the neck (CP), PC, BMI and %GC were shown to be effective in the diagnosis of the metabolic syndrome, mainly PP. Regarding nutritional status, 76%, 21% and 30%, respectively, presented eutrophy, excess weight and high% GC. The %GC, waist circumference (PC) and waist-to-height ratio (RCE) were higher in females than in males. Total cholesterol presented the highest percentage of inadequacy (37%), followed by triglycerides (18%). The overall prevalence of the metabolic syndrome was 2.35%, being observed only in the male sex (6.25%). Conclusion: PP, BMI, %GC, PC and CER are good predictors of metabolic changes in adolescents, so these measures should be used together in the nutritional assessment of this group.(AU)

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

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.

Avaliar relação do número de leucócitos com riscos cardiovasculares associados às características de nascimento, situação nutricional e exames bioquímicos. Métodos: Estudo transversal, desenvolvido com 475 adolescentes, nascidos de 1992 a 2001, em Viçosa (MG). Buscaram-se os prontuários maternos nas unidades hospitalares. Foram registrados: peso e comprimento ao nascer, perímetro cefálico, perímetro torácico, boletim de Apgar, tempo de gestação. Na adolescência, avaliaram-se índice de massa corporal, pregas cutâneas, composição corporal, hemograma, exames bioquímicos e variáveis clínicas. Para análise usaram-se Statistical Package for the Social Sciences (SPSS) versão 20.0 e Data Analysis and Statistical Software (Stata), com os testes de Kruskal-Wallis, Mann-Whitney, qui-quadrado ou Exato de Fisher e regressão linear. Nível de significância adotado α<0,05. O estudo foi aprovado pelo Comitê de Ética e Pesquisa com seres humanos da UFV. Resultados: O peso e o comprimento ao nascer, perímetro cefálico e torácico foram maiores entre os meninos. Na adolescência, o número de leucócitos foi maior nos indivíduos com excesso de peso e gordura corporal e elevados índice de adiposidade corporal, relação cintura-estatura e perímetro da cintura. Apenas os triglicerídeos alterados apresentaram diferença entre as medianas de leucócitos. Independentemente da variável antropométrica do modelo final de regressão, a fase da adolescência, o número de plaquetas, eosinófilos, monócitos e linfócitos associou-se ao aumento de leucócitos. Conclusões: As variáveis de nascimento não se associaram às alterações nos números de leucócitos, enquanto as variáveis antropométricas mostraram-se bons indicadores para maior número de leucócitos, independentemente da fase da adolescência e sexo.

Estado nutricional, alterações metabólicas e hábitos alimentares em adolescentes do município de Viçosa, MG / Nutritional status, metabolic changes and food habits in adolescents of Viçosa, MG

OBJECTIVE: To evaluate whether excessive weight and body fat are associated with metabolic and food habits changes in adolescents METHODS: It was made the analysis Body composition, food habits, fasting glucose and lipid levels were analyzed from 159 adolescents, aged 10 to 14 years, male and female, from public schools in Viçosa MG. We used Kolmogorov-Smirnov test; Student's t distribution and Mann Whitney; Pearson and Spearman correlation, chi-square and Poisson regression, with p< 0.05. Results: From the total changes found, 25.6%; 39% and 67.3% corresponded, respectively, to overweight, excessive body fat and inadequate total cholesterol. Adolescents with excessive weight and body fat have the highest weight, waist and hip circumference, Body Mass Index of Fat (BMIF), Body Mass Index Fat Free (BMIFF) values. Overweight adolescents had a higher prevalence of HDL (PR = 2.55, 95%CI = 1.52 to 4.29) and triglycerides (PR = 3.30, 95%CI = 1.44 to 7.57) inadequacy and those with excessive body fat have a tripled prevalence of low HDL levels (PR = 3.05, 95%CI = 1.69 to 5.48, p < 0.001). The association between excessive weight and HDL and triglycerides remained significant following adjustment for gender and age; however, for excessive body fat, only the association with HDL remained significant after the adjustment (PR = 3.07, 95%CI = 1.70 to 5.54). There was no association of nutritional status (BMI/age) and body fat percentage with inadequate intake of food groups, as well as the inadequate availability of sugar and oil. CONCLUSIONS: Excessive weight and/or body fat was associated with inadequate levels of HDL and triglycerides, reinforcing the importance of adequate lifestyle to prevent these changes

OBJETIVO: Avaliar se o excesso de peso e o excesso de gordura corporal estão associados com alterações metabólicas e hábitos alimentares em adolescentes. MÉTODOS: Analisaram se composição corporal, hábitos alimentares, glicemia de jejum e níveis lipídicos de 159 adolescentes de 10-14 anos, de ambos os sexos, de escolas públicas de Viçosa, MG. Utilizaram-se os testes de Kolmogorov-Smirnov, t de Student e Mann Whitney; correlação de Pearson e Spearman, qui-quadrado e regressão de Poisson bruta e ajustada, com p < 0,05. RESULTADOS: Em relação às alterações apresentadas, 25,6%, 39% e 67,3% apresentaram, respectivamente, excesso de peso, excesso de gordura corporal e colesterol total inadequado. Adolescentes com excesso de peso e de gordura corporal apresentaram maiores valores de peso, circunferência da cintura e do quadril, Índice de Massa Corporal de Gordura (IMCG) e Índice de Massa Corporal Livre de Gordura (IMCLG). Adolescentes com excesso de peso apresentaram maiores prevalências de inadequação de HDL (RP = 2,55; 95%IC = 1,52 4,29) e triglicerídeos (RP = 3,30; 95%IC = 1,44-7,57) e adolescentes com excesso de gordura corporal apresentaram uma prevalência triplicada de baixos níveis de HDL (RP = 3,05; 95%IC = 1,69-5,48; p grupos alimentares, bem como com a inadequação da disponibilidade de açúcar e de óleo. CONCLUSÕES: O excesso de peso e/ou de gordura corporal esteve associado aos níveis inadequados de HDL e triglicerídeos, reforçando a importância do estilo de vida adequado para prevenção dessas alterações

Anthropometric indices to identify metabolic syndrome and hypertriglyceridemic waist phenotype: a comparison between the three stages of adolescence / Indicadores antropométricos para identificar síndrome metabólica e fenótipo cintura hipertrigliceridêmica: uma comparação entre as três fases da adolescência

OBJECTIVE: To determine the prevalence of metabolic syndrome (MS) and the hypertriglyceridemic waist phenotype (HW) in a representative adolescent sample; as well as to establish which anthropometric indicator better identifies MS and HW, according to gender and adolescent age. METHODS: This cross sectional study had the participation of 800 adolescents (414 girls) from 10-19 years old. Anthropometric indicators (body mass index, waist perimeter, waist/stature ratio, waist/hip ratio, and central/peripheral skinfolds) were determined by standard protocols. For diagnosis of MS, the criteria proposed by de Ferranti et al. (2004) were used. HW was defined by the simultaneous presence of increased waist perimeter (>75th percentile for age and sex) and high triglycerides (>100 mg/dL). The ability of anthropometric indicators was evaluated by Receiver Operating Characteristic curve. RESULTS: The prevalence of MS was identical to HW (6.4%), without differences between genders and the adolescence phases. The waist perimeter showed higher area under the curve for the diagnosis of MS, except for boys with 17-19 years old, for whom the waist/stature ratio exhibited better performance. For diagnosing HW, waist perimeter also showed higher area under the curve, except for boys in initial and final phases, in which the waist/stature ratio obtained larger area under the curve. The central/peripheral skinfolds had the lowest area under the curve for the presence of both MS and HW phenotype. CONCLUSIONS: The waist perimeter and the waist/stature showed a better performance to identify MS and HW in both genders and in all three phases of adolescence.

OBJETIVO: Determinar a ocorrência de síndrome metabólica (SM) e do fenótipo cintura hipertrigliceridêmica (CH) em amostra de adolescentes e estabelecer qual indicador antropométrico melhor identifica SM e CH, de acordo com gênero e fase da adolescência. MÉTODOS: Estudo transversal com 800 adolescentes (414 meninas) de 10-19 anos. Indicadores antropométricos (índice de massa corporal, perímetro da cintura, relação cintura/estatura, relação cintura/quadril e relação pregas cutâneas centrais/periféricas) foram determinados por protocolos padronizados. Para diagnóstico da SM, foi usada a proposta de Ferranti et al. (2004). A CH foi definida pela presença simultânea de perímetro da cintura aumentado (>75 percentil por idade e sexo) e triglicerídeos elevados (>100 mg/dL). O desempenho dos indicadores antropométricos foi avaliado por meio da curva Receiver Operating Characteristic. RESULTADOS: A prevalência de SM foi idêntica à de CH (6,4%), sem diferenças entre os gêneros e entre as fases da adolescência. O perímetro da cintura apresentou maior área abaixo da curva no diagnóstico da SM, exceto para meninos entre 17-19 anos, para os quais a relação cintura/estatura exibiu melhor desempenho. No diagnóstico da CH, a cintura isolada apresentou maior área abaixo da curva, exceto para os meninos nas fases inicial e final da adolescência, nos quais a relação cintura/estatura obteve maior área. A relação entre as pregas cutâneas apresentou pior desempenho para identificar SM e CH. CONCLUSÕES: O perímetro da cintura e a relação cintura/estatura mostraram o melhor desempenho para identificar SM e CH em ambos os sexos e nas três fases da adolescência.